Nakajima, Kan, Ayani, Nobutaka, Matsuoka, Teruyuki et al. · PCN reports : psychiatry and clinical neurosciences · 2025 · DOI
This case report describes one patient with bipolar disorder who developed ME/CFS after COVID-19 and was treated with different types of steroid medications. Strong steroids (betamethasone and prednisolone) triggered a severe manic episode requiring hospitalization, but a weaker steroid (hydrocortisone) improved her fatigue without worsening her mood. The findings suggest that choosing the right type of steroid may be important for ME/CFS patients who also have mood disorders.
This case highlights that ME/CFS patients with existing psychiatric conditions require individualized corticosteroid treatment strategies. The observation that different steroid types have markedly different psychiatric effects suggests that receptor selectivity should guide therapeutic choice, potentially improving outcomes and safety in this vulnerable population.
This is a single case report and cannot establish causation or define prevalence—it does not prove that all ME/CFS patients with bipolar disorder will respond similarly to these medications. The findings cannot be generalized beyond this patient, and controlled trials are needed to test whether hydrocortisone is broadly superior to other steroids in this subgroup.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Nakajima, Kan, Ayani, Nobutaka, Matsuoka, Teruyuki, Kasahara, Kenya, Nakajima, Yoshiyuki, Ikawa, Haruki, et al. (2025). Corticosteroids with low glucocorticoid activity as a potential therapeutic strategy for post-COVID-19 myalgic encephalomyelitis/chronic fatigue syndrome in patients with bipolar affective disorder: A case report.. PCN reports : psychiatry and clinical neurosciences. https://doi.org/10.1002/pcn5.70222
BibTeX
@article{mecfsatlas-nakajima-2025-corticosteroids-low,
author = {Nakajima, Kan and Ayani, Nobutaka and Matsuoka, Teruyuki and Kasahara, Kenya and Nakajima, Yoshiyuki and Ikawa, Haruki and Kitaoka, Riki and Akimoto, Tatsuhiko and Narumoto, Jin},
title = {Corticosteroids with low glucocorticoid activity as a potential therapeutic strategy for post-COVID-19 myalgic encephalomyelitis/chronic fatigue syndrome in patients with bipolar affective disorder: A case report.},
journal = {PCN reports : psychiatry and clinical neurosciences},
year = {2025},
doi = {10.1002/pcn5.70222},
note = {PubMed: 41089430},
url = {https://www.mecfsatlas.com/evidence/nakajima-2025-corticosteroids-low},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/nakajima-2025-corticosteroids-low
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