Psychological Effects of Steroids - Article Example

Psychological Effects of Steroids In order to understand the psychological effects of steroids, it is important to have a clear understanding of what is classified as a steroid and some facts about the use and abuse of steroids. Steroids are forms of natural and artificial testosterone, and were originally prescription drugs regulated by the Food and Drug Authority. In the 1990s Anabolic steroids were classified in the United States as controlled substances policed by the Drug Enforcement Administration. A similar move was made in the United Kingdom in 1996. Anabolic steroids were then deemed addictive drugs (Keane, 2005). Androgenic-anabolic steroids (AAS) are synthetic derivatives of the male hormone testosterone which are known to exert strong effects on the human body that may be beneficial for athletic performance. They have therefore become popular amongst athletes. Since the majority of steroid users are involved in sports, the majority of research and exploration of the effects of steroids is related to the influence in sports and done with athletes. Steroid use is also connected to the use of alcohol, tobacco and other ‘mood-altering’ drugs. Thus its effects may not be separable from the use of these drugs. The significance of the problem and the need for research into its effects is reflected in the increasing use of steroids. “In 1987 it was estimated that one million Americans were using anabolic steroids to improve their physique. Since then, several surveys have confirmed the spread of use of these drugs among young people. In one 1988 survey of 3403 male high school students from across the USA the rate of current or previous anabolic steroid use was nearly 7% . In another, over a thousand male students in three American colleges were surveyed, and 2% reported anabolic steroid use. In a third survey of over a thousand high school students conducted the following year, 3% of students (5.0% of males, 1.4% of females) reported anabolic steroid use” (Williamson, 1994). Increasing use has also been reported in the United Kingdom. Pope and Katz (1988) did early research to investigate the psychological effects of steroids. They indicate that although many studies were done on the adverse medical effects of steroids, only few studies were done up to that time on the psychiatric effects. At the time they found only three such reports apart from their own work. One was of a 17-year old body-builder who developed depression, paranoid ideation, and audible thoughts six months after starting the use of anabolic steroids. Another case was of a 27-year old body-builder who developed euphoria, irritability, racing thoughts and hyperactivity within only a few days of taking steroids. In the third report four of five depressed men reported paranoid thoughts within a few days. In their own work the authors had a patient, a 40 –year old, who noted several psychological effects after two weeks of being on steroids. These symptoms included severe depression, sleep disorder, feelings of guilt and hallucinations. Another patient who was only 22 years old started taking steroids to assist in his body building. He soon noticed symptoms of increased irritability, difficulty sleeping and confusion. In order to further investigate these effects and increase the evidence for the effects of the steroids, the authors interviewed 41 body builders and football players, including 2 women, who had used the drugs. The participants ranged in age from 17 to 51 years. They agreed to answer a questionnaire. Their results included that five of the subjects reported having psychotic symptoms while exposed to steroids, while there were none of these symptoms at other times when they were not taking the steroids. The symptoms included auditory hallucinations (hearing voices) and paranoid delusions. Four participants reported mild psychotic symptoms such as jealousy of girlfriend. Additionally five participants met the criteria for having manic episodes and eight others narrowly missed the criteria. Examples of the manic behavior included one who impulsively bought a very expensive sports car which he could not pay for when he stopped taking the steroids and. However a year later when he was again on steroids he repeated the behavior and bought another more expensive car. Another subject bought an old car and deliberately drove it into a tree at a high speed while his friend video-taped the action. On attempting to withdraw from the drug one of the effects was depression. Despite these results the authors suggest some reasons why there are not more reports of psychological effects of steroids. Of course it is possible that athletes are unwilling to reveal their steroid use to their physicians and others. This makes it difficult to fully record the effects in experiments. Maybe more accurate results can be obtained by observing the athletes in their natural settings. Another difficulty