Can Steroids Cause Anxiety, Insomnia, or Mood Changes?

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Corticosteroids, commonly called steroids, are widely used to treat inflammation and a range of medical conditions. Drugs such as prednisone, prednisolone, dexamethasone, and methylprednisolone can be highly effective, but their effects are not limited to the part of the body being treated.

For some people, corticosteroids can also affect sleep, mood, behavior, and other aspects of mental health.

A person who starts a corticosteroid may suddenly find themselves sleeping much less, feeling unusually restless, becoming irritable, or experiencing changes in mood that seem difficult to explain. Because the medication is being used to treat a physical condition, these changes may not immediately be recognized as a possible adverse effect.

How Can Corticosteroids Affect Mental Health?

Corticosteroids have a structure very similar to cortisol, a hormone naturally produced by the adrenal glands that plays an important role in the body's response to stress. Like cortisol, corticosteroids act on glucocorticoid receptors, which are found throughout the brain and play a role in mood, cognition, sleep, and emotional regulation.

The psychiatric effects of corticosteroids can vary considerably. While some people experience relatively mild changes, others develop more pronounced symptoms.

Possible effects include:

• Insomnia or reduced need for sleep.
• Anxiety, agitation, or restlessness.
• Irritability.
• Rapid mood changes.
• Euphoria or elevated mood.
• Difficulty concentrating.
• Depressed mood.
• Confusion.
• Hallucinations or other psychotic symptoms.

These reactions do not mean that everyone who takes a corticosteroid will experience psychiatric side effects. In fact, many people take these medications without developing significant changes in mood or behavior.

Why Can Steroids Cause Insomnia?

Sleep disturbance is one of the effects that can become noticeable soon after starting corticosteroid treatment, especially with higher doses.

Corticosteroids can affect the body's stress-response system and circadian rhythms, which may contribute to sleep disruption. Depending on the medication and dosing schedule, they may produce a feeling of increased alertness or activation at a time when the body would normally be preparing for sleep.

For someone who is already vulnerable to insomnia, even a relatively short period of disrupted sleep can have consequences beyond feeling tired the next day, since sleep deprivation can increase irritability, emotional reactivity, difficulty concentrating, and anxiety.

This can create a cycle in which the medication contributes to poor sleep, and poor sleep then makes other psychological symptoms more noticeable.

Can Steroids Cause Anxiety or Mood Changes?

They can.

Anxiety, agitation, and restlessness have also been reported, although psychiatric responses to corticosteroids vary considerably between individuals. Some people may experience a noticeable elevation in mood, euphoria, or symptoms of mania.

Mood changes can also move in the opposite direction. Depression has been reported as part of the spectrum of corticosteroid-related psychiatric effects.

A person may feel that their personality or emotional state has suddenly changed, without realizing that the medication could be contributing to what they are experiencing.

But it is also important not to assume that every emotional change occurring during corticosteroid treatment is caused by the drug. The underlying illness, pain, hospitalization, uncertainty about one's health, other medications, and disrupted routines can all affect mental health.

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Sometimes several of these factors are present at the same time.

Does a Higher Dose Mean a Higher Risk?

The likelihood of psychiatric adverse effects appears to increase with higher doses of systemic corticosteroids, but dose is not the only factor involved. The type of corticosteroid, duration of treatment, underlying medical condition, previous psychiatric history, and other medications may all be relevant.

Importantly, a person does not need to have a history of mental illness to experience a psychiatric reaction to a corticosteroid.

When Should You Seek Medical Help?

A new and significant change in mood, behavior, sleep, or thinking after starting a corticosteroid is worth discussing with the prescribing clinician. More severe symptoms deserve prompt medical attention, particularly marked agitation, severe confusion, extreme changes in behavior, hallucinations, delusions, or symptoms of mania.

When discussing these symptoms with a healthcare professional, it is important to mention when they began and when corticosteroid treatment was started or changed. If a person begins experiencing unusual psychological symptoms shortly after starting or increasing a corticosteroid, the medication should be considered as one possible contributor.

However, corticosteroids should not be stopped abruptly without medical guidance. After prolonged treatment, in particular, the body may need time to resume normal cortisol production, and sudden withdrawal can cause serious problems.

Instead, the appropriate response may involve adjusting the dose, changing the timing of administration, switching treatments, or treating the psychiatric symptoms themselves. The decision depends on the medical condition being treated and the individual's circumstances.