White House aides fear Trump's drugs have triggered manic behavior: report

A stunning report in the New York Times Thursday night described President Donald Trump lashing out and demanding his own appointees prosecute his enemies, an egregious breach of norms and real and present danger to American democracy. Most shocking of all was the fact that this largely wasn't some anonymously sourced bombshell — most of the comments the Times' report was based on Trump made publicly

But far down in the report was a notable nugget about the White House that wasn't based on publicly available information. According to the Times reporters, Trump's own aides are worried that his manic and erratic public behavior this week may be a result of his illness and the medications he's been taking:

White House aides privately expressed concern about whether the president's animated mood in recent days stemmed from the dexamethasone. Doctors not involved with the president's care said it could have a significant effect on a patient's behavior.

As I've reported, the president's public behavior since taking the steroid dexamethasone has genuinely seemed even more heightened and frantic than is typical for him. I argued that there are multiple explanations for the president's temperament, none of which are particularly comforting.

Unfortunately, the president's physician, Dr. Sean Conley, has proven utterly unreliable about Trump's health. He's refused to answer many questions and admitted to skirting the truth in order to provide an "upbeat" picture of the president's condition. But the Times's report suggested experts and those around the president are highlighting the possibility that the steroids could be significantly altering his mood:

Dr. Negin Hajizadeh, a pulmonary/critical care physician at Northwell Health, noted that the majority of Covid patients receiving dexamethasone are on mechanical ventilation and in a state of induced coma, so they do not exhibit any behavioral side effects. But, she said, large studies show that generally 28 to 30 percent of patients will exhibit mild to moderate psychiatric side effects like anxiety, insomnia, mania or delirium after receiving steroid treatments, and about 6 percent may develop psychosis.

"When we prescribe steroids we warn our patients: 'This may cause you to feel jittery, might cause you to feel irritable,'" Dr. Hajizadeh said. "We will tell family members, especially for our older patients, 'This may cause insomnia, this may cause changes in eating habits and, in extreme cases, mania and impaired decision making.'"

It's hard to overstate how serious this is. In addition to the usual national security concerns that arise when the stability of the president's mental state is in question, he currently has the power to impact people's lives in myriad ways. He's negotiating future plans for debating his Democratic opponent Joe Biden, trying to set up new campaign events while he may still be infectious, and he's thrown discussions about a potential second stimulus package into chaos. The president is hardly the picture of stability under normal circumstances, but the prospect that drug-induced mania may be affecting his decision-making at this time is unacceptable.

That's why many have argued he should have already invoked the 25th Amendment to transfer power to Vice President Mike Pence until it's clear he's through his case of COVID-19 and can carry out his duties unimpeded by the infection or its treatment. In light of his behavior and his own aides' reported concerns, it should be a much bigger deal that the president has refused to relinquish control his office.