Can Prednisolone Increase Anxiety? Understanding the Link

October 10, 2025 •

4 min read

Studies show that mild to moderate psychiatric reactions, including anxiety, can occur in about 28% of people who use corticosteroids like prednisolone [1.2.1, 1.2.5]. Yes, it is a documented fact that can prednisolone increase anxiety and cause other mood-related side effects [1.2.1, 1.2.4].

Quick Summary

Prednisolone, a corticosteroid, can cause anxiety by altering stress hormones and brain chemistry [1.2.1]. This effect is more common at higher doses and can also occur during withdrawal. Management involves medical guidance, lifestyle changes, and possibly medication adjustments [1.4.1].

Key Points

Direct Link: Yes, prednisolone, a corticosteroid, is known to cause anxiety as a common side effect by altering stress hormones and brain chemistry [1.2.1, 1.2.4].
Prevalence: Studies indicate that mild to moderate psychiatric reactions like anxiety affect a notable percentage of corticosteroid users, with some reports as high as 28% [1.2.1, 1.2.5].
Mechanism: It mimics the stress hormone cortisol, disrupting the body's natural stress response and altering mood-regulating neurotransmitters like serotonin and dopamine [1.2.1, 1.5.2].
Risk Factors: High doses are the most significant risk factor. Other factors include long-term use, a pre-existing history of anxiety, and female gender [1.2.1, 1.3.2, 1.7.2].
Management is Key: Patients should never stop taking prednisolone abruptly. Management strategies include dose adjustment by a doctor, lifestyle changes, and stress-reduction techniques [1.4.1, 1.4.6].
Withdrawal Anxiety: Anxiety can also be a symptom of prednisolone withdrawal if the medication is stopped too quickly, as the body needs time to resume its natural cortisol production [1.2.1, 1.6.3].
Temporary Effect: For most people, anxiety symptoms caused by prednisolone will subside after the medication is gradually tapered and discontinued [1.4.1].

Understanding Prednisolone and its Function

Prednisolone is a powerful prescription corticosteroid, a synthetic version of the naturally occurring stress hormone cortisol [1.2.1, 1.5.7]. Its primary function is to reduce inflammation and suppress overactive immune responses [1.2.1, 1.5.7]. Doctors prescribe it for a wide range of conditions, including allergic reactions, arthritis, autoimmune diseases, asthma, and inflammatory bowel disease [1.2.2, 1.7.4]. By inhibiting the production of inflammatory substances in the body, prednisolone effectively reduces symptoms like swelling, redness, and pain [1.2.1]. While highly effective, this interference with the body's natural hormone balance can lead to a variety of side effects, including significant psychological changes [1.2.3, 1.7.7].

The Link Between Prednisolone and Anxiety

Anxiety is a common and well-documented side effect of taking prednisolone and other corticosteroids [1.2.1, 1.2.4]. Research indicates that a significant percentage of users experience psychiatric side effects. For instance, some meta-analyses found that 28% of corticosteroid users reported mild to moderate reactions like anxiety [1.2.1]. A 2023 study involving over 3,000 patients on long-term oral corticosteroids found that anxiety was the most commonly reported new mental health disorder [1.2.7, 1.3.6].

Symptoms can range from restlessness and a feeling of being "on edge" to a racing heart, shortness of breath, and even full-blown panic attacks [1.2.2]. These feelings can be distressing, especially for individuals who have never experienced anxiety before [1.2.2].

How Does Prednisolone Cause Anxiety?

The mechanism behind prednisolone-induced anxiety involves its impact on the brain's neurochemistry and stress-response systems [1.2.5, 1.7.7]. Here's a breakdown:

Hormonal Disruption: Prednisolone mimics cortisol, the body's primary stress hormone, which controls the 'fight or flight' response [1.2.1]. Taking this external (exogenous) steroid disrupts the natural balance of the hypothalamic-pituitary-adrenal (HPA) axis, the system that regulates stress [1.7.7]. This can lead to increased heart rate, blood pressure, and alertness, which contribute to feelings of anxiety [1.2.1].
Neurotransmitter Imbalance: Corticosteroids can alter the levels of key mood-regulating neurotransmitters [1.5.2]. They have been shown to modulate dopamine and serotonin pathways and elevate levels of glutamate, an excitatory neurotransmitter. This chemical imbalance can lead to mood swings, emotional instability, and heightened anxiety [1.5.2, 1.7.7].
Brain Structure Changes: Long-term use of corticosteroids has been associated with structural changes in the brain, including atrophy in the hippocampus (involved in memory and depression) and overactivation of the amygdala, which is central to processing fear and anxiety [1.5.6, 1.7.7].

Who is Most at Risk?

