Prednisone is a synthetic corticosteroid medication widely used to reduce inflammation and suppress the immune system for conditions like asthma, arthritis, and autoimmune disorders. While effective in managing physical symptoms, prednisone can also influence mental health, with effects varying among individuals. Understanding how this medication interacts with the body and mind is important.
Prednisone’s Influence on Brain Chemistry
Prednisone, a synthetic version of cortisol, a hormone naturally produced by the adrenal glands, travels throughout the body, including the brain. Corticosteroids like prednisone can alter the balance of neurotransmitters, the brain’s chemical messengers. This includes influencing the serotonin and dopamine systems, both of which are involved in mood regulation, motivation, and cognitive function.
Research indicates that corticosteroids can affect the expression and activity of genes involved in the synthesis and regulation of these neurotransmitters. Chronic exposure to corticosteroids has been linked to decreased serotonin levels and altered dopamine signaling in certain brain regions. Prednisone can also influence the hypothalamic-pituitary-adrenal (HPA) axis, a system that regulates stress responses and hormone production, which in turn affects neurotransmitter release.
Prednisone can also impact brain structure. Studies show that steroids can cause structural and volume changes in both white and gray matter. Individuals taking systemic steroids may have a larger caudate, a gray matter region involved in planning and memory. Inhaled glucocorticoids have been associated with a smaller amygdala, a gray matter area linked to emotional processing and regulation. These changes in brain regions and neurotransmitter systems contribute to the psychological effects.
Identifying Psychological Changes
Individuals taking prednisone may experience a range of psychological and behavioral changes. Mood swings are common, with feelings rapidly shifting from euphoria or increased energy to anxiety, anger, or depression. These shifts can seem irrational and come without clear provocation.
Other symptoms include irritability, insomnia, and restlessness. Some may experience a false sense of well-being, while others may feel anxious, have difficulty concentrating, or experience confusion and memory loss. The intensity of these mood changes can increase with higher doses of prednisone.
More severe effects, though rarer, can manifest, such as psychosis, including hallucinations (seeing or hearing things that do not exist) or delusions (strange and frightening thoughts). These severe psychiatric effects are uncommon with doses less than 40 mg/day of prednisone, but the risk increases significantly to about 18.4% at doses above 80 mg/day. These psychological changes are recognized side effects of the medication and do not indicate a personal failing.
Managing Side Effects and Seeking Support
Coping with the psychological effects of prednisone involves open communication with your prescribing doctor. Discuss any mood or behavioral shifts experienced while on the medication. Never stop taking prednisone abruptly, as this can lead to withdrawal symptoms, including severe mood swings and suicidal thoughts.
Doctors may consider adjusting the prednisone dosage, as psychiatric side effects are often dose-dependent. Lifestyle adjustments can also help; taking prednisone in the morning may mitigate insomnia, as medication levels are lowest at bedtime. Engaging in regular physical activity, like brisk walking or cycling, can help improve mood by releasing endorphins.
Stress reduction techniques such as meditation, deep breathing exercises, and maintaining good sleep hygiene are also beneficial. Informing family and friends about potential mood changes can help them understand and support you. If psychological symptoms are severe, such as intense mood disturbances, thoughts of self-harm, or psychotic symptoms, seek immediate medical attention. These effects are typically temporary and often resolve once the medication is tapered or discontinued.