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Corticosteroid- and Anabolic Steroid—Induced Mental Status Disturbances

Corticosteroids and anabolic steroids can induce remarkably similar presentations in the mental status changes that they precipitate. Most individuals demonstrate affect and mood changes consistent with patients diagnosed with either bipolar or unipolar affective disorder. In addition, affective changes can be accompanied by delusions in the minority of subjects. Presentation of the drug-induced disorder is dose dependent. Patients experiencing corticosteroid-induced mental status changes are commonly ingesting the equivalent of approximately 60 mg/d of prednisone orally with the symptoms appearing in most patients within a week of starting the drug. In addition, women are more likely to experience these mental status changes. Subjects abusing anabolic steroids generally do not exhibit any mental status changes until a dose equivalent to intramuscular testosterone 600 mg/wk has been reached. Unlike corticosteroids, high-dose exposure of anabolic steroids is accompanied by increased aggressive behavior that is problematic from not only a medical but also a legal standpoint.