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Dexamethasone: Rare Side Effect of Drug Given to Trump for Covid Includes Grandoise Delusions

Newsweek logo Newsweek 10/5/2020 Kashmira Gander
Donald Trump sitting on a table: President Donald Trump works in the Presidential Suite at Walter Reed National Military Medical Center after testing positive for COVID-19 on October 3, 2020 in Bethesda, Maryland. President Trump’s medical team says the President’s oxygen levels dropped and he took dexamethasone. © Joyce N. Boghosian/The White House via Getty Images President Donald Trump works in the Presidential Suite at Walter Reed National Military Medical Center after testing positive for COVID-19 on October 3, 2020 in Bethesda, Maryland. President Trump’s medical team says the President’s oxygen levels dropped and he took dexamethasone.

President Donald Trump has been prescribed dexamethasone for COVID-19, a steroid that has a range of potential side effects including mental problems such as aggression, agitation, and anxiety.

At a press conference on Sunday at Walter Reed National Military Medical Center, where Trump is being treated for COVID-19, White House physician Dr. Sean Conley said the president was prescribed dexamethasone after the president's blood oxygen levels dropped twice.

Dexamethasone is a steroid that suppresses the immune system to prevent the release of substances that can trigger inflammation. The drug was found to benefit critically ill patients in trials in the U.K., raising questions about the severity of the president's condition.

The cheap, common medicine is used to treat inflammatory conditions including ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders.

Some of the more common side effects can affect a patient's mental state, such as aggression, agitation, anxiety, irritability, depression, changes to mood, and nervousness. Trouble thinking, speaking or walking can also occur. Other common side effects include blurred vision, producing less urine, dizziness, an irregular heartbeat or pulse, headaches, and noisy breathing. Patients may also experience numbness or tingling in the limbs, swollen fingers, hands, feet or lower legs, pounding in the ears, difficulty breathing at rest, and weight gain.

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There are a range of less common side effects, too, like stomach cramps, back ache, and bloody or tarry stools. Dexamethasone has also been linked to rare reports of grandiose delusions, psychosis, delirium, and hallucinations.

Dr. J. Michael Bostwick, a psychiatrist at the Mayo Clinic who has studied the psychiatric effects of steroids, told The New York Times steroids are mostly used without much concern for psychotropic effects, but patients should be monitored for changes to their mood, thinking or sleep. Steroids can trigger psychiatric side effects "at almost any dose," he said.


Gallery: I'm a Doctor and Here's Why Trump Should be Alarmed (ETNT Health)

As well as dexamethasone, the president is also having a monoclonal antibody therapy that mimics the proteins the body creates to fight infection, and the anitviral drug remdesivir. In addition to oxygen, he has also been given Zinc, vitamin D, famotidine, melatonin and aspirin.

Since he was diagnosed, Trump and the White House have portrayed the president as strong, and said on Friday his condition was mild. On Sunday afternoon, Trump left hospital for around 15 minutes, waving to supporters from the backseat of a vehicle. The day before, the White House released photos of the president working at hospital, prompting his His daughter IvankaTrump to tweet: "Nothing can stop him from working for the American people. RELENTLESS!" Dr. Brian Garibaldi who is treating the president said he may be discharged on Monday.

However, some experts have expressed concern about the combination of treatments the president is receiving.

Dr. Thomas McGinn, physician-in-chief at New York State health provider Northwell Health told The New York Times it appeared doctors were "throwing the kitchen sink at him" when it comes to the drugs they're using.

"Is he sicker than we're hearing, or are they being overly aggressive because he is the president, in a way that could be potentially harmful?" said McGinn.

According to the World Health Organization, dexamethasone reduces the risk of dying in patients on ventilators by about one third, and one fifth in patients only needing oxygen. Patients are generally given the drug when their condition appears to be deteriorating. McGinn said that prescription was the "most mystifying" of what the president has been given so far.

Regarding Trump's oxygen levels, which fell to below 94 percent according to Conley, Carlos del Rio, an infectious-disease expert at Emory University, told Politico "Once you drop below 94 percent, by definition you have severe Covid."

Vin Gupta, an affiliate assistant professor of health metrics sciences at the University of Washington's Institute for Health Metrics and Evaluation, tweeted on Sunday that doctors would not generally prescribe an experimental antibody cocktail, Remdesivir and dexamethasone to a patient who had drops in their oxygen levels "unless there's COVID Pneumonia."

He tweeted: "What did his chest imaging show? The American people deserve basic information on their President."

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