CQ - While longer term oral corticosteroid therapy (eg. greater than a week or two) can cause hypomania, mania, depression, or psychosis in suseptible individuals. These effects are usually dose related, but seldom seen.

Injectible cortisone minimizes this risk as it acts locally (ie. at the injection site) rather than systemically. The cortisone slowly diffuses from the site of action and produces very low blood levels, and is subsequently metabolized to inactive metabolites in the liver. The chances of a cortisone injection causing hypomania (ie. euphoria) is minimal when compared to oral corticosteroid therapy. I suppose that there is a slight risk of these side effects, but I have never seen them with the cortisone injections.

It might be worth mentioning your observations to your doctor. If it happens again, the doc may have to use lower dosages of cortisone to try to avoid these side effects. Another shot would be the only way to prove a cause/effect relationship between the injected cortisone and the euphoria/anxiety.

OTOH, it is possible that the doctor accidentally injected the cortisone into an artery, instead of the muscle tissue. This could cause higher blood levels of the cortisone and possible cause the symptoms that you experienced. If this was the case, you would have possibly felt a near immediate "rush" of euphoria.

These are just guesses; ask your doctor if he has ever seen side effects like these.

Take care - Cam

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