Can corticosteroids cause mental disorders?

Corticosteroids are a group of drugs frequently used in medicine, but their prescription must be careful. They are associated with adverse effects, including mental disorders.

Last update: 08 August, 2022

Steroids are a group of drugs with anti-inflammatory and immunomodulatory properties. For this reason, since they were first synthesized, they have been widely incorporated into clinical practice. However, within the unwanted reactions of corticosteroids are mental disorders.

The adverse effects they produce require careful management., since they can become a double-edged sword. Alterations in the neuropsychiatric sphere induced by the use of steroids have been described since the 1950s.

This reality shows that adverse effects of this type are often underestimated by health personnel. Similarly, little is known about the causes of steroid-induced disorders and more research is needed.

Knowing its existence is essential to be able to prevent, detect and treat it effectively.

Risk of mental disorders with corticosteroids

The dose of corticosteroids seems to play a fundamental role in the appearance of neuropsychiatric symptoms; being more frequent at high doses. These side effects usually improve with withdrawal of treatment.

However, it is not always possible to do so. And depending on the duration of glucocorticoid therapy, the dose should be progressively decreased.

The administration of medications used in psychiatry is recommended to treat these effects.

Another risk factor described for the appearance of adverse effects in the mental sphere is the presence of hypoalbuminemia. For this reason, the use of glucocorticoids in those patients with reduced levels of plasma proteins, it should be done with special caution.

Psychiatric history and steroids

Psychiatric history is not considered a risk factor of adverse effects associated with the use of steroids. In fact, the incidence shown among patients with a psychiatric history and that of the general population is similar.

Regarding age, it has not been possible to establish a range of increased risk for developing mental disorders due to corticosteroids.

No direct association was found between the risk of mental adverse effects with these drugs and previous depression or anxiety.

Gender and Chronic Glucocorticoid Use

The female sex seems to have a greater predisposition to this type of side effects. However, this may be due to the fact that pathologies such as systemic lupus erythematosus and rheumatoid arthritis are more frequent in women.

The management of these conditions usually includes steroid therapy, giving these patients more vulnerability. Lastly, the previous use of these substances does not rule out the possibility of adverse effects in future regimens.

What are corticosteroid-induced mental disorders?

Glucocorticoid-induced mood disorders include depressive symptoms as well as mania and hypomania. In some patients, even a mixed condition is observed, showing symptoms that change over the days.

It is common for the mood disturbance to appear within the first few days after starting steroid therapy. However, they can debut after a few weeks.

It is important to highlight that the appearance of psychiatric symptoms should always force to seek the organic cause of it. Therefore, corticosteroid-induced affective disorders are considered a diagnosis of exclusion.

It is advisable to approach the patient from a multidisciplinary perspective, first ruling out any other origin of the clinical picture.

Depressive symptoms and memory impairment

Despite the fact that depression is one of the most frequent neuropsychiatric adverse effects, there is little information in the literature on the subject. Among the causes of this paradox is the underestimation that continues to exist regarding the disease.

Although for the patient the symptoms are experienced as devastating, for the surrounding environment it is easy to ignore themsince they do not represent a direct attack on the environment.

mania and hypomania

At the other extreme of adverse effects are states of agitation and aggressive behavior induced by steroids. There is more scientific evidence available for mania and hypomania than for depressive disorders, despite the fact that they have a similar frequency.

Patients typically present with symptoms that include the following:

  • Insomnia.
  • hyperactivity
  • Ideas of grandeur.
  • Verbiage with disjointed language.

Is there a risk of suicide with corticosteroids?

It has been possible to show a significant increase in the risk of suicide in patients treated with corticosteroids. This affects even people who do not have any significant psychiatric history.

Suicide may become a possibility, despite appropriate medical treatment being instituted. For this reason, it is a mistake to underestimate the psychiatric symptomatology associated with steroids.

In fact, as we have already anticipated, the risk does not seem to be related to the severity of the patient’s underlying condition. Rather, there would be a dose-dependent behavior.

Suicide ideation, attempts, and completion present a real risk in patients with neuropsychiatric side effects. the rise of this risk can be up to 7 times higher than in the general population.

Physicians should be alert for signs of suicide attempts in patients taking high doses of these medications.

steroid psychosis

With the concept of steroid psychosis the first studies on the adverse effects of corticosteroids were reported. The association of symptoms, including hallucinations and delirium, they tend to be more frequent in patients who show hypomania or mania than in those with depression.

Although there is no action protocol for a steroid-related psychotic episode, atypical neuroleptics and mood stabilizers are recommended.

Cancer, mental disorders and corticosteroids

Steroids are very commonly used in cancer patients. In particular, because they are very useful in managing the symptoms associated with the treatment of neoplasms.

However, the adverse neuropsychiatric effects experienced by these patients are often more severe than in other groups of people. The explanation for this phenomenon is related to the fact that, in addition to steroids, they are prescribed narcotics.

Therefore, there is a dual effect on the central nervous system. Likewise, it is likely that the neoplastic process they undergo causes neurobiological changes that are little understood at present, which determine this greater predisposition to steroid psychosis.

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