What happens to the brain with prescription steroids?

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Long-term use of prescription steroids has a negative impact on white matter, a new study has found. Image credit: Maciej Frolow/Getty Images.
  • Glucocorticoids – commonly known as prescription steroids – are a type of medication used to treat a variety of conditions that also have known potential side effects.
  • Researchers at Leiden University Medical Center have found that prescribed steroids cause structural and volume changes in the white and gray matter of the brain.
  • Scientists believe these findings may help explain some of the psychiatric side effects of prescribed steroids, although more research is needed.

Glucocorticoids – also known as corticosteroids or simply steroids – are a class of drugs prescribed for a variety of different diseases and conditions. These are different from anabolic steroids which can be used to increase muscle mass.

As for, prescription steroids can sometimes have serious side effects, including neurological issues, such as mood swings and cognitive issues.

Now, a team of scientists from Leiden University Medical Center in the Netherlands have found evidence to suggest that the use of prescribed steroids causes structural and volume changes in the white and gray matter of the brain.

This study was recently published in the journal BMJ open.

Doctors mainly prescribe corticosteroids to help reduce inflammation in the body, suppress the body’s immune system, or balance hormone levels

They normally prescribe them as tablets or inhalers, although sometimes people need injections of prescribed steroids. There are also topical corticosteroids in the form of lotions or creams.

A doctor may prescribe steroids for the following conditions:

Using glucocorticoids for a long time increases the risk of developing certain side effects, such as:

According to doctoral researcher Merel van der Meulen, from the Department of Medicine, Division of Endocrinology, Leiden University Medical Center and lead author of this study, Previous search of people with Cushing’s disease, who have very high levels of the body’s glucocorticoid cortisol, shows that long-term exposure to glucocorticoids can affect both brain function and structure.

Correcting cortisol levels can at least partially reverse these changes. But what about people whose steroid levels rise due to other medical needs?

“A few small studies in selected populations have also shown that long-term use of systemic glucocorticoid medications is associated with certain differences in the brain,” van der Meulen said. Medical News Today.

“We wondered if these effects of glucocorticoids on brain structure could also be observed in the large population-based cohort from the UK Biobank, including users of inhaled glucocorticoids,” she added.

The research team looked at data, including questionnaires and MRIs, from 222 systemic glucocorticoid users – that is, they took the prescribed drug by mouth or by injection – and 557 inhaled glucocorticoid users from the UK biobank population recruited between 2006 and 2010.

None of the participants had a history of neurological, psychiatric or hormonal problems. The researchers compared data from glucocorticoid users with data from 24,106 people who were not using steroids.

The researchers found that participants using systemic or inhaled prescribed steroids had less intact white matter structure in the brain than non-steroid users. However, this observation increased in systemic steroid users compared to inhaled steroid users.

white matter occurs deep in the brain and is made up of bundles of nerve cells. It plays a role in neural connections and signaling in the brain.

Scientists further found that participants taking systemic steroids had a greater caudate – part of the brain’s gray matter involved in high-level activities like planning movement execution, learning and memory – compared to non-users.

And participants using inhaled glucocorticoids had smaller tonsils than those not taking prescribed steroids. The tonsil is also part of the gray matter of the brain and is linked to the processing and regulation of emotions.

DTM spoke with Dr. Santosh Kesari, neurologist at Providence Saint John’s Health Center in Santa Monica, California, and regional medical director of the Research Clinical Institute of Providence Southern California about this study.

“I was thrilled to know that someone had done this study that really validates what we’ve known for a long time – that steroids cause brain atrophy and many neuropsychiatric symptoms or side effects,” he said.

“This study showed that steroids have an effect on brain structure,” Dr. Kesari continued. “You lose white matter, which [makes up] connections from one neuron to another. There is also some loss of gray matter, the true neurons, which needs to be investigated [further].”

Dr. Kesari explained that white matter is the conduit of information from one neuron to another:

“When you lose white matter, everything slows down, which means slower response, potentially memory issues, or cognitive issues. And then there [are] also psychiatric problems, so they [people who take prescription steroids] can become restless, depressed, have mood swings, things like that.

Adding to the white matter discussion, van der Meulen said previous research shows that glucocorticoids can have psychiatric side effects, such as depression and anxiety.

“In our observational study, we report associations between glucocorticoids and lower white matter microstructure in the brain,” she continued. “It is possible that these associations are related to psychiatric side effects of glucocorticoids, but further research is needed to confirm this.”

DTM also spoke with Dr. Ilan Danan, sports neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, California.

He cautioned that it is important to note that there is a difference between the prescribed steroids discussed in this study and those taken by athletes.

“Unlike steroids that may be prescribed by doctors, those that athletes will consider will be more for performance enhancement,” he explained. “Those are androgen-like anabolic steroids which do not necessarily apply in this context.

As for the next steps in this research, van der Meulen said there are many unanswered questions that she hopes to address in the future.

“For example, are these effects reversible? she wondered. “How do they depend on the dose and duration of glucocorticoid use and the type of glucocorticoid medication used? And could selective glucocorticoid receptor modulators — a type of drug of the glucocorticoid type which has a more selective effect and therefore potentially [fewer] side effects – prevent these effects from occurring? »

Dr. Dana said he would like to know more details about how long participants used the steroids prescribed and whether systemic glucocorticoid users took the drug orally or by injection.

“These are things that as a doctor [I] would like to know so that I can determine whether or not this has a potential impact on my clientele,” he added.

And Dr Kesari said that although this study documents brain atrophy, more research is needed to understand how it happens.

“We need to do more basic science research to understand the mechanisms of how steroids cause this brain damage and then how we can mitigate it with other drugs or repair mechanisms in the future, whether it’s stem cells or growth factors that can stimulate stem cells,” he said.

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