with such experimentation is that usually those who take steroids also practice what is described as ‘stacking’, where they take a combination of drugs at the same time, oral and inject able, so it is difficult to separate out the effects of the steroids alone. “The severe psychogenic side effects of these high doses include aggressive and violent behavior. Problems with drug withdrawal and drug dependence are also common in users of anabolic steroids and these drugs may also provoke psychiatric disorders” (Corrigan, 1996). Although side effects can occur with all anabolic steroids, since they are psychoactive substances psychological change is not unexpected if they are used for long periods of time. He reports two cases in Sydney which fit the descriptive term steroid rage or what is known commonly as “roid rage”. These were both brutal murders and in both cases the murderers were users of anabolic steroids. One battered his wife to death and then shot himself. The other man met a woman at a night club, took her to a stairwell of a nearby hotel and killed her. He claimed that something snapped in him. Some of the earlier research that Corrigan reported included increased irritability and aggression in a study of the effects of anabolic steroids on both men and women. Another report was of more frequent episodes of anger of greater intensity and duration and a more hostile attitude in steroid users when compared with non-steroid users. The psychological changes are classified from milder to more severe changes- “Early effects are seen as changes in mood and euphoria: there is an increase in confidence, energy and self-esteem, with enhanced motivation and enthusiasm. There is also diminished fatigue, sleeplessness and an ability to train through pain. Libido may be decreased, but is more often increased, sometimes markedly. Irritability, anger, agitation and a "strange edgy feeling" are commonly reported. With larger doses or after taking anabolic steroids for a longer time, there is a loss of inhibition and a lack of judgment, with mood swings or grandiose ideas. Prolonged users become suspicious, quarrelsome, impulsive and more aggressive. Severe effects manifest when these aggressive feelings increase to the extent that violent, hostile, antisocial behavior develops, meriting the descriptive title, well known in the steroid-taking community, of "roid rages". These rages can result in property damage, self-injury (including reckless driving or crashing cars), assaults, marriage break-ups, domestic violence, child abuse, suicide and attempted murder or murder”. (Corrigan, 1996) Apart from the intense rage demonstrated by some steroid users, there are other psychiatric effects reported by Corrigan, including schizophrenia, hypomania and mania, delirium, depression, suicide, and paranoia. As early as 1980 there were reports of acute schizophrenia where a 17-year-old male body builder developed acute schizophrenia when taking methandienone; he recovered on stopping the drug, but relapsed when he took it again. Other studies have also indicated schizophrenia and associated symptoms. In addition to Pope and Katz’s studies, Perry et al (quoted in Corrigan, 1996) studied 20 weight lifters taking anabolic steroids who reported such symptoms as paranoid thoughts, depression and increased hostility and aggression. Studies reported by Williamson (1994) also support the evidence of psychological effects of steroids. In a study by Choi et al.,( 1990, quoted in Williamson, 1994) three anabolic steroid users and three non-user controls were monitored over several months of training incorporating two cycles of drug use. Levels of aggression in the steroid users were higher at all times than in the controls, and also increased significantly during periods of anabolic steroid use. Yates et al.,(1992, quoted by Williamson, 1994) used psychological testing to show higher ratings of aggression in 12 weightlifters who were either currently using anabolic steroids or had used them within the last year, compared to 25 weightlifters who reported no previous anabolic steroid use. Additional reports of paranoid and manic behavior were reported. “ A 32-year-old prison security officer became grandiose and paranoid whilst taking methandrostenolone and shot a shop assistant in the spine leaving her permanently paraplegic, a 23-year-old construction worker who was taking a combination of methandrostenolone, oxymethalone and testosterone in preparation for a body-building contest became irritable and grandiose and violently murdered a hitchhiker, and a 24-yearold teacher taking methandrostenolone, oxandrolone, stanazolol and testosterone broke off his engagement to be married and later set off a homemade explosive device under the car of his fiancée” (Williamson, 1994). According to the researchers of these cases there was no previous history of psychiatric illness and the illnesses were brought on by their use of anabolic steroids. All