The human body has a remarkable ability to self-regulate and maintain a state of balance and harmony. This is achieved through the secretion of various chemicals, including steroid hormones. When the body loses its balance, it can result in mental, physical, and emotional problems. It is a well-known fact that steroids can cause physical issues, but there is ongoing research to determine if they can also cause mental health problems. More specifically, can steroids cause depression? is a question that researchers are trying to answer.
Medical science has made remarkable progress in treating naturally occurring imbalances in the body. They have successfully replicated the chemicals our body produces or fails to produce in some cases. Synthetic or anabolic steroids, as we call them, are effective solutions to many medical problems. However, they are not invincible. Their misuse or imbalance can lead to various health issues. It may be of interest to us to compare the similarities and possible side effects between synthetic and natural steroids. We also need to find out “Can anabolic steroids cause depression”.
This blog post will not only educate you about what steroids are, why they are used, and what their side effects are; it will also explore the relationship between steroids and depression. We will delve deeper into whether steroids have the ability to affect our mental health or not. If yes, can they specifically cause depression? By the end, not only will you have knowledge about this topic, but you will also have useful tips to manage the issue effectively.
Before going deeper into the topic of steroid-induced depression, we first need to be clear about the nature, classifications, and uses of steroids, as well as their side effects.
What are Steroids?
Steroids refer to a broad class of organic molecules with a specific chemical structure. Steroids have different types and are produced by 3 major glands in our body, namely:
- The adrenal cortex
- The testes
- The ovaries
The adrenal gland and its secretions
The adrenal glands on top of the kidneys have various functions. They secrete chemicals from both the medulla and adrenal cortex. We will skip discussing the non-steroid hormones from the medulla for now and focus on the rest.
Steroid hormones produced by the cortex include:
- Mineralocorticoids help regulate the body’s water and salt balance, which is important for maintaining blood pressure. An important mineralocorticoid is called aldosterone.
- Glucocorticoids, such as cortisol, are hormones produced by the adrenal cortex that help reduce stress levels and perform various functions, such as breaking down digested food and preventing arthritis with anti-inflammatory properties.
- Androgens, including testosterone, are male sex hormones responsible for developing sexual characteristics, muscle mass, skeletal system, and producing red blood cells. They are primarily produced in the testes, but a small amount is also produced in the adrenal glands of both males and females.
- Estrogen is a steroid hormone mainly secreted by the ovaries, but a small amount is also released by the adrenal cortex. Estradiol, a type of estrogen, is responsible for skeletal growth.
Steroid hormones of the testes and ovaries
As was previously mentioned, female ovaries produce progesterone and estrogen, while male testes produce testosterone.
- Testosterone works to regulate sex drive, increase strength and muscle mass, and control the production of sperm.
- The estrogen produced by the ovaries is also primarily a sex hormone, regulating sex drive and the menstrual cycle and strengthening the skeletal system. Estrogen’s role in bone and joint health is one reason most women face so many joint problems after menopause, when estrogen levels decrease significantly in the body.
- Progestins, the most important of which is progesterone, are also released by ovaries and are mainly responsible for maintaining the uterus and pregnancy.
Synthetic steroids and their uses
If, for one reason or another, our body fails to produce adequate amounts of these steroids, synthetic versions are there for us to take in order to compensate for the lost function.
You may have heard people say that a person looks so big and muscular because he has taken steroids, or that an athlete was expelled from the team because he was found to be using steroids or performance-enhancing drugs.
Well, what these people have done is take anabolic steroids, which are synthetic versions of the male sex hormone testosterone, in order to strengthen their muscles and increase their strength. Doctors also prescribe them to treat hormonal imbalances or delayed puberty.
Testosterone is also taken by trans individuals who are undergoing sex change.
Estrogen in synthetic form is sometimes prescribed to individuals going through menopause. Estrogen, along with progestins, is taken as birth control. Estrogen in the form of pills can also lead to improved sleep, a lower risk of developing cataracts, stronger bones and joints, and healthy skin.
