A common pill prescribed to millions of Americans annually could lead to crippling depression, anxiety and mood swings, experts warn.
About 18 million prescriptions are filled every year for prednisone, a corticosteroid used to treat everything from migraines to Crohn’s disease to allergic reactions.
Corticosteroids are meant to reduce inflammation by mimicking the effects of the ‘stress hormone’ cortisol and suppressing immune system reactions.
While most people take them for a few days at a time, those with chronic conditions may spend months or even years at a time on them.
But taking corticosteroids like prednisone for long periods of time may deplete the brain of mood-boosting hormones, leading to depression, anxiety and even mania.
Hilary Hodge, a disability advocate living in France who takes steroids on and off for chronic illnesses, told the Daily Mail she’s normally ‘a very mellow and gentle person.’
‘So I am surprised when the steroids make me crankier than I used to be,’ she said.
Emily Mendez, from Indiana, said she started experiencing mania symptoms within days of receiving a steroid injection of Kenalog (triamcinolone) for shoulder pain. Now she’s forced to only use the drug as a ‘last resort’.
Emily Mendez (pictured), former psychotherapist in Indiana, said a steroid injection gave her symptoms of ‘mania’ within days
‘When taken at high doses or for extended periods, corticosteroids can interfere with the balance of certain brain chemicals, potentially leading to an increased likelihood of symptoms of depression, anxiety, mood swings, irritability or even mania or psychosis,’ Dr Jeffrey Ditzell, lead psychiatrist at Dr Ditzell Psychiatry in New York City, told the Daily Mail.
Corticosteroids reduce inflammation and pain throughout the body by mimicking the effects of cortisol, a ‘stress hormone’ released by the adrenal glands to regulate inflammation, by binding to glucocorticoid receptors in cells.
They also suppress the immune system, which triggers inflammation.
These are different from anabolic steroids – synthetic forms of testosterone often used as performance-enhancing drugs by athletes – and generally treat autoimmune conditions, allergic reactions and inflammation.
The most commonly prescribed corticosteroid in the US is prednisone.
‘As a pharmacist, I see these medications used for anything from a sore throat to a skin rash to asthma to an unknown condition that involves the immune system,’ Dr Erika Gray, pharmacist and founder and chief medical officer at ToolBox Genomics, told the Daily Mail.
Corticosteroids usually come as pills but can also be taken as injections, via ear and eye ingestion or as intravenous infusions.
Prednisone in particular is thought to disrupt the hypothalamic-pituitary-adrenal (HPA) axis, which coordinates the hypothalamus, pituitary gland and adrenal glands, all of which regulate the body’s stress response.
This dysregulation can send stress hormones like cortisol into overdrive, contributing to mood swings and symptoms of depression.
‘Long term corticosteroid use can also cause the memory section of our brain to decrease in size which can negatively affect our memory and mood,’ Dr Gray said.
‘A great way to think about the effect of corticosteroids on the brain is this medication makes your brain feel it is under constant stress.’
The most commonly prescribed corticosteroid in the US is prednisone with about 18 million prescriptions per year (stock image)
Mendez, a former psychotherapist and mental health author, was given an injection of the corticosteroid Kenalog, a brand name for triamcinolone, in 2023 for shoulder pain.
‘Within a day of getting this steroid injection, I started to experience hypomanic symptoms. I had been stable previously,’ Mendez, who has bipolar disorder, told the Daily Mail.
‘I called my psychiatrist, who increased my medication dose for bipolar disorder. Despite this, I developed severe mania and was hospitalized shortly after. The onset of hypomania/mania coincided with the steroid injection.’
Doctors at the hospital told Mendez the steroid injection likely triggered the hypomania, a less severe form of mania that causes extreme mood and energy changes.
‘Because of this, and the fact that I live with bipolar, steroids will be a last resort for me in the future,’ she said.
A TikTok user, Amanda Powell, said prednisone made her feel like she was ‘losing’ her mind.
‘I saw therapist after psychiatrist over and over and over again and nothing was going right. They prescribed me depression and anxiety medication and it just made my mania worse,’ she said in a recent video.
‘The crazy thing is people never associate prednisone with mania.’
In another video posted earlier this year, Powell said, ‘The side effects aren’t worth the journey sometimes.’
Dr Ditzell said prednisone in particular is most commonly associated with depression, irritability and mania at high doses, while its counterpart dexamethasone may increase the risk of sleep disruptions along with mood disorders.
He also said oral corticosteroids are most likely to cause depression and other mood issues. These include prednisone, prednisolone, methylprednisolone and hydrocortisone.
He explained inhaled versions of the drugs have a ‘lower risk of mood effects due to low systemic absorption’ while topical creams have a ‘very low risk of systemic mood side effects unless used over large areas for long periods’.
Dr Gray also said ‘using topical hydrocortisone for long periods of time and over a large part of the body’ could increase the risk of systemic absorption.
Dr Ditzell believes the risk of depression is highest with bigger doses – over 40 milligrams per day – over longer periods of time.
Hilary Hodge (pictured) told the Daily Mail while she is normally ‘mellow’, steroids make her moods drastically shift
Women and older patients may also be at a greater risk due to having more hormone fluctuations and general sensitivity to medications.
‘The risk of depression and mood changes can be managed and, in some cases, lowered or prevented with using the lowest effective dose of the medication for the shortest duration of time,’ he said.
‘The use of local instead of systemic steroids when possible is recommended. For example, for asthma, allergies or eczema, inhaled, nasal or topical steroids are often safer than oral medications.’
He also suggests tapering the dose slowly, which means gradually decreasing it over time before stopping. This helps minimize any effects from sudden dosage changes.
Dr Gray also advised against quitting cold turkey.
‘Never stop corticosteroids medication suddenly or without your prescribers help. These medications need to be slowly decreased over time.’
Experts urged those taking corticosteroids to keep a close eye on potential side effects and seek medical attention immediately if they notice drastic changes in mood.
‘While taking corticosteroids, it is important to take immediate action if you experience suicidal thoughts or urges, if you feel out of control, or experience intense agitation or paranoia. Call a crisis line, reach out to a mental health professional, or go to the ER,’ Dr Ditzell said.
‘These symptoms are rare, but serious.’
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