Corticosteroids and Their Effects on Mental Health

Corticosteroids, commonly referred to as steroids, are widely used to treat inflammation and various medical conditions. These medications, such as prednisone, prednisolone, dexamethasone, and methylprednisolone, can be highly effective in treating a range of conditions, but their effects are not limited to the physical body.

Source: cdn2.psychologytoday.com

For some people, corticosteroids can also affect sleep, mood, behavior, and other aspects of mental health. A person who starts a corticosteroid may suddenly find themselves sleeping much less, feeling unusually restless, becoming irritable, or experiencing changes in mood that seem difficult to explain. Because the medication is being used to treat a physical condition, these changes may not immediately be recognized as a possible adverse effect.

Corticosteroids have a structure very similar to cortisol, a hormone naturally produced by the adrenal glands that plays an important role in the body’s response to stress. Like cortisol, corticosteroids act on glucocorticoid receptors, which are found throughout the brain and play a role in mood, cognition, sleep, and emotional regulation.

How Can Corticosteroids Affect Mental Health?

The psychiatric effects of corticosteroids can vary considerably. While some people experience relatively mild changes, others develop more pronounced symptoms.

• Insomnia or reduced need for sleep.
• Anxiety, agitation, or restlessness.
• Irritability.
• Rapid mood changes.
• Euphoria or elevated mood.
• Difficulty concentrating.
• Depressed mood.
• Confusion.
• Hallucinations or other psychotic symptoms.

Why Can Steroids Cause Insomnia?

Sleep disturbance is one of the effects that can become noticeable soon after starting corticosteroid treatment, especially with higher doses. Corticosteroids can affect the body’s stress-response system and circadian rhythms, which may contribute to sleep disruption.

Depending on the medication and dosing schedule, they may produce a feeling of increased alertness or activation at a time when the body would normally be preparing for sleep. For someone who is already vulnerable to insomnia, even a relatively short period of disrupted sleep can have consequences beyond feeling tired the next day, since sleep deprivation can increase irritability, emotional reactivity, difficulty concentrating, and anxiety.

Can Steroids Cause Anxiety or Mood Changes?

Anxiety, agitation, and restlessness have also been reported, although psychiatric responses to corticosteroids vary considerably between individuals. Some people may experience a noticeable elevation in mood, euphoria, or symptoms of mania.

Mood changes can also move in the opposite direction. Depression has been reported as part of the spectrum of corticosteroid-related psychiatric effects.

Does a Higher Dose Mean a Higher Risk?

The likelihood of psychiatric adverse effects appears to increase with higher doses of systemic corticosteroids, but dose is not the only factor involved. The type of corticosteroid, duration of treatment, underlying medical condition, previous psychiatric history, and other medications may all be relevant.

Importantly, a person does not need to have a history of mental illness to experience a psychiatric reaction to a corticosteroid.