Update
Blog
Written by Dr. Bassam Dheyaa, Specialist Adult Psychiatrist at The Valens Clinic, Dubai.
Corticosteroids, such as cortisone and prednisolone, are commonly prescribed to treat or help with a variety of inflammatory and autoimmune conditions. They are powerful medications with significant therapeutic benefits. However, they also have profound effects on mood and mental health, leading to corticosteroid-induced mood swings.
These synthetic drugs mimic the effects of cortisol, a hormone produced by the adrenal glands. Cortisol suppresses inflammation, promotes a balance in wake-sleep patterns, and helps the body adapt to physical, psychological, and environmental stressors. However, the psychological effects of corticosteroids can be significant.
Corticosteroids can influence brain function by altering the balance of neurotransmitters, such as serotonin, GABA, and dopamine, and by affecting the hypothalamic-pituitary-adrenal (HPA) axis. These changes can lead to significant mood fluctuations and psychological symptoms in some people.
Types of Mood Changes:
Some individuals may experience an initial sense of euphoria and increased energy levels, especially at the beginning of corticosteroid treatment. Others may experience heightened irritability and anxiety, making patients feel on edge and easily agitated. With prolonged use or high doses, some develop feelings of sadness, hopelessness, and loss of interest in daily activities. Rapid and unpredictable mood swings are common, with individuals fluctuating between feelings of happiness, anger, and sadness.
In more severe cases, corticosteroids can trigger manic or hypomanic episodes, characterized by excessive energy, decreased need for sleep, grandiosity, or impulsive behavior. In cases of high doses or long-term use, steroid-induced psychosis can occur, which requires urgent management.
Risk Factors:
Several factors can influence the likelihood and severity of these mood changes, including dosage, duration, other medications, and general health. Higher doses and longer durations of corticosteroid treatment increase the risk of mood changes. Genetic predisposition and a personal history of mental health disorders make individuals more vulnerable to corticosteroid-induced mood changes. The use of other medications, especially those that affect the central nervous system, can exacerbate the psychological effects of corticosteroids.
Managing Corticosteroid-Induced Mood Changes:
Educating patients about the potential mood changes associated with corticosteroid use is crucial. Patients should be encouraged to report any psychological symptoms to their healthcare provider promptly. Close monitoring by healthcare providers is essential, particularly when starting or adjusting corticosteroid therapy.
Gradual tapering of corticosteroid doses, rather than abrupt discontinuation, can help minimize mood swings and physical side effects. Psychological support, including counseling or therapy, can be beneficial in managing mood changes and helping patients develop coping strategies. In some cases, adjusting the corticosteroid dose or switching to a different medication with fewer psychological side effects may be necessary.
Conclusion:
While corticosteroids are invaluable in managing medical conditions, their impact on mood and mental health cannot be ignored. By understanding the psychological side effects and implementing effective management strategies, healthcare providers and patients can work together for better mental well-being.
Regular communication with healthcare providers is crucial for monitoring mood changes. Lifestyle adjustments such as stress management, exercise, and a balanced diet can support mental health during corticosteroid therapy.