Progestin pills not only work as birth control pills, but they can also be taken for heavy and painful periods.
There are many other steroid hormones that you can take for various purposes. For instance:
- Betamethasone and dexamethasone are oral steroids and can be taken as tablets. They are used for treating arthritis and some other autoimmune conditions, and they mainly focus on reducing swelling and inflammation.
- Prednisolone is taken in the form of eye drops to reduce inflammation in the eye.
- Methylprednisolone, triamcinolone, and some other steroids are taken through injections as a form of treatment for rheumatoid arthritis, lupus, and other autoimmune conditions.
- Some steroids are topical and are applied directly to the skin in the form of gel or cream. They are used to treat itchy and scaly skin caused by conditions like psoriasis. The most notable examples include hydrocortisone and mometasone.
Now that we know what steroids are, let’s head on to our major concern “Can steroids cause depression?”. Let’s explore the connection between steroids and depression and identify the associated factors that could lead to depression.
Can Steroids Cause Depression? Finding the Connection
Just like every useful medication, steroids have their side effects too. Aside from having the potential to treat so many problems, it can cause some problems of its own too. The physical side effects of steroids are numerous, but can they cause psychological problems too? If yes, then what are they?
As we know, our bodies and our minds are deeply interconnected. Anything that disturbs the balance in the body will do so in the mind as well. People who use steroids often report violent rage, paranoia, and rapid mood shifts. Research has shown that treatment with corticosteroids produces many psychiatric symptoms. While frustration and behavioral issues are common, but, can steroids cause depression?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V) categorizes steroid-induced depression under the category of substance/medication-induced mood disorders. Let’s look at what the experts have to say about the connection between depression and steroids.
- One study by Stoudemire and Edwards showed that long-term use of corticosteroids causes cognitive impairment, which can lead to dementia and delirium.
- Although the exact means by which steroids cause depression is unknown, several theories have been proposed. One hypothesis is that steroid-induced psychopathology is caused by decreased levels of corticotropin, which is responsible for regulating the body’s stress level, and norepinephrine, which is related to fight or flight response. This also provides an explanation for why patients with major depressive disorders have abnormal levels of cortisol in their bodies. (Lydia Ann, MD and Robert McCarron, DO)
- In a recent study by Y Yagi et. al., (2021) 95 people were given steroids as treatment options, and out of those 95 patients, 15 developed depression, while the rest of them developed other psychological symptoms, including insomnia and delirium.
- It is interesting to note that the short-term and long-term effects of steroids might be opposing each other. For instance, this study noted that the short-term effects of steroid usage can cause euphoria and manic symptoms, while in the long run, it will cause depressive symptoms. (Thomas P. Warrington). The same study reported that in some instances, the problem might be so severe that we need to use mood stabilizers.
- On the issue of prevalence, a study by Jeffrey R. Curtis et. al. indicated that 90% of individuals who have taken steroids, specifically glucocorticoids, for more than 60 days will experience adverse psychological symptoms.
Sex Hormones and Depression
- The steroid hormone testosterone is also linked with depression, especially when its level in the body is below normal. In more severe cases, it can lead to intentional self-harm and suicidality as well. (Nackeeran S et. al., 2016)
- Testosterone is not only linked with depression in males but its effects can be found in females as well. For instance, lower than normal levels in females are linked with depression, a decrease in bone density and osteoporosis, declining libido, and an increase in body fat. (Uwe D Rohr, 2002). It was the same study that found out that higher levels of testosterone in females can also be problematic. For instance, Rohr believes that depression during puberty in girls can be attributed to increasing levels of testosterone.
- According to a study by Farid Talih, MD, depression and other psychiatric symptoms are among the side effects of anabolic steroids, which also include testosterone. These should, however, subside after the use is discontinued.