While it's not possible to predict exactly who will experience anxiety from prednisolone, certain factors increase the risk [1.2.5]:

Dosage: High doses of prednisolone are the most significant risk factor. The incidence of psychiatric side effects increases dramatically with higher doses; for example, one study noted a jump from 1.3% at doses ≤40 mg/day to 18.4% at doses >80 mg/day [1.3.2, 1.7.2].
Duration of Treatment: People on long-term courses of prednisolone are more likely to experience side effects as the drug has more time to impact hormone levels [1.2.1, 1.2.7].
Pre-existing Conditions: Individuals with a personal or family history of anxiety or other psychiatric disorders may find their symptoms are triggered or worsened by the medication [1.2.1, 1.2.2].
Gender: Some studies suggest that women may be more likely to experience anxiety from corticosteroids than men [1.2.1, 1.3.2, 1.3.4].

Comparison of Mood-Altering Side Effects

Anxiety is just one of several potential mood changes. Patients may experience a spectrum of effects, which can sometimes be contradictory.


Side Effect	Description	Prevalence	Onset/Duration
Anxiety	Feeling restless, on-edge, worried, or panicky; physical symptoms like racing heart [1.2.2].	Common, occurs in a pooled proportion of 8% to 28% of users [1.2.1, 1.3.5].	Can occur soon after starting treatment, especially with high doses [1.7.3].
Euphoria/Hypomania	Feeling unusually energetic, "revved-up," or high; decreased need for sleep [1.2.3, 1.7.6].	Common with short-term, high-dose therapy [1.7.6].	Often an initial reaction to the medication [1.7.1].
Depression	Feeling down, hopeless, fatigued, with a lack of interest in usual activities [1.2.2].	More commonly associated with long-term therapy [1.7.6].	A pooled proportion of 22% of users experience depressive symptoms [1.3.5].
Mood Swings	Rapidly shifting emotions, from sadness to anger to euphoria, often without a clear reason [1.7.4].	Common side effect; can be volatile [1.7.1, 1.7.4].	Can happen at any point during treatment [1.7.1].

Managing Prednisolone-Induced Anxiety

If you are experiencing anxiety while taking prednisolone, it's crucial to communicate with your healthcare provider. Never stop or adjust your dosage without medical guidance, as abrupt discontinuation can cause withdrawal, which may also include anxiety [1.4.1, 1.6.3].

Medical Consultation: A doctor may adjust the dose, change the taper schedule, or in some cases, prescribe an alternative medication for the underlying condition [1.4.1, 1.6.2]. For severe anxiety, a short-term anti-anxiety medication might be recommended [1.4.5].
Lifestyle Adjustments: Simple wellness practices can make a significant difference. Taking the dose in the morning may help reduce sleep disturbances, which can worsen anxiety [1.4.3]. Regular exercise, a balanced diet, and staying hydrated are also beneficial [1.4.3, 1.4.6].
Avoid Triggers: It is recommended to avoid alcohol and caffeine, as they can exacerbate psychiatric symptoms and worsen side effects [1.4.1, 1.4.3].
Stress-Reduction Techniques: Practices like breathwork (e.g., box breathing), meditation, yoga, and mindfulness can help regulate the nervous system and manage feelings of anxiety [1.4.3, 1.6.2].

Conclusion

Prednisolone is a vital medication for many inflammatory conditions, but it carries a recognized risk of causing anxiety and other mood disturbances. This link is primarily due to the drug's effect on the body's natural stress hormone systems and brain chemistry [1.2.1, 1.7.7]. The risk is highest with large doses and prolonged use [1.3.2]. While these side effects can be distressing, they are typically temporary and resolve after the medication is tapered off [1.2.1, 1.7.4]. Open communication with your doctor and employing effective coping strategies are key to managing these psychological effects and ensuring safe treatment.

For more authoritative information, you can visit the National Institutes of Health (NIH).

Frequently Asked Questions

Anxiety symptoms from prednisolone are typically temporary and should subside after you finish your prescription and taper off the medication as directed by your doctor [1.2.1, 1.7.4]. If symptoms persist for more than a few days after stopping, you should seek medical advice [1.2.1].

Yes, the dosage is the most important risk factor. High doses of prednisolone (e.g., over 40mg per day) are significantly more likely to cause psychiatric side effects, including anxiety, compared to lower doses [1.3.2, 1.7.2].

Yes, anxiety can be a symptom of prednisolone withdrawal. It is crucial to taper off the medication gradually under a doctor's supervision to allow your adrenal system to resume its normal cortisol production [1.2.1, 1.6.3].

You can manage anxiety by taking your dose in the morning, getting regular exercise, practicing stress-reduction techniques like deep breathing, and avoiding caffeine and alcohol. Always consult your doctor before making any changes [1.4.1, 1.4.3].

Yes, depending on the condition being treated, alternatives may be available. For example, NSAIDs like Motrin for inflammation or certain antirheumatic drugs for arthritis have a lower risk of mood-related side effects. Discuss these options with your healthcare provider [1.4.1].

Prednisolone can cause a range of mood changes, including euphoria (feeling high), depression, irritability, agitation, and rapid mood swings that can seem to come on for no reason [1.2.3, 1.7.4].

Yes, it is very important to inform your doctor about any history of anxiety or other mental health conditions. This is a risk factor, and your doctor needs this information to monitor you appropriately and manage potential side effects [1.2.1, 1.2.2].