Steroids and depression

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Abstract
Adrenal steroids are commonly prescribed drugs, the central effects of which are rarely alluded to in routine clinical practice or systematically investigated in medical research. Glucocorticoids are important in the pathogenesis of depression, but this potentially serious psychological side effect is often overlooked in clinical practice. The unwanted behavioural effects of anabolic steroids are widely known, but those of glucocorticoid therapy, though recognised for over 45 years, receive less attention. Placebo controlled studies have reported that a third of patients taking glucocorticoids experience significant mood disturbance and sleep disruption.1 More importantly, up to 20% of patients on high dose glucocorticoids report psychiatric disorders including depression, mania, psychosis, or a mixed affective state.2 A recent double blind placebo controlled trial of corticosteroid administration in healthy individuals showed that 75% of subjects developed disturbances in mood and cognition, which reversed when steroids were stopped.3 We do not know the characteristics of those who are vulnerable to adverse effects, but those with higher cumulative dosages …