Steroids can significantly alter mood and behavior. The term “steroids” covers two distinct classes of compounds, Anabolic-Androgenic Steroids (AAS) and Corticosteroids, both of which impact the central nervous system through different mechanisms and usage patterns. These drugs can induce a spectrum of psychiatric symptoms ranging from mild irritability to severe depression, mania, and even psychosis.
Anabolic vs. Corticosteroids: Defining the Different Causes
Anabolic-Androgenic Steroids (AAS) are synthetic derivatives of the male hormone testosterone, designed to promote muscle growth and enhance athletic performance. Misuse of AAS for non-medical purposes often involves very high doses that far exceed normal physiological levels. The psychological changes associated with AAS use generally lean toward increased aggression, irritability, and states of elevated mood.
Corticosteroids, such as prednisone or dexamethasone, are a different class of drug used medically to treat inflammation, allergies, and autoimmune conditions. These are synthetic versions of cortisol, a natural stress hormone. Corticosteroid-induced mood alterations more commonly involve depressive symptoms, anxiety, and emotional lability, where mood shifts rapidly and dramatically. The effects are often observed in individuals taking the medication for therapeutic purposes under a doctor’s supervision.
The Neurochemical Mechanism Behind Mood Alterations
The psychological effects of steroids are rooted in their direct interaction with the brain’s hormone and neurotransmitter systems. Anabolic steroids exert their influence by binding to androgen receptors throughout the body, including those in brain regions responsible for mood and impulse control. This interaction is thought to disrupt the balance of crucial signaling molecules like serotonin and dopamine, which regulate emotion and reward.
High concentrations of AAS modulate the GABAergic system, the brain’s primary inhibitory system. Changes in GABA receptor function, particularly in the lateral anterior hypothalamus, are linked to reduced impulse control and increased aggressive behavior.
Corticosteroids primarily affect the brain by interfering with the Hypothalamic-Pituitary-Adrenal (HPA) axis, the body’s central stress-response system. As synthetic cortisol, they flood the system, which can dysregulate the delicate feedback loop that controls natural stress hormone levels. This disruption of the HPA axis is strongly associated with the development of mood disorders, mirroring the hypercortisolemia seen in some clinical depressive states.
Elevated cortisol levels interfere with the regulation of serotonin and dopamine within the limbic system, which manages emotion and memory. Corticosteroids have been linked to structural changes, such as reduced volume in the hippocampus and overactivation of the amygdala. These changes contribute to the range of anxiety and depressive symptoms experienced by users.
Spectrum of Psychological Symptoms
The manifestations of steroid-induced mood changes vary significantly between the two drug classes and are often dose-dependent. AAS use is notably associated with hypomania or euphoria, where users experience a sense of invincibility, high energy, and reduced need for sleep. However, this often swings toward intense irritability, hostility, and paranoia, which can manifest as the well-known “roid rage,” characterized by exaggerated and sometimes violent reactions to minor provocations.
Upon cessation of AAS, users frequently experience a severe withdrawal phase due to the sudden drop in synthetic hormones and the body’s inability to produce its own hormones immediately. This withdrawal can lead to profound depression, fatigue, loss of appetite, and in serious cases, suicidal ideation. The rapid shift from manic-like symptoms to deep depressive states highlights the dramatic mood swings that characterize AAS use.
In contrast, corticosteroids can induce emotional lability, where individuals experience rapid and unpredictable mood shifts. Anxiety, insomnia, difficulty concentrating, and a general feeling of dysphoria are common side effects, even at moderate doses. High-dose corticosteroid use can precipitate a severe condition known as steroid-induced psychosis, involving hallucinations, delusions, and disorganized thinking. The severity of these symptoms is typically correlated with the dosage and duration of the treatment.
Managing and Mitigating Mood Swings
The most important step in managing steroid-induced mood swings is open communication with a healthcare professional. For individuals taking prescribed corticosteroids, the doctor may implement a gradual dose reduction, or tapering, to minimize psychiatric side effects and prevent adrenal insufficiency. In cases where the steroid cannot be immediately discontinued, the physician may prescribe medications to manage the psychiatric symptoms.
Steroid-induced mania or psychosis may be treated with mood stabilizers, such as lithium or valproate, or low-dose antipsychotics like risperidone. For depressive symptoms, an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI), may be used alongside the steroid treatment. Individuals misusing AAS must seek support for cessation, as stopping the drug is the only way to resolve the underlying hormonal imbalance.
During the recovery phase, especially following AAS withdrawal, psychological support and careful monitoring for severe depression are important. Lifestyle adjustments, including maintaining strict sleep hygiene, engaging in regular physical activity, and employing stress-reduction techniques, can help stabilize the central nervous system. Immediate professional help should be sought if any individual experiences severe aggression, paranoia, or has thoughts of self-harm or suicide.