Nasereddin Lara, Alnajjar Omar, Bashar Homam, Abuarab Sara Feras, Al-Adwan Rahma, Chellappan Dinesh Kumar, Barakat Muna
Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan.
MEU Research Unit, Middle East University, Amman 11831, Jordan.
Diseases. 2024 Nov 23;12(12):300. doi: 10.3390/diseases12120300.
Corticosteroids are extensively used in medicine for their powerful anti-inflammatory and immunosuppressive effects. However, their psychiatric side effects-such as mood disturbances, anxiety, and psychosis-are significant yet often underappreciated. This review provides a comprehensive exploration of corticosteroid-induced psychiatric disorders, with a focus on their underlying mechanisms and clinical implications. We examine how corticosteroids influence the hypothalamic-pituitary-adrenal (HPA) axis, leading to the dysregulation of stress responses and alterations in neurotransmitter levels, particularly dopamine, serotonin, and glutamate. These changes are linked to structural abnormalities in key brain areas such as the hippocampus and amygdala, which are implicated in mood and anxiety disorders, psychosis, and conditions like post-traumatic stress disorder (PTSD) and eating disorders. This review highlights the need for healthcare providers to be vigilant in recognizing and managing corticosteroid-induced psychiatric symptoms, especially in vulnerable populations with pre-existing mental health conditions. The complex relationship between corticosteroid type, dose, duration, and mental health outcomes is explored, emphasizing the importance of personalized treatment approaches to mitigate psychiatric risks. Given the widespread use of corticosteroids, there is an urgent need for more focused research on their psychiatric side effects. This review underscores the importance of patient education and careful monitoring to ensure optimal therapeutic outcomes while minimizing mental health risks associated with corticosteroid therapy.
皮质类固醇因其强大的抗炎和免疫抑制作用而在医学中被广泛使用。然而，它们的精神副作用，如情绪障碍、焦虑和精神病，虽很显著却常常未得到充分重视。本综述全面探讨了皮质类固醇诱发的精神障碍，重点关注其潜在机制和临床意义。我们研究了皮质类固醇如何影响下丘脑 - 垂体 - 肾上腺（HPA）轴，导致应激反应失调以及神经递质水平改变，特别是多巴胺、血清素和谷氨酸。这些变化与关键脑区如海马体和杏仁核的结构异常有关，而这些脑区与情绪和焦虑障碍、精神病以及创伤后应激障碍（PTSD）和饮食失调等情况有关。本综述强调医疗保健提供者需要警惕识别和管理皮质类固醇诱发的精神症状，尤其是在已有心理健康问题的脆弱人群中。探讨了皮质类固醇类型、剂量、持续时间与心理健康结果之间的复杂关系，强调个性化治疗方法对于减轻精神风险的重要性。鉴于皮质类固醇的广泛使用，迫切需要对其精神副作用进行更有针对性的研究。本综述强调了患者教育和仔细监测的重要性，以确保获得最佳治疗效果，同时将与皮质类固醇治疗相关的心理健康风险降至最低。
