The Relationship Between Steroids and Bipolar Disorder

The Relationship Between Steroids and Bipolar Disorder Bipolar Disorder Treatment Medications Print The Relationship Between Steroids and Bipolar Disorder By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Medically reviewed by Medically reviewed by Steven Gans, MD on September 10, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD on September 10, 2019 Bipolar Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Your Rights Pillbox / U.S. National Library of Medicine In her memoir Skywriting, television journalist Jane Pauley disclosed that she has bipolar disorder.?? The illness appeared when she was given steroids for a case of hives, she says. The revelation refocused public attention on the relationship between steroids and manic depression.?? In the portion of her book excerpted in the August 20, 2004 issue of People, Pauley writes that she experienced hypomania following the first administration of steroids for her hives and depression with the second. The depression was serious enough that she was prescribed a low-dose antidepressant, and she rebounded into an agitated mixed state and rapid cycling.?? Her doctor explained that the antidepressant unmasked a never-before-suspected vulnerability to bipolar depression. But, according to Pauleys account, the mood swings began with the steroids. She was hospitalized at the time and stabilized on lithium. What Are Steroids? When taken in as a medication, steroids (also known as corticosteroids) are synthetic drugs that are similar to cortisol, a hormone naturally produced in the body.?? While the term steroid is typically equated with its drug form, the body also makes steroids naturally. Studies have shown that corticosteroids, like the one Pauley was prescribed, can induce psychiatric symptoms. The use of steroids is associated with mood disturbances and psychosis. Mania and depression can be triggered by the initiation as well as withdrawal of steroids. Corticosteroids Corticosteroids are used in the treatment of a wide variety of medical conditions including:?? AsthmaEmphysemaCrohns diseaseBursitisTendinitisUlcerative colitisHivesInsect bitesNasal allergiesEczemaPsoriasis What the Research Says Single-use steroids are highly unlikely to cause any kind of mental  disturbance. Rather, it  is the prolonged and steady administration of steroids that may cause these uncommon psychiatric side effects.?? By her own account, Pauley was taking steroids for five months before the mood swings began. A 2006 meta-analysis found psychiatric adverse effects common from steroid use, with hypomania and euphoria being the most common. Long-term use, however, has been associated with depression. It also found that the severity of the adverse effects related to the dosage.?? According to a 2003 case report, while the underlying mechanism is still unclear, adverse psychological symptoms associated with corticosteroid  use is potentially reversible with dose reduction or discontinuation of the drug.?? However, treatment of the psychiatric symptoms is often required. According to forensic psychiatrist Dr. Henry Lahmeyer, single-use steroids are unlikely to cause any kind of mental disturbance. Rather, more often, it is the prolonged and steady administration of steroids that may cause these psychiatric side effects. By her own account, Pauley was taking steroids for five months before the mood swings began. Another 2004 study also indicated that some of the changes noted in the hippocampus can be prevented with selective antidepressant and anticonvulsant drug treatments such as Eskalith (lithium).?? It is important to be aware of the potential psychiatric impact of steroids, and continued research holds better promise for understanding these potential psychiatric side effects.??