Psychiatric side affects of anabolic steroids

Multiple studies have related anabolic androgenic steroids (AAS) with psychiatric disorders, but some other studies have found that subjects with psychological and psychiatric disorders are more prone to use AAS, that way it becomes difficult to know which one is the cause.

The most frequent psychiatric side effects are mood disorders and dependence, shown in the next table extracted from a 2008 article we can see them listed. [1]:

Subsequently a 2010 study includes the result of a large survey in AAS users, reporting the following psychiatric adverse effects [2]:

We will now briefly review the most important ones:

Mood disorders

By far, the most common psychiatric adverse effects are mood disorders, including aggressive behavior, depression, irritability and mood lability.

A self-report survey study reported “23% of respondents reported major mood syndromes—12% with psychotic symptoms and 8% with drug dependence.” [3]

This is of course related to the in-cycle and off-cycle hormone level changes in users and will be directly related to the dose, potency and predisposition of the user.

Another interesting study published in 2006, studied two pair of twins (one of the twins being an AAS user, and the other one not) and found high levels of aggressiveness, hostility, anxiety and paranoid ideation in the twins who used AS. The non-user twins showed no deviation from their initial status. [4]

Suicide Risk

A study published in 1999 analyzing eight cases of suicide attempts in AAS users, found that most of the patients were already depressed and the cessation of AAS use (end of a cycle probably) could have triggered the suicide attempt. [5]

Specific disorders

Some disorders have been described exclusively in AAS users, an eating disorder variant called ‘eating disorder, bodybuilder type’ and a dissatisfaction with the physical appearance termed muscle dysmorphia (both of which described for the first time in women) [6]

Criminality

A study published in 2006 reviewing criminal records of individuals that tested positive for AAS use and comparing them with non-AAS users, showed that various types of criminality might be related to steroid use, mostly because of “impulsive behavior” caused by these hormones, but of course this will be most important in users with prior tendency for criminality. [7]

And to end this article, after mentioning the most extreme of the psychiatric side effects, the criminality, we cannot avoid mentioning the famous case of Chris Benoit a famous wrestler and AAS user that killed his son and wife before committing suicide, an act, that probably not directly related to the AAS use, but could have contributed to it (yet this is probably the most extreme case ever reported). [8]

Bibliography

1- Drug Alcohol Depend. 2008 Nov 1;98(1-2):1-12. doi: 10.1016/j.drugalcdep.2008.05.004. Epub 2008 Jul 2. Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern?. Kanayama G, Hudson JI, Pope HG Jr.
(http://www.sciencedirect.com/science/article/pii/S0376871608001919 )
2- Regul Toxicol Pharmacol. 2010 Jun;57(1):117-23. doi: 10.1016/j.yrtph.2010.02.001. Epub 2010 Feb 12. Adverse health effects of anabolic-androgenic steroids. van Amsterdam J, Opperhuizen A, Hartgens F.
(http://www.sciencedirect.com/science/article/pii/S027323001000019X )
3- Arch Gen Psychiatry. 1994 May;51(5):375-82. Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes. Pope HG Jr, Katz DL.
( http://archpsyc.jamanetwork.com/article.aspx?articleid=496600 )
4- Eur Psychiatry. 2006 Dec;21(8):563-9. Epub 2006 Mar 10. Psychiatric and hostility factors related to use of anabolic steroids in monozygotic twins. Pagonis TA, Angelopoulos NV, Koukoulis GN, Hadjichristodoulou CS, Toli PN.
(http://www.sciencedirect.com/science/article/pii/S0924933805002117 )
5- Ann Clin Psychiatry. 1999 Dec;11(4):223-31, Anabolic androgenic steroids and suicide. Thiblin I, Runeson B, Rajs J.
( http://www.ncbi.nlm.nih.gov/pubmed/10596737 )
6- Psychother Psychosom. 2000;69(1):19-26. Psychiatric and medical effects of anabolic-androgenic steroid use in women. Gruber AJ, Pope HG Jr.
( http://www.karger.com/Article/Abstract/12362 )
7- Arch Gen Psychiatry. 2006 Nov;63(11):1274-9. Criminality among individuals testing positive for the presence of anabolic androgenic steroids. Klötz F, Garle M, Granath F, Thiblin I.
(http://archpsyc.jamanetwork.com/article.aspx?articleid=668226 )
8- Wrestler Killed Wife and Son, Then Himself. New York Times.
( http://www.nytimes.com/2007/06/27/us/27wrestler.html?_r=0 )