What the study found
The review found that corticosteroid use was associated with more severe depressive symptoms, and that manic symptoms were more frequent than depressive symptoms during the acute phase, defined as the first 8 weeks after treatment started. Psychotic symptoms were uncommon, and anxiety was not consistently associated with corticosteroid use.
Why the authors say this matters
The authors conclude that routine monitoring for mood and psychotic changes is warranted, especially early after corticosteroid initiation and in older patients or those receiving higher daily doses. The study suggests these findings may help clinicians watch for mental health changes while balancing them against the physical benefits of corticosteroid therapy.
What the researchers tested
The researchers conducted a PRISMA-guided systematic review and meta-analysis of observational studies in medical corticosteroid users. They searched MEDLINE and Embase through 10 October 2025, screened additional hand-searched records, and excluded randomized controlled trials and several study types not aligned with their question. They pooled results with random-effects meta-analyses, assessed study quality with the Newcastle-Ottawa Scale, rated certainty with GRADE, and ran an exploratory meta-regression for dose, duration, cumulative dose, age, and sex.
What worked and what didn't
Compared with non-users, corticosteroid use was associated with higher depressive symptom scores (standardized mean difference 0.92). During the acute phase, manic symptoms were more frequent than depressive symptoms (odds ratio 2.42), while psychotic symptoms were estimated at 2.4% of users. Anxiety showed no significant association, and the exploratory meta-regression suggested higher daily dose and older age were associated with greater depressive severity, whereas cumulative dose, treatment duration, and sex were not.
What to keep in mind
The certainty of evidence was generally low to very low across pooled outcomes, even though study quality was generally moderate to high. The moderator findings from meta-regression were explicitly described as exploratory and should be interpreted cautiously. The review also notes between-study variability, and the abstract does not describe limitations beyond these points.
Key points
- Seventy-three observational studies were included, with a total sample of 3,759,659 people.
- Corticosteroid use was associated with higher depressive symptom scores than non-use.
- In the first 8 weeks after starting treatment, manic symptoms were more frequent than depressive symptoms.
- Psychotic symptoms were estimated in 2.4% of corticosteroid users.
- Anxiety was not significantly associated with corticosteroid use.
- Higher daily dose and older age may be linked to greater depressive severity, but this finding is exploratory.
Disclosure
- Research title:
- Corticosteroid use is linked to more depressive symptoms
- Authors:
- Keisuke Kusudo, Yuki Mashima, Hideaki Yasuda, Teruomi Iyo, Hiroyoshi Takeuchi
- Institutions:
- Chiba Aoba Municipal Hospital, Chiba East Hospital, Chiba Hospital, Chiba University, Keio University Hospital, Keio University Hospital, National Hospital Organization
- Publication date:
- 2026-06-28
- OpenAlex record:
- View
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