Anabolic Steroids and The Depression Connection

The term “roid rage” has been applied to the explosive and often irrational behavior seen in men and women who use anabolic steroids (especially those that are highly androgenic) on a regular basis above the therapeutic dosage. Many marriages and friendships I have known have fallen on hard times as a result of the severe mood swings that many steroid users experience. The irritability experienced by males and females on anabolic /androgenic steroids are paralleled by a condition that millions of women each month endure, commonly referred to as “premenstrual tension syndrome”. Anabolic steroids, however, also have the opposite psychological effect in many abusers.

That is, the steroids act as potent mood elevators thereby mimicking the effects that are experienced when using anti-depressant drugs. When a steroid cycle is stopped, many male athletes experience a condition known as “estrogen rebound”. The “other hormone” that a male produces in smaller amounts than women is suppressed during the steroid cycle. Once the cycle has been stopped estrogen production which had been suppressed during the steroid cycle is now released as if “a dam had broke”.
The greater the dosage of anabolic/ androgenic steroids used for longer periods of time the more severe the rebound effect of estrogen can be.

Further Background and Mounting Evidence

Anabolic steroids have attracted much attention in the athletic and medical worlds in the past decade as their use by college, professional, and even Olympic athletes has become much more prevalent and circumspect. Thought once to offer only an unfair advantage in size and strength to athletes in competition, these drugs have since been shown to produce adverse medical and psychological effects. Current research indicates that androgenic steroids, both oral and injectable, cause changes in brain wave activity similar to those changes caused by stimulants and anti-depressants, as well as a variety of medical complications.

Of growing concern to physicians and psychologists is the mounting evidence that anabolic /androgenic steroids cause severe and sometimes permanent mental disorders. The addictive nature of steroids often leads users to administer progressively higher doses and more exotic combinations of the drugs to maintain and increase the initial muscle building effects (Occhipinti 1997).

Abundant clinical and anecdotal evidence suggests that steroids often lead to unusually aggressive and irrational behavior. These side effects are most often observed in individuals who have consumed high doses of steroids for an extended period of time, while also “stacking” several types of steroids to be administered together (Dalby 1992); for example, testosterone and nandroline deconate. In fact, one researcher cites that all of the users examined in his study who experienced psychotic symptoms were “stacking” between two and four steroids (Pope & Katz 1988).

Dr. Bruce Svare, Professor of Psychology at State University of New York at Albany summarizes the research: significantly, none of the anabolic steroids available are completely free of androgenic (masculinizing) properties (Gilman et al, 1985), and abusers routinely self-administer extremely large doses of the hormones for long periods of time (Katz and Pope, 1988; Haupt and Revere, 1984). Increasingly, it appears that anabolic steroid-induced behavioral change, especially an increase in aggression and violence, may be one of the more reliable outcomes of this form of drug abuse (Katz and Pope, 1988). (Svare 1990)

Dr. Donald H. Catlin, an NCAA drug-testing expert and director of UCLA’s Paul Ziffren Olympic Analytical Laboratory, cites a nandroline preparation called Deca-Durabolin as the most dangerous steroid. He explains: “It is administered in an oil-based solution and releases its contents over weeks and months; consequently, the pituitary is suppressed for a long period of time.
My clinical impression is that if one had to take steroids, the oral agents are less medically dangerous than the oil-based injected solutions.”
(Nuwer 76, 1990)

Some twenty murders have been associated with the use of anabolic steroids in the U.S. in the past decade (Corrigan 1996).
Pope stated that “there are unquestionably crimes in which steroids are a necessary if not primary factor in the criminal or violent behavior” (Lubell 1989). Courts have acknowledged that steroid abuse should be considered a significant factor in these cases.

In Maryland vs. Williams, 1986, the judge instructed the jury that “the toxic levels of anabolic steroids had impaired the defendant’s ability to appreciate the criminality of his acts” (Lubell 1989). Additionally, Dr. J. Thomas Dalby cites a case of armed robbery in which “the judge ruled that the use of a steroid was a significant mitigating factor and that the use of this agent was distinguished from drugs abused for recreational purposes” (Dalby 1992).