three men reverted to their ‘normal’ behavior in prison where it is believed that they had no access to steroids, suggesting that when not on steroids the manic behavior disappeared. Additional reports of mental illness associated with steroid use include “A 17-year-old male with no previous psychiatric history developed a schizophrenia- like illness characterized by paranoid ideas and hallucinations six months after commencing regular use of an unknown dose of methandienone (methandrostenolone) obtained on the black-market. The illness subsided after discontinuation of the drug” (Annitto and Layman, 1980 quoted in Williamson, 1994). “A 27-year-old man with a history of mood swings developed symptoms of mania (elation, insomnia, increased energy and pressure of thoughts) a few days after commencing a self-administered course of oxandrolone. His symptoms disappeared with a few days of stopping the drug, only to reappear a week later after recommencing it” (Freinhar and Alvarez, 1985 quoted in Williamson, 1994). “A 20-year, old man who took a 5-week course of an intramuscular anabolic steroid preparation in an attempt to gain a place on an American football team became depressed and irritable, and his behavior became uncharacteristically irrational, finally culminating in an attempt to rob a department store “(Dalby, 1992, quoted in Williamson, 1994). In nearly all the studies the fact that the psychological effects reverted or decreased when the steroid use was stopped adds to the validity of some kind of relationship between the steroid use and the psychotic behavior. Depression has been shown in many cases as one of the effects of steroid use. Though it has been observed mainly as a withdrawal symptom, it can also occur during the use of the steroid. There have been varying results of the occurrence of depression. Brower et al. (1990, quoted in Morris, n.d.) identified the depression as part of the symptoms of withdrawal only. However Pope and Katz (1987, quoted in Morris, n.d.) showed that participants developed depression during withdrawal only when off the drug. Conversely, Perry, Yates, and Andersen (1990, quoted in Morris, n.d.) reported high levels of depression among 20 weightlifters when they were in their competitive cycles and using the drugs. Morris (n.d.) conducted this study to examine the occurrence of depression during the period of steroid use by using both steroid users and non-steroid users. The sample consisted of 8 users and non-users, each group having an equal amount of men and women, all athletes. They all completed a Depression scale, once during the competitive cycle and once when not in the competitive cycle. The results suggested that the athletes using anabolic steroids had higher levels of depression during both use and non-use cycles than the non-users. The author suggests that “ withdrawal may be an intensifying factor, and that depression may either be constant for athletes on steroids independent of cycle or that a complex combination of physiological and social-psychological factors result in different casual sequences in competitive and non-competitive cycles”. He further suggests that “It is possible that steroid use, especially the "stacking" of various drugs, results in violent mood swings. During the non-competitive off-drug cycle, depression may be more likely associated with withdrawal and loss of self-esteem as physical powers diminish”. The use of the Depressive scale allowed the study to show the difference in feelings of the participants when using steroids and when not using. During use the responses are “are rife with inflated, even grandiose ideation during their usage cycles. Diametrically opposite feelings of weariness, lethargy, low self-esteem, insecurities, etc. are reported during their off cycles”. The study showed that the level of depression was higher throughout the study in users than in the non-users, even during the period of non-competitive cycle. The author also mentions the small sample size as a consequence of people not being willing to admit to steroid use and therefore not available for research studies on the effects of these steroids. Pope and Katz (1994,quoted in Corrigan, 1996) also suggested “that steroid users are most vulnerable to major depressive episodes during the first three months after discontinuing anabolic steroid use”. Depression during use or withdrawal from steroids has also been known to lead to suicide. Hartgens and Kuiper (2005) summarized the research on the psychological effects of steroids. One of the first studies was performed by Lindstom et al which showed mood changes and an increased libido by male body-builders when on steroids. Mood disturbance were shown by some researchers, although not confirmed by others. The mood changes associated with steroid use included depression, paranoia, mania and psychotic features. Another psychological condition that has been associated with steroid use is related to body