Dexamethasone: Rare Side Effect of Drug Given to Trump for COVID Includes Grandiose Delusions

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.

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.

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 daughter Ivanka Trump 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.

Daniel Davis, professor of immunology at the University of Manchester, U.K. and the author of The Beautiful Cure, a book about the immune system, told Newsweek dexamethasone "is probably only really appropriate in treating people with severe symptoms of COVID-19" as it prevents a person's immune system being overly active and causing lung damage.

"It's not clear why this drug would be useful in a patient with mild symptoms, because obviously you do want a person's immune system to be able to fight off the virus itself," he said.

Ian Hall, professor of molecular medicine at the University of Nottingham U.K., told Newsweek it is difficult to comment without all the relevant details, but requiring oxygen is a marker of more severe disease, and would mean Trump should benefit from dexamethasone.

"Dexamethasone works as an anti-inflammatory, so there is logic in combing it with an anti-viral drug as well, which I assume is why remdesivir was also given," Hall said.

Regarding the use of the antibody therapy in addition to dexamethasone and remdesivir, Hall said this would not be done in the U.K. outside the context of a clinical trial "as clearly there are potential risks as well as potential benefits of treatment and hence using experimental drugs outside of a clinical trial is not logical in my view."

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."

You don’t start dexamethasone, Remdesivir and given an experimental antibody cocktail to the President in the setting of low oxygen “dips” unless there’s COVID Pneumonia.

What did his chest imaging show? The American people deserve basic information on their President — Vin Gupta “😷!” MD (@VinGuptaMD) October 4, 2020

This article has been updated with comment from Daniel Davis and Ian Hall.