Prednisolone

What it is

Prednisolone is a corticosteroid, a synthetic form of a hormone the body makes to restrain inflammation. It acts broadly on the immune system and passes from the blood into the brain.¹ It was tested in schizophrenia on the idea that inflammation contributes to the illness in some people.²

How well it works

A trial led from UMC Utrecht, with hospitals in the Netherlands, Belgium and Denmark, gave 42 people with schizophrenia that had begun within the previous seven years either a six-week course of prednisolone or a placebo, on top of their usual treatment. Symptoms improved in both groups to the same degree. The trial stopped early because recruitment was slow.²

A trial in Bergen, Stavanger and Trondheim used the same course. It planned to include 90 people but stopped after 12 because of the COVID-19 pandemic. Symptoms tended to improve more on prednisolone, but the difference was not clear enough to rule out chance.¹

Across 70 trials of add-on treatments with possible anti-inflammatory effects, medicines designed to suppress inflammation did no better than the others.³

Side effects

In the Utrecht-led trial, no serious side effects occurred during treatment.² In the Norwegian trial, blood sugar and the white blood cell count rose on prednisolone, psychotic and manic symptoms did not worsen, and the three serious adverse events all occurred on placebo.¹

High doses of corticosteroids can bring on psychiatric symptoms.⁴ In autoimmune psychosis (opens in a new tab), where the immune system is the proven cause, they are part of the standard treatment.⁵

What we don’t know yet

• Whether a course of corticosteroids helps people with schizophrenia who have clear signs of inflammation.