- On the other hand, the female sex hormone estrogen is also found to be the cause of depression if its level is disrupted. The neurotransmitter serotonin, which plays a pivotal role in the development of depression, is deeply linked with the steroid hormone estrogen, so if estrogen is disturbed, serotonin is disturbed, resulting in depression. Miller, K.J. & Rogers, S.A. 2007)
- Many researchers have also found out that birth control pills, which are mainly the steroid hormone progesterone, can also cause severe hormonal imbalances, including depression. The results, however, are mixed.
- Another steroid hormone, glucocorticoids such as cortisol, which is the body’s stress hormone, are linked with euphoria and pleasant feelings in the beginning, but in the long term, they are also a predictor of mood problems, including irritability and depression. J Clin Med. 2021
Interference with Neurotransmitters
When you think about hormones and neurotransmitters, and how they have an impact on each other, think of a deeply convoluted cobweb. There are several ways in which they influence each other’s activity.
- One reason could be that some steroid hormones have the ability to interfere with neurotransmitters responsible for mood regulation. For instance, corticosteroids have the ability to reduce serotonin, which is responsible for the regulation of mood, sleep, and pain. If corticosteroids are in excess in the body for some reason, it can lead to mood fluctuations and consequently, depression.
- Corticosteroids can also interfere with the levels of GABA, which can lead to anxiety, changes in mood, depression, and a decreased capacity to tolerate pain. In addition, while it does not directly cause depression, it can disrupt the deeply affected faculties of depression, including the hippocampus, a region of the brain linked to memory and emotional processing.
Impact of Neurosteroids
Our brain also has the capacity to produce steroid hormones to some extent. The hormones synthesized in the brain are referred to as neurosteroids. They have the capacity to impact neural activity, giving them the power to influence our moods.
Some major neurosteroids:
- Allopregnanolone, which can influence the levels of GABA, potentially leading to anxiety and depression.
- Pregnenolone, or “mother steroid” (as it produces many other steroid hormones), also has the potential to affect mood and produce cognitive deficits.
- Tetrahydrodeoxycorticosterone (THDOC) is also found to have a role in anxiety and depression if produced at abnormal levels.
Steroid-Related Withdrawals
Some steroids have the capacity to cause dependency, and if they are stopped abruptly, they will lead to withdrawal symptoms just like any other addictive drug. These symptoms can include irritability, anger, and mood disturbances. These symptoms should, however, subside after some time.
So in the quest to explore the question, Can steroids cause depression? The evidence strongly suggests that they can. Based on the collective body of research studies and the interconnected factors that have been explored, it’s evident that there is a substantial link between steroid use and depression.
Steroid-Induced Depression Symptoms
So how can you tell if you have depression when you are using steroids? For this, you have to be mindful of some signs and symptoms, such as:
- Persistent feelings of sorrow or melancholy, or a general feeling of despair
- Insomnia, or excessive sleeping, disrupting regular sleep patterns.
- Significant weight gain or weight loss due to altered eating habits.
- Persistent feelings of exhaustion and lack of energy.
- Increased worry, nervousness, or restlessness.
- Diminished interest or pleasure in activities once found enjoyable.
- Impaired focus and cognitive function.
- Avoidance of social interactions and a preference for isolation.
- Aches, pains, and other physical discomforts without apparent cause.
- Decreased libido and no interest in sexual activity
- Thoughts about or planning for self-harm or suicide.
Risk Factors and Vulnerability
It is important to note that some people are more vulnerable to developing depression as a side effect of steroid medication than others. Not everyone who is taking the same medication will develop the same type of symptoms. Some individuals may not experience any issues at all. However, there are some factors that can make you more susceptible, including:
- Previous medical history
- History of a preexisting mental disorder.
- Personal vulnerability. Some people are more vulnerable to developing mood disorders than others.
- The dosage and duration of steroids matter too. If you are taking high doses for a long time, you are likely to experience greater adverse effects.
- Age can be another factor. Some researchers believe that older adults may be more susceptible to the mood-altering effects of corticosteroids, including depression. So with age, your vulnerability increases.
- If the steroids you are taking have caused some addiction, they are likely to create more severe psychological issues, including depression.
