Do steroids trigger mania in multiple sclerosis? Not always!

This paper consists of an unusual case history and an overview of the relationship between multiple sclerosis, manic episode and corticosteroid treatment. Bipolar disorder and multiple sclerosis co-occur at a relatively higher rate. A 25-year old woman with a 7-year history of multiple sclerosis admitted to our hospital with right side weakness. During examination she showed some manic behavior patterns and diagnosed as ‘bipolar disorder-manic episode’ by psychiatrists. She was suggested to receive high dose steroids for her attack and antipsychotics for the manic episode but refused the latter. Unexpectedly at the third day of steroid treatment, instead of being triggered, almost all of the manic symptoms disappeared. This is the first report of a multiple sclerosis patient with bipolar disorder whose manic symptoms were cured after receiving steroids.