As the Walls Come Tumbling Down

During this “phase” or “off-cycle” the male experiences a loss of euphoria that is typically replaced by deep depression, and this factor alone is often enough to send the psychologically crippled individual scrambling back to their steroid addiction. Androgenic steroids, both oral and injectable, have been found to cause changes in brain wave activity similar to those changes observed when stimulants and anti-depressants are used. A real and ever growing concern of many doctors is the mounting evidence that anabolic/androgenic steroids cause severe and sometimes permanent mental disorders. Many athlete’s become paranoid, even unreasonable and to quote former professional bodybuilder Steve Michalik, “unrealistic maniac’s”.

In 1990, Pope and his colleague David L. Katz, M.D. described three males…who developed an organic mood disorder/manic episode while using steroids. All three impulsively committed a felonious act that lead to incarceration, i.e., attempted murder and kidnapping, attempted murder, and murder (Pope&Katz 1990). After publication of their research, Pope and Katz received numerous calls from lawyers and district attorneys around the country, describing clients who had committed various violent crimes, including several homicides, apparently under the influence of anabolic steroids.

Dr. Brian Corrigan, Consultant Physician at the Institute of Sports Medicine, Concord Hospital, Sydney, Australia, groups the psychological effects of steroids into three categories.
The initial effects are most commonly evidenced in mood changes and euphoria. An increase in confidence, energy, self-esteem, motivation, and enthusiasm are common (Corrigan 1996). One 23 year old user proclaimed that steroids made him feel like he was “the strongest person in the world” (Pope&Katz 1990). Corrigan also notes that users may experience a marked increase in libido, as well as, irritability, anger, and agitation (Corrigan 1990).

As steroid doses and duration of use increase, abusers demonstrate a loss of inhibition and a lack of judgment accompanied by mood swings and grandiosity (Corrigan 1996). Many users report feeling that nothing in the world can hurt them (Pope&Katz 1989). They do, however, often become increasingly suspicious, quarrelsome, impulsive, and more aggressive.

Finally, Corrigan notes that “severe effects manifest when these aggressive feelings increase to the extent that violent, hostile, antisocial behavior develops”, resulting in a “roid rage”. Such rages can result in property damage, assaults marital problems and attempted murder or murder (Corrigan 1996) During these rages, steroid users report that they feel invincible. One 20 year old armed robbery suspect who was caught by police after a foot chase, challenged them to shoot him (Dalby 1992).

At least one study reports the onset of personality changes, including increased alcohol consumption, after the use of steroids, but notes that the degree of violence experienced was markedly more severe than in previous episodes in which only alcohol was implicated (Conacher 1989) Wesley had supposedly been sober since his treatment at Briarwood in 1986, but began drinking again as his steroid abuse increased. Several other studies indicate that depression and suicidal ideation often accompany the feelings of uncontrollable violence and paranoia experienced by steroid users (Perry 1997). In fact, testosterone, which was once used to treat depression is now known to cause it (Corrigan 1996).

One need only peruse the extensive research and case studies devoted to the relationship between anabolic/androgenic steroids and aggression to agree with Dr. Svare that “…steroid hormones promote aggressive behavior, and they do so with great effectiveness (Svare 1990). Drs. William Annitto and William Layman warn that “…we should be alert to the possibility that a schizophrenic-like reaction in an athlete may be related to the ingestion of anabolic steroids” (Annitto & Layman 1980).

Steroids have been found to be extremely addictive, and can lead to a progression of higher dosages and more exotic combinations when the initial muscle building effects are no longer achieved. How steroids affect the brain has up until recently been a relative mystery to the medical community. The fall of communism as we know it in Europe released volumes of research on ten’s of thousands of athletes and the positive and negative effects of these drugs that was compiled over a 40 year period by the physicians of Eastern Europe. The brain functions on a delicate balance that allows nutrients to pass through or across the blood brain barrier where essential fatty acids, and amino acids, notably: Phenylalanine, Glutamine, Tryptophan, Tyrosine and Taurine can have a direct effect on the brain.

During anabolic/androgenic steroid cycles many essential amino acids that are targeted for the brain, which assist in the formation of neuro-transmitters, an example: epinephrine and norepinephrine, serotonin and cholecystokinin) are inhibited or blocked totally. These critically important neuro-transmitters are interfered with as a result of the increased ammonia and urea levels in the blood stream, that are a direct result of anabolic and especially androgenic steroid use. Additionally, the athlete’s diet typically consists of a high protein intake in addition to training at a higher level of intensity. Both of these conditions increase the plasma concentration of protein fragments, which result in increased ammonia levels in the body.

