the silent side-effect: androgenic-anabolic steroid use and mood disorders

take a step back for a moment and consider the effect of performance enhancing drugs on an athlete. likely, you have conjured up images of super-human performances on the field; batters hitting further, sprinters running faster, or cyclists pedaling harder. this is certainly the ‘glamorous’ side to the use of these drugs, but what we don’t often consider is the negative health consequences associated with taking peds. more specifically, we give almost no consideration to the mental health concerns associated with the acute and chronic use of anabolic-androgenic steroids (aas).

in a recent study by piacentino et. al (2015) the researchers completed a systematic review of the literature, in which the link between anabolic-androgenic steroid use was linked to psychopathology in athletes. i highly recommend spending some time with the entire article, as many of the findings will not be discussed here. it is important to note as well, as the authors of this article do, that aas are extremely difficult to study, due primarily to their illicit nature, so although this review is comprehensive and exhaustive, it may not represent the true psychiatric danger of aas use.

one of the most dangerous aspects of aas abuse is substance addiction. when this is layered on top of the obsessive and addictive characteristics already displayed by top level athletes, this is indeed a worrying situation. the authors of this systematic review indicated that aas abusers had a high likelihood of developing dependance (withdrawal symptoms following cessation of administration), with one study putting the number as high as 30% of aas abusing athletes. this dependence, the researchers point out, then leads to an increased tolerance and subsequent increases in dosages, sometimes resulting in dosages that are 10-100x greater than “legitimate medical practice” - supra-physiological dosages that can result in major health concerns.

specific to mood disorders, animal models have demonstrated that aas use can cause changes in brain morphology, to a state consistent with major depression disorder. investigations in humans have revealed a relatively high percentage (23%) of aas users reported mood disorders, ranging from major depressive disorder to type i and ii bipolar disorder. although it is tempting to suggest that those individuals who have a propensity for mood disorders will also be those athletes who abuse aas, the authors are quick to point out that there is an established dose-response between aas and psychopathological symptoms, with one study showing weightlifters expressed more depressive symptoms whilst on aas compared to when they were not. furthermore, a retrospective study by malone et. al (1995) indicated that as many as 10% of weightlifters and bodybuilders experienced depression, even after the cessation of aas use, suggesting chronic mood disruptions with aas use.

many more interesting studies can be found in the review article; again it is must-read for anyone interested in aas use in athletes. we will revisit this systematic review in future posts, and pull out some important and interesting findings that link aas use and suicide, anxiety, eating disorders, psychosis and behavioral disorders.