- People who have some sort of renal dysfunction or liver problems are also at higher risk.
- People who have damage to their blood-brain barrier are at a greater risk of steroid-induced psychopathology.
- Lastly, there can be an indirect connection as well. For people who are taking some steroid that has depression as a side effect and, at the same time, have no social support in their lives, problems can worsen for them.
That being said, it should be kept in mind that steroids are not something to be afraid of. Not everyone who takes them develops psychological symptoms.
Even if you do, there is nothing to worry about because there are plenty of treatment options available that can suit your personal needs.
Treatment for Steroid-Induced Depression
As is the case with many problems, prevention, early diagnosis, and timely treatment are the best strategies.
Even though there are no FDA-approved medications solely for the treatment of steroid-induced psychiatric symptoms, many options are available, such as:
- Tapering off the dosage of steroid medication slowly. Many studies have found that once people stopped using steroids, their depressive symptoms were reversed.
- If, for some reason, the individual cannot stop using steroids, they can start treating their depression on the side. For instance, sertraline (SSRIs) or other first-line antidepressants can be recommended.
- Lithium has also been found to be successful in managing and preventing glucocorticoid-associated depressive disorder. ECT can be considered in cases of severe depression.
- Benzodiazepines are usually recommended for agitation symptoms associated with steroid induced depression.
- Other than medication, lifestyle changes, stress management, and psychotherapy are always useful to make sure problems don’t get out of hand.
Wrapping Up
After our detailed exploration of the question, Can steroids cause depression? What we have learned is that yes, steroids can, in fact, cause depression. But things are more nuanced than just a simple yes. While it does have the capacity to alter the neurochemical balance of the body and potentially cause depression, it is not always the case, and it does not happen for everyone.
It is also important to note that depression is not the only adverse symptom since many of them can cause manic and psychotic symptoms as well. It is very important in this case that one seeks professional help and doesn’t self-medicate. It is very important to keep in mind that reaching out to your healthcare provider is very important. Not only to get help for your issue but also to see if your depression is caused by steroids or if it is a stand-alone problem.
If it’s the former, it can be resolved by changing your medications and seeking other treatment options. In most cases, it will resolve itself once you stop taking the steroid medication you are taking. If it’s the latter, you can be at risk of developing a major depressive disorder and need to seek psychotherapy.
In any case, it is very important to know that you should not take any type of steroid without a prescription from a doctor. Especially in the case of anabolic steroids. It is tempting to think that you can become stronger and more attractive without sweating much in the gym, but remember that while these drugs might inflate your muscles like a balloon, they are most likely hollowing you out from the inside.
Frequently Asked Questions
1. What are 3 emotional side effects of steroids?
The most common emotional side effects of steroids include irritability, anxiety, aggression, and depression.
2. Does depression from steroids go away?
Depression caused by steroids usually goes away once you stop taking steroid medications. Still, there are many ways in which you can manage depression, even during your steroid treatment.
3. How long does steroid-induced depression last?
The symptoms may last anywhere from a few days up to a few weeks. In most cases, they subside within days but may last up to 6 weeks after discontinuation.
4. Can short-term steroids cause depression?
It depends on the type of medication. Some start developing mental health issues just after 4-5 days of use.
5. What are 5 common side effects of steroids?
Increased appetite, rapid mood swings, muscle weakness, irregular heartbeat and weight gain
6. How long do steroids stay in your system?
It depends on how and which type you take. For instance, if taken orally, they can stay in your system for up to 14 days. Some of them last up to 1 month in the body. It also depends on the dosage.
7. Are steroids addictive?
Corticosteroids, commonly used for anti-inflammatory and immunosuppressive properties, are not typically considered addictive in the same ways that drugs of abuse, such as opioids or stimulants, can be. Anabolic steroids taken for muscle gain, on the other hand, are very addictive.
8. Do you feel bad after stopping steroids?
Steroids that are addictive do leave withdrawal symptoms, making you feel dizzy, lightheaded, or tired, along with other unpleasant symptoms.