image. Because these steroids are usually used primarily to increase body size, most users are dissatisfied with their bodies and have low self-esteem. This sometimes leads to what is called ‘reverse anorexia syndrome’. These athletes believe their bodies to be too small and disproportionate and they are therefore obsessed or preoccupied with their bodies. They are described as having a narcisstic personality, or an ‘Adonis complex’. It is not uncommon for steroid users to become addicted to the use and so resulting in addictive behavior in them, including a perception of self as not strong or big enough and leading to long-term use of the steroids. Most of the research on steroids has been done on men. Gruber and Pope (2000, quoted in Hartgens and Kuiper, 2005) studied the effects of steroids on women athletes. The researchers observed a number of mental abnormalities among the steroid users, including polysubstance dependence, hypomanic symptoms, depressive symptoms during withdrawal, rigid dietary practices, non-traditional sex roles and chronic dissatisfaction and preoccupation with their physiques. The authors summarize the psychological effects of steroid “AAS may exert profound effects on mental state and behavior, although only a small number may be affected. Increased aggression and hostility seem the most prominent alterations observed, although this condition may become serious in only a limited number of users. Mood disturbances may occur, the extent of which is dose dependent. AAS users often expose a narcissistic personality and are often dissatisfied with their own body” (Hartgens and Huiper, 2005). There is some debate about the reliability of these results. Though there are far more studies showing psychological effects of steroids, these studies have been scrutinized for different reasons. One of the major limitations would be obtaining a sample. Since steroids are illegal in most parts of the world, it is not easy to get participants to come forward and admit to taking steroids in order to take part in a study. Therefore much of the data have been obtained from either non-empirical (anecdotal/single case study) or quasi-empirical methods. In addition even the participants who agree to a study may not be willing to reveal the extent of their steroid use and therefore most laboratory studies do not investigate the actual doses of AAS currently abused in the field. Therefore, those studies may not reflect the actual (adverse) effects of steroids. It is also difficult to monitor the effect of the steroid when it is complicated by other factors such as the use of other chemicals, or ‘stacking’. For example, although many studies suggest a link between anabolic steroid use and aggressive behavior, a causal relationship has not yet been clearly established. Williamson 91994) suggests that “it may be that people who are potentially more aggressive would be more likely to use anabolic steroids. Alternatively, anabolic steroid users may take the drugs with an expectation that they will cause aggression, seeing this as desirable for competition or training Another limitation of such research is being able to set up a study with a control group. Setting up placebo-controlled trials with one group being given the steroid and one group given a placebo with neither group knowing which they were given, although needed to get conclusive results, is not ethical. Additionally, intentionally giving participants the large doses of steroids that will be required to confirm results is also dangerous. Dimeft and Malone (quoted in Corrigan, 1994) take a different view of the anabolic steroid complications and conclude from their study that anabolic steroid use may not always lead to psychiatric disorder, but may predispose a person to it. In at least one study reported (Bahrke et at., 1990. Quoted in Williamson, 1994), a comparison of 30 male current anabolic steroid users, 23 previous users and 40 nonusers failed to demonstrate any significant difference between the three groups with regard to aggression/hostility. Research must definitely continue in the use of steroids; however the challenges may slow down the progress. References. Corrigan, B. (1996). Anabolic steroids and the mind. Medical Journal of Australia, 165(19), 222–6. Hartgens, F. and Kuipers, H. (2004) Effects of androgenic-anabolic steroids in athletes. Sports Medicine 34(8):513-554 Keane, H. (2005) Diagnosing the male steroid user: drug use, body image and disordered masculinity Health. Vol. 9 (2): 189-208, Morris, R (n.d.). The Effects of Steroid use on Depression among Athletes. Vital Quest, Retrieved 10/15/2008, from http://www.vitalquests.org/publication2steroiduse.html Pope, H.G. and Katz, D.L. (1988). Affective and psychotic symptoms associated with anabolic steroid use. American Journal of Psychiatry. 148:487-490 Williamson, D. (1994). The psychological effects of anabolic steroids. International Journal of Drug Policy, 5(1), 18–22. Read More