A-Z of Corticosteroid Withdawal: Fatigue

F is For Fatigue:

Almost everyone who stops using topical steroid creams experiences a severe wave of fatigue at the beginning of withdrawals. The tiredness is overwhelming, and it certainly took me by surprise when I first stopped the creams.

The fatigue first hit me a few days into withdrawals. I suddenly felt overwhelmingly tired and lay slumped on the settee day after day, with little energy to even get up and perform basic tasks. It was as if something had sapped every last bit of my energy. All I wanted to do was sit quietly and stare out of the window, which is not like me at all. I am usually the kind of person who gets fed up being stuck in at home and wants to get out and do things, but this fatigue knocked me down hard.

Despite the overwhelming tiredness, my sleep patterns were haywire. I would go to bed, feeling exhausted, but lie awake for hours, before dropping off for a couple of hours and waking again later. in the early weeks I would routinely lie awake until midnight, fall asleep, wake at 2 a.m., sleep again, wake at 4 a.m. and then go into a very deep sleep until I had to get up. It was if my body clock had shunted ahead by a few hours. Even now, five months into withdrawals, my eyes pop open at 2 a.m. every morning without fail, but thankfully, I soon fall back asleep again nowadays.

There is no doubt in my mind that the extreme fatigue is down to stress on the adrenal glands. These little glands sit on top of the kidneys and are responsible for regulating many important bodily functions. One important hormone regulated by the adrenals is Cortisol, an important steroid hormone. It affects the immune system and blood sugar levels in the body and is produced in response to stress. The body detects cortisol levels and either increases or decreases production on demand. Unfortunately, when steroid creams are used, the cortisone in the creams fools the body into thinking it is producing sufficient cortisol, and the adrenal glands slow down cortisol production. When steroid creams are suddenly stopped, the adrenal glands need time to recover and start making their own cortisol again, and this is what causes the fatigue.

Here are some of the experiences that the members of the google forum have had concerning withdrawal fatigue:

"...I had crisis on Tuesday, headache and tiredness, so I was sleeping
almost all day (of course I didnt sleep at night, I think its been 2
months now since the last time I could sleep before 6 am).
Does anybody know what is the case with this insomnia?"


"Hi, just a quick question to anyone out there ... did the Red Skin Syndrome
make you feel more tired than you have ever been in your life?
I slept in the afternoon yesterday for three hours, then last night from
12pm to 9am, now, i feel as though I want to go back to bed already.  I
have been like this for about three days now.  Night sleep is restless, but
that's nothing new.  The terrible fatigue, however, *is* new.   I know its
a trivial complaint compared to the various other symptoms we are all
enduring, but is this terrible tiredness usual?  I feel as though I never
want to wake again.  thanks. "


"I just want to be in my bed even just when face and neck is
flaring, having no energy. Originally when flaring on steroids I thought it
was just that I didnt want to face the world (that too!), but it feels so
much like fatigue, which leaves after flare subsides. The amount of energy
I have between flares can be enormous, it's just a rollercoaster, one hour
at a time. "

This extreme tiredness is a symptom very early on in withdrawals. As the adrenals heal and the body begins to recover (we are like burn victims), energy levels slowly return to normal. Those in the early stages of steroid withdrawal need to rest and listen to their bodies. this phase will pass soon enough.