The Relationship Between Steroids and Bipolar Disorder

Prednisone 50 MG Oral Tablet

Pillbox / U.S. National Library of Medicine

In her memoir "Skywriting," television journalist Jane Pauley disclosed that she has bipolar disorder. The illness appeared, she says, when she was given steroids for a case of hives. This revelation refocused attention on the relationship between steroids and manic depression.

In the portion of her book excerpted in the August 20, 2004 issue of People, Pauley writes that she experienced hypomania following the first administration of steroids for her hives and depression with the second. The depression was serious enough that a low-dose antidepressant was prescribed for her, and she rebounded into an agitated mixed state and rapid cycling. Her doctor explained that the antidepressant "unmasked a never-before-suspected vulnerability to bipolar depression." But, according to Pauley's account, the mood swings began with the steroids. She was hospitalized at the time and was stabilized on lithium.

What Are Steroids?

The term "steroid" applies to a very "large family of chemical substances, comprising many hormones, body constituents, and drugs." While steroids typically may be thought of in their drug form, our body actually makes them naturally, and many of our body processes include steroids. Therefore, it should not be surprising that administered steroids might cause side effects, including a rare "steroid psychosis," which may include psychosis, mood disturbance, or delirium.

Studies have shown that corticosteroids, like the one Pauley was prescribed, can induce psychiatric symptoms. In "Steroid-Induced Mental Disturbances," the authors report on a 1972 study by the Boston Collaborative Drug Surveillance Program in which patients who took different doses of Prednisone (a corticosteroid), showed more frequent mood disturbances: psychosis, mania, and depression. The paper also mentions that while mania is the most frequent response to the use of steroids, depression is often triggered by steroid withdrawal.

Commonly Prescribed Steroids

Some of the most commonly known names of corticosteroids include:

  • Cortisone and hydrocortisone
  • Prednisone
  • Flonase (fluticasone propionate nasal spray)
  • Lanacort (hydrocortisone topical)
  • Nasonex (mometasone nasal)

Corticosteroids are used in the treatment of a wide variety of medical conditions including:

Dehydroepiandrosterone (DHEA)

Over-the-counter sales of another steroid hormone, dehydroepiandrosterone (DHEA), have come under fire from many in the medical community with one researcher calling it "the snake oil of the '90s." DHEA became widely popular for its ability to boost energy, specifically among an older population, as DHEA naturally decreases within the body with age.

The concern for this compound comes from its popularity as a supplement and its presence as one of the most abundant steroids in the human body. A 1999 study reports: "This multifunctional hormone has long been a compound of interest to research psychiatrists. But little is known about potential adverse effects of DHEA when consumed on an acute or chronic basis." The study reports a case of mania in an older man with no previous personal or family history of bipolar disorder that appeared to be related to recent DHEA use.

What the Research Says

A 2006 meta-analysis finds psychiatric adverse effects common from steroid use, with hypomania and euphoria most common. Long-term use has been associated with depression. It finds the severity of the adverse effects related to the dosage.

"The reaction is usually reversible with dose reduction or discontinuation of the corticosteroid. In cases where this cannot be done, typical treatment involves an antipsychotic medication."

The research of Wood et al also indicates that some of the changes noted in the hippocampus can be prevented with "selective antidepressant and anticonvulsant drug treatments" such as Eskalith (lithium.)

While steroid-induced mental disturbances are rare, continued research holds better promise for understanding these potential psychiatric side effects.

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