Steroids Linked To Changes In Gray And White Matter In The Brain

Summary: Corticosteroids are among the most commonly used drugs. They are used to manage various health conditions, from pain, inflammation, allergies, and autoimmune disorders. However, their prolonged use is also associated with many side effects, including a higher risk of mood swings, depression, reduced cognition, and more. A new study comparing MRI brain scans of steroid users with non-users found that these effects on mental health are due to structural changes in the brain that occur due to prolonged use of steroids.

Steroids are among the most commonly used drugs to manage pain and inflammation. They are among the most common medications for allergies and autoimmune diseases. Quite often, people have to use steroids continually for years to keep their disease condition in control. Here, of course, we are talking about corticosteroids, not androgens, which are performance-enhancing drugs. The human body has many different steroidal hormones with various functions. Sex hormones are not the only steroids. Corticosteroids are very close to the hormones secreted by the adrenal gland in their structures.

Corticosteroids are the drugs of choice for managing severe asthma, autoimmune disorders, and even chronic pain. Doctors may prescribe these drugs for either inhalation or oral intake. Though these drugs are relatively safe when inhaled, on prolonged use, inhaled and oral drugs have similar side effects. Some of the common side effects of corticosteroids are increased infection risk, water retention, high blood pressure, mood swings, behavioral changes, stomach upset, weight gain, and more. Doctors have long known these side effects. Nonetheless, they have to prescribe these medications for many disease conditions, as there are no other options. Online addiction counseling is also a helpful treatment option for those who suffer from addiction, including opioid dependence. Combining corticosteroids with online addiction counseling may help to manage chronic pain and opioid dependence more effectively.

For example, inhaled corticosteroids are the most effective treatment for many asthma patients. Similarly, doctors may require using corticosteroids to manage chronic inflammatory conditions. Though doctors have long known that corticosteroids cause mood swings and symptoms like anxiety, depression, mania, and other mental health issues, but they do not know the cause of these side effects. They are unsure if these side effects are due to some metabolic changes, hormonal changes, altered levels of neurotransmitters, or something else. Now, study shows that these mental health issues probably arise due to structural brain changes caused by prolonged corticosteroid use.

In the new study, researchers used a UK biobank that contains data from more than half a million adults aged 40 to 69 years. For their study, researchers analyzed the MRI brain scans of 222 people using systemic steroids and another 557 using inhaled steroids. In addition, they compared their brain scans with 24,106 non-steroid users.

The study found that both inhaled and systemic steroid use was associated with structural brain changes like reduced white and gray matter in the brain. It means that neuronal connectivity is compromised by prolonged steroid use. The study found that white matter structures were especially less intact in long-term steroid users. Needless to say, researchers also found that such brain damage was more prominent in oral steroids users compared to inhaled steroids users. 

Additionally, the study found systemic steroid use resulted in larger caudate, whereas inhaled steroids caused a smaller amygdala. Both these structures play important roles in cognition and emotional processing. These structural changes in the brain of systemic steroid users were also associated with more severe signs of depression, fatigue, restlessness, and apathy. 

It is among the first studies to show that prolonged corticosteroids cause structural changes in the brain, which results in neuropsychiatric side effects. Moreover, the study found that such side effects are common with oral and inhaled corticosteroids. Corticosteroids are widely used drugs and are regarded as irreplaceable in many disease conditions. Thus, researchers say that this study shows an urgent need to find safer alternatives to synthetic corticosteroids.

Gurpreet Singh Padda, MD, MBA, MHP

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