Dexamethasone and the Sensation of a 'High'
Dexamethasone is a potent synthetic corticosteroid used to treat a wide variety of conditions, including inflammation, allergies, and certain cancers [1.7.1]. While highly effective, it can produce a range of psychiatric side effects. Many patients report experiencing a false sense of well-being, euphoria, high energy, and insomnia, which can be interpreted as a 'high' [1.2.5, 1.3.1]. These effects are not a recreational high but rather a medically-recognized side effect often termed 'steroid euphoria' [1.2.2].
Short-term corticosteroid therapy is more likely to cause euphoria or hypomania, while long-term use is more often associated with depressive symptoms [1.8.1]. The incidence of these reactions varies widely, with some studies showing mild to moderate reactions in about 28% of patients and severe reactions in nearly 6% [1.8.1].
Why Does Dexamethasone Cause These Feelings?
The exact mechanisms behind corticosteroid-induced psychiatric symptoms are not fully understood. However, theories suggest they relate to how these drugs mimic cortisol, a natural hormone, and affect various systems in the brain [1.6.2, 1.6.5].
- HPA Axis Disruption: Corticosteroids can disrupt the normal function of the hypothalamic-pituitary-adrenal (HPA) axis, the body's central stress response system. This can lead to mood instability [1.8.4].
- Neurotransmitter Imbalance: The drugs may influence neurotransmitters like dopamine and serotonin, which play a crucial role in mood regulation. Elevated dopamine activity, in particular, has been linked to manic symptoms [1.4.4, 1.8.3].
- Brain Structure Effects: Research indicates that corticosteroids can affect brain structures like the hippocampus, which is involved in memory and emotional processing [1.6.5].
Risk Factors and Onset
The most significant risk factor for developing psychiatric side effects from dexamethasone is the dosage [1.2.1]. Higher doses are associated with a greater risk. For example, one study on prednisone (a similar steroid) found a 1.3% incidence of psychiatric disturbances at doses of 40 mg/day or less, which jumped to 18.4% for doses over 80 mg/day [1.2.2, 1.5.5].
These symptoms can appear at any time but most often occur early in the treatment course, sometimes within days or even hours of the first dose [1.2.1, 1.2.7]. One review found a median onset time of 11.5 days [1.2.1].
Comparison with Other Corticosteroids
Dexamethasone is not unique in causing these side effects. Other corticosteroids, like prednisone, are also well-known for producing similar psychological effects [1.3.1]. Both medications can cause euphoria, insomnia, mood swings, and personality changes [1.3.1]. Dexamethasone is a long-acting, potent glucocorticoid, which can influence the risk and nature of these side effects compared to shorter-acting steroids [1.7.1].
| Feature | Dexamethasone | Prednisone |
|---|---|---|
| Primary Use | Anti-inflammatory, immunosuppressant for various conditions including arthritis, severe allergies, and cancer [1.7.1] | Anti-inflammatory, immunosuppressant for conditions like asthma, allergies, and autoimmune diseases [1.3.7] |
| Psychiatric Side Effects | Euphoria, hypomania, insomnia, mood swings, personality changes, psychosis [1.2.5, 1.3.1] | Euphoria, mood swings, depression, psychosis, confusion, delirium [1.3.1, 1.3.2] |
| Onset of Effects | Can occur within days or even hours of starting treatment [1.2.1] | Symptoms typically emerge a few days or weeks after starting treatment [1.2.4] |
| Dose Relationship | Risk is dose-dependent; higher doses increase likelihood of effects [1.7.5] | Risk sharply increases with doses over 40 mg/day [1.2.2, 1.3.7] |
Managing the 'High' and Other Mood Changes
If you experience distressing mood or energy changes while taking dexamethasone, it is crucial to speak with your doctor. Management strategies often involve adjusting the treatment plan.
- Dose Reduction: The primary management strategy is to reduce the corticosteroid dose or discontinue the medication, if medically possible [1.4.2]. Symptoms typically resolve with this approach.
- Timing of Dose: Since dexamethasone can cause insomnia and increased energy, taking the dose in the morning can help minimize sleep disruption [1.6.1, 1.6.3].
- Medication: In severe cases where the dose cannot be changed, a doctor might prescribe other medications. Atypical antipsychotics (like olanzapine or risperidone) may be used for psychosis or agitation, while mood stabilizers like lithium have also been used [1.4.2, 1.4.5].
- Patient Education: Simply being aware that these side effects are possible can help patients and their families recognize and report them early [1.2.4].
Conclusion
While dexamethasone does not cause a 'high' in the recreational sense, it can induce significant psychiatric effects like euphoria, heightened energy, and mood swings that some people describe in this way [1.2.7, 1.3.1]. These reactions are a known side effect of corticosteroid therapy, strongly linked to dosage, and typically occur early in treatment [1.2.1]. Understanding these potential effects and communicating with a healthcare provider is key to managing them safely and effectively. In most cases, symptoms are temporary and resolve after adjusting or stopping the medication [1.8.1].
For more information from an authoritative source, you can visit the Mayo Clinic's page on corticosteroids.
