How steroids can affect your mood and behavior
If you’ve been prescribed steroids, there’s a high chance that you may notice that they affect your mood or make daily life more difficult. Many people report that they struggle to focus while others feel anxious, irritable, angry, or depressed. In rare cases, patients can even experience hallucinations and delusions.
As with any challenge, knowing what to expect can be helpful. The mental health challenges commonly linked to steroid use are:
Depression
As many as one third of steroid-treated patients experience some degree of depression, which can make itself felt as sadness, fatigue, insomnia, or even unexplained weight loss.
Anxiety and mania
Some patients report feeling unusually anxious (worried) or show signs of mania. Mania is defined as a state of unusually high energy levels or feelings of euphoria (overwhelming positivity and even a detachment from reality).
Mood swings and irritability
This can range from minor irritability to severe mood swings that impact your daily life and put a strain on your relationships with others.
Anger
Some patients might experience increased feelings of anger about things that would not usually bother them too much.
Although these concerns can be very distressing for you, your family, and your friends, recognizing the source of the problem as a steroid side-effect is an important first step in addressing these feelings. It’s really important to understand that these are some of the most frequently reported side-effects of steroid treatment and that they are reversible once steroid doses are reduced.
“Mental health challenges are some of the most frequently reported steroid side effects”
Why does this happen?
Dr Michelle Petri is a Professor at John Hopkins University in Baltimore where she founded the Lupus Center in the 1980s. Her John Hopkins Lupus Cohort of over 3,000 patients is famous all over the world for the knowledge that it has brought about the challenges of lupus, including those faced by patients as a result of their steroid treatment.
Dr Petri explains that the reason clinicians still use steroids such as prednisone is that they reduce the strength or the immune response by binding to the white blood cells that drive inflammation (swelling). However, they also affect other cells found throughout the body - including the brain.
This means that while the steroids you take are achieving their intended effects on the cells in your immune system, they’re also affecting the cells in your central nervous system, which can change how you feel and behave.
What to look out for
Your thoughts and feelings matter. Try to pay close attention to how you’re feeling and keep in mind that the steroids you’re taking may be the cause. Many patients find that it’s helpful to track their daily mood and concerns. By using the tracker tools in the Sam Journey tracker you can monitor your mental health, gain perspective, and prepare for more productive conversations with your doctor.
Top tips for taking care of yourself
Taking care of yourself when you feel down, stressed or exhausted can be hard. In managing the mental health effects of steroid treatment, it’s important to prioritize these things:
1. Be open and honest with your doctor
If you have concerns about the impact of steroids on your mental health, make a note of any new or worsening symptoms and speak with your doctor as soon as possible. It’s important that you work together to try to figure out whether these symptoms are due to your underlying disease, the steroids, or possibly both.
2. Try to be open with others too
We all need a little help sometimes. When you’re ready, talking to close family or friends about your concerns, and letting them know they could be related to your steroid use and that you may be more emotional than usual can be very helpful.
3. Get involved in tracking changes
Try to make monitoring your mood a regular thing, noting when symptoms occur, how often, and any possible triggers.
4. Try to make time for the things that nourish you
We’re all different when it comes to the things that make us feel good inside. For some, this could be taking a short walk, doing some light gardening, or simply reading a book. Whatever it is for you, try to make a little time for it, even on days when you feel very low.
5. Adjust medications when necessary
Your doctor might adjust your steroid dosage to the lowest effective dose. Keeping the dose as low as possible while still maintaining control of the disease is the best way to reduce side-effects.
6. Consider additional support
Sometimes, managing insomnia might be as simple as an over-the-counter sleep aid. For other issues, such as severe depression, more comprehensive treatment might be required, including the support of a psychiatrist and the use of prescription antidepressants.
“It's very important to verbalize depression because all too often the physician brings it up rather than hearing from the patient that this is a concern,” says Dr Petri.
“And it's important to remember that depression will present in different ways in different people. So communication is always going to be key in the patient-physician relationship.”
To hear more from Dr Petri, watch our film on mental health.
The bottom line
While steroids are a highly effective way to help patients manage inflammatory and autoimmune conditions, they have a very real impact on brain cells which can affect mood. By taking steps to look after yourself, such as tracking your mood and being open with your doctor, you can make a positive investment in your mental health.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.