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Steroids Psychosis on Steroids

Anabolic Androgenic Steroids


An anabolic steroid psychosis is commonly referred to as roid rage. The androgenic effects of testosterone undoubtedly increase agressiveness. Many times this effect turns into uncontrollable rage.

Androgenic steroids or anabolic steroids are derivatives of the male sex hormone, testosterone. Anabolic steroids are believed to be widely used by professional and amateur athletes in all sports. The chief reason for use is to build the body and enhance the exercise endurance. Even though the drugs have been around since the 1940s, there is a lot of mystery surrounding them. There are more myths associated with the use of anabolic steroids than any other class of drugs. The reason is partly because no one knows for sure exactly how good or bad these drugs. While there are many anecdotal reports about these drugs, randomized clinical trials are lacking. Infact, the majority of health care professionals who write about these drugs have no idea about the structure nor have they even prescribed them. All the writings on cyberspace are copied from other articles and the myths are mixed with facts, thus complicating the issue.

In the last decade, there have been a few isolated reports of psychiatric problems after use of anabolic steroids. Recently, there have been a number of well publicized cases of Roid rage. Anabolic steroids do have the potential to cause physical side effects but no one knows what the central nervous system side effects are and how they are related to these drugs.

The question of addiction to steroids is debatable and no real evidence exists for it. Even if the problem exists, many users may not be seeking treatment for fear of harassment from the governmental authorities.

Anabolic steroids have been associated with a range of psychiatric symptoms, although the limited research literature in this area does not yet prove a causal link.

Aggression and violence


Steroid Side Effects

There have been a few studies which have shown that animals administered anabolic steroids for a long time can become aggressive. This type of aggression is common in both males and females. There are some clinical studies in humans which report similar findings.  

Anecdotal reports of aggression have been reported with almost each type of anabolic steroid. In most cases, the aggression has been reported after usage of high doses of steroids. Besides aggression, other central nervous system symptoms include extreme irritability, wide mood swings (depression to anxiety), both verbal and physical violence and paranoia. In most cases, the paranoia has been persecutory and all individuals become hypervigilant. Hostility towards colleagues, family members and friends has been widely reported among users of anabolic steroids.

In all cases, it has been shown that when the steroid drugs are discontinued the aggression and volatile behavior stops. The most disturbing side effects of high dose anabolic steroids usage has been Roid Rage. This extreme violent behavior has often been associated with use of very high levels of anabolic steroids.

It has been observed in clinical studies that many individuals who do take high levels of anabolic steroids undergo cyclical changes in their moods. The depression which can set in can be quite severe. This is usually followed by a manic phase that is often associated with violence and anger- even the slightest thing out of the ordinary leads to explosion of violent out bursts.

Many past users of anabolic steroids admit to such emotions which they say are out of conscious control. Many past users have admitted damaging properties, vehicles, assaulting people randomly and even abusing animals. In many cases this has resulted in the individual being excluded by family and friends. Many spouses or girlfriends have admitted that they felt extremely afraid of their husband/boyfriend when he was taking steroids.

The majority of individual deny such behaviors changes prior to the use of steroids. There is recent evidence that individuals who abuse anabolic steroids have 3-4 times the incidence of violent behaviors compared to the average population.



Psychosis has been reported in at least 5-20% of individuals who take anabolic steroids. The higher the dose, the greater the likelihood of psychosis. In all cases, the psychosis subsides when the steroid is discontinued. Most studies have shown that the episodes of psychosis tend to peak during the on-cyclic phase. Individuals who have a predisposition personality are more likely to develop these psychotic episodes.


Psychosis presents in varied ways in individuals who take anabolic steroids. In some cases, the individual develops paranoia and feels that the whole world is conspiring against him. Others develop grandiose perceptions of invincibility. Often the psychotic episode is associated with intense mania. When the steroid is discontinued, the symptoms of psychosis gradually disappear although some degree of paranoia persists for years. In many cases, individuals have required anti –psychotic medications to treat the paranoia.

Changes in personality

Most of these studies have been done retrospectively and so there is always a certain degree of bias based on memory lapses. In any cases, most individuals indicate that after they took anabolic steroids, they noticed a change in their personality. This change was also observed by family and friends.Bodybuilding Athlete


There is some work that reveals that body builders who do take anabolic steroids develop a personality disorder with negative attributes. Over time family members have claimed that these individuals became paranoid, schizoid, anti social, borderline, narcissistic and histrionic. Of these personalities, the most dominant change has been the evolution of anti-social and borderline personality.

Mood and anxiety disorders

Other mood disorders which have been known to occur in users of anabolic steroids are affective and anxiety episodes. Depression and mania are the two extremes quite common in body builders. Several studies indicate that the incidence of these disorders may be as high as 50%. Some individuals go from severe depression to the other extreme of anxiety, power, invincibility, racing thoughts and recklessness. These episodes are common during the on-cycling phase but the depressive episodes persist during the off-cycling phase. In some individuals these affective disorders do persist for many months and even years after discontinuation of the steroids. In one study, individuals were given testosterone and compared to individuals who took placebo. Individuals who took the anabolic steroid did show a tendency to develop mania of varying degrees.


The topic of dependence to anabolic steroids is not new. There have been countless reports for the past 30 years from athletes who have reported their inability to discontinue these drugs even after their body building career was over. Whenever an attempt was made to discontinue the steroids, many individuals developed withdrawal symptoms. Withdrawal symptoms appear to be more common in individuals who have used anabolic steroids for long periods and at high doses. Some studies indicate that after years of consistent use, nearly 40%-60% of individuals develop a withdrawal reaction when the drugs are stopped. The cravings are so severe that the majority go back to taking the anabolic steroids. Of note is that individuals who do report dependence to steroids are the ones who take extremely high doses of these drugs. Also associated with the dependence has been a high incidence of mood and behaviors changes.

Withdrawal symptoms

Steroid Injection

During the withdrawal phase, the typical symptoms include severe depression, apathy, suicidal ideations, extreme anxiety, racing thoughts, insomnia, decrease libido, numerous somatic complaints and headaches. Most complain of an assortment of body aches and pains.

There is belief that some body builders who stop using anabolic steroids start to see their bodies revert back to normal and they simply are not able to face up to such a body. This feeling compounds the problem and intensifies the appetite for anabolic steroids.

Today, the DSM-3 also a sub classification of disorders related to anabolic steroids and dependence.

Mechanism(s) of dependence

How dependence to anabolic steroids occurs is not fully understood. There are suggestions that there may be an association with certain opioid neurotransmitters or to levels of endogenous sympathomimetic amines. Todate, a few athletes who have developed full blown dependence and withdrawal symptoms have been treated with supportive drug therapy. There is no antidote to steroid drug dependence. When individuals who have developed steroid dependence are weaned of these drugs, they also remain dependent on other prescription medications like xanax and pain killers.Steroid Dependence & Alchol
There is other data that indicate that individuals who abuse anabolic steroids also abuse many other illicit drugs like opioids, cocaine and alcohol. While the number of individuals with multiple addictions is low, there is concern that the abuse of prescription drugs is at an all time high in the same individuals. 



With many reports of Roid rage and deaths in users of anabolic steroids, there is a great awareness among the medical community about these substances. Today, the field of psychiatry has taken a greater interest in these drugs. The potential signs and symptoms are now being recognized more frequently, so that appropriate treatment can be initiated.



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