“A patient who already has PTSD is going to have a more sensitive nervous system that will be more reactive to the addition of an exogenous stressor such as steroids, creating a medication-based trigger.”
Steroids can lead to a range of physical and mental health side effects, making it essential to recognize and address these impacts. Dr Kurtis Kaminishi, a geriatric psychiatrist at a leading academic medical center in San Francisco, shares his insights on the mental health challenges associated with steroids, with a focus on resilience, recovery, and the importance of patient support.
Dr Kaminishi’s interest in psychiatry started as early as age 7 after watching a television show featuring a “doctor for the mind.” He studied for his medical doctorate at Poznan University of Medical Sciences in Poland and gained his General Psychiatry specialization at the University of Southern California.
Instead of immediately entering residency, he decided to enroll in the Hult International MBA program with campuses in Dubai, Shanghai, and Boston. This allowed him to gain international exposure and experience and develop a keen interest in health economics and the impact of various demographic trends and global healthcare models.
After completing his General Psychiatry specialization in Southern California, Dr Kaminishi’s growing interest in healthcare economics and the "silver tsunami" of the aging baby boomer population led him to subspecialize in geriatric psychiatry, in which he completed a fellowship at the University of California San Francisco.
“The patients I tend to see are primarily admitted for medical reasons and also need a psychiatric consultation for any behavioral, cognitive, or mood changes that are affecting their hospitalization.
Steroid therapy essentially mimics the body’s natural stress hormone, cortisol. Still, this external dosing can disrupt the body’s own hormone balance, exacerbating existing mental health issues and potentially causing new ones.
A patient that already has PTSD is going to have a more sensitive nervous system that will be more reactive to the addition of an exogenous stressor such as steroids, creating a medication-based trigger.”
He points out that these changes, particularly with long-term use, can trigger anxiety, depression, confusion, irritability, and sleep disturbances. In hospital settings, he has observed severe cases where steroids contribute to conditions such as delirium, agitation, and profound sleep loss, which further impact the patient’s overall health.
“Inpatient environments often amplify stress responses due to sensory overload and the loss of familiar surroundings, which, combined with steroid effects, can complicate recovery.”
Dr Kaminishi emphasizes the importance of patients and caregivers remaining vigilant about early mental health symptoms.
“Common issues that may indicate steroid-toxicity include restlessness, insomnia, mood swings, irritability, and forgetfulness. Persistent symptoms can impair a patient’s quality of life and make it harder for healthcare teams to identify steroid-related causes.
We often rely on patterns of when symptoms emerge to help identify if symptoms are due to the disease being treated, a steroid-toxicity, or another cause entirely - if it is shortly after starting steroids or after a dose increase, they’re often linked to the medication.”
While acknowledging the critical role steroids play in treating inflammation and immune disorders, Dr Kaminishi advocates for a balanced approach to mitigate their impact.
“Mindful and wellness practices make a significant difference, with exercise, hydration, good sleep hygiene, limiting alcohol, and attending medical checkups all being particularly important.”
Dr Kaminishi stresses that many patients feel isolated, especially when managing side effects alongside a new diagnosis. He encourages patients to reach out to support groups for their condition.
“Patients often find strength in community and learn valuable tips for coping. This peer support can help reduce isolation, alleviate anxiety and foster a network for sharing practical advice and emotional support.”
By focusing on resilience practices, regular monitoring, and community support, patients can better navigate the complex side effects of steroid exposure. Dr Kaminishi’s insights underscore the importance of a proactive, compassionate approach to managing mental health alongside medical treatment, ensuring that patients have the tools to thrive through challenging therapies.