The Relationship Between Steroids and Bipolar Disorder

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Pillbox / U.S. National Library of Medicine

In her memoir "Skywriting," television journalist Jane Pauley disclosed that she has bipolar disorder. The illness appeared when she was given steroids for a case of hives, she says. The revelation refocused public 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 she was prescribed a low-dose antidepressant, 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 stabilized on lithium.

What Are Steroids?

When taken in as a medication, steroids (also known as corticosteroids) are synthetic drugs that are similar to cortisol, a hormone naturally produced in the body. While the term "steroid" is typically equated with its drug form, the body also makes steroids naturally.

Studies have shown that corticosteroids, like the one Pauley was prescribed, can induce psychiatric symptoms. The use of steroids is associated with mood disturbances and psychosis. Mania and depression can be triggered by the initiation as well as withdrawal of steroids.

Commonly Prescribed Steroids

Some of the most common 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:

  • Asthma
  • Emphysema
  • Crohn's disease
  • Bursitis
  • Tendinitis
  • Ulcerative colitis
  • Hives
  • Insect bites
  • Nasal allergies
  • Eczema
  • Psoriasis

Over-the-Counter Steroids

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 in older adults, 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 reported that DHEA "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 did, however, report 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

According to forensic psychiatrist Dr. Henry Lahmeyer, single-use steroids are highly unlikely to cause any kind of mental disturbance. Rather, it is the prolonged and steady administration of steroids that may cause these uncommon psychiatric side effects. By her own account, Pauley was taking steroids for five months before the mood swings began.

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

According to a 2003 case report, while the underlying mechanism is still unclear, adverse psychological symptoms associated with corticosteroid use is usually reversible with dose reduction or discontinuation of the drug.

Another 2004 study also indicated 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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