What you have now in the body is literally a metabolic traffic jam of proteins, and amino acids that are circulating in the blood stream (plasma) competing for absorption with other amino acids for the limited number of receptor sites within in body. As a result necessary amino acids are blocked from their metabolic destination, which can interfere with the manufacture of certain essential neuro -transmitters in the concentrations that the body requires maintaining psychological homeostasis. This can and has resulted in the steroid rage or “roid rage” which has been documented and used a defense for violent behavior in those individuals that have been convicted of serious crimes. In the first ever published study done solely on the psychological effects caused by anabolic /androgenic steroids.

Doctor Ritchi Morris, Ph.D., ND, a New York based sports psychologist found some startling revelations. Dr. Morris took a group of 16 elite bodybuilders and professional football players who regularly use anabolic/androgenic steroids and found a direct correlation between the drug use and a depression syndrome commonly found among alcoholics and cocaine users. Dr. Morris further noted that all the athletes in the study experienced significant depression during their “off drug cycles”. Several in his study developed a psychological dependency, choosing to stay on steroids year round rather than face the “black dog” of depression and the negative self image that has been associated with the down cycle.

Conversely, Dr. Morris’s control group demonstrated almost no mood swings between peak and off peak training sessions. A few members of the control group actually said they felt better when they were in a more relaxed maintenance cycle due to the fact they had more time to spend in other of life’s endeavor’s. In all cases of the study the natural athlete’s confidence level remained at a near constant “high”, while the steroid users confidence rose and fell regularly.

Dr. Morris who has a large practice in the White Plains, NY, was a world class elite powerlifters, states: “They come off the stuff (steroids) and watch themselves deflate like a balloon with a slow leak. They cannot bench 450 pounds anymore, and their bodies begin to go back to what they were, sometimes even weaker than before.” In reality, the athlete’s bodies are never the same again, as certain neuro-chemical changes and damages that have been sustained to the central nervous system are permanent.

As mentioned earlier in the article there is an increase in the level of ammonia and area that are retained during the drug cycle that can reach toxic levels. It has been found that the more exotic stacking of drugs and the higher the dosage, the more noticeable and severe the symptoms. The older drugs, which are making a comeback (Dianabol), have the potential to cause psychological negative effects in a man due to the increased likelihood of developing Gynocomastia (the notorious bitch tits). Additional side effects include atrophy of the testicles, which is permanent, and will probably send most men into a state of paranoia all by itself.

Women athletes do not escape the psychological side effects by any stretch of the imagination. What women would not fret over increased facial hair, an enlarged clitoris and increased body odor as well as deepening of the voice. Dr. Morris concludes his study by stating that all subjects on the steroid cycles experience some level of paranoia with doubts about friendships and personal relationships that occurred during periods of low self-image. Dr. John Lombardo, MD of the Cleveland Clinic, a co-author of the American College of Sports Medicine: Position Paper on Anabolic Steroids states: “These people have a strong sense of well being and how they look and feel, and steroids give them a tremendous up.”

Other researchers have found similar findings: Doctor Harrison Pope, Jr. MD, at McLean Hospital in Belmont, Massachusetts and David Katz, MD, of Harvard Medical School report that anabolic/androgenic steroids use leads to psychological disturbances. Clinical as well as anecdotal evidence has found that many times the drugs lead to unusually aggressive and irritable behavior. These doctors interviewed over 40 bodybuilders and football players that admitted to using steroids. Almost half of those interviewed reported maniac and near maniac behavior during their drug cycles. The most common symptoms reported were hyperactivity and inflated self-esteem, which increased their drive to train harder during their workouts. Dr. Katz reported one bodybuilder who, convinced of his own immortality, deliberately drove his new Corvette into a tree at over 60 miles per hour while a friend videotaped him. (Yes, he did live, and no he is not immortal). Several other subjects experienced severe psychotic behavior during their steroid cycles.

One had hallucinations, while another became paranoid and believed that his friends were stealing from him. All these episodes stopped when the steroid cycle stopped. Dr. Katz believes the way Dr. Morris does with regard to the effects of certain types of steroids (especially the androgenic class = Anadrol 50, etc.) on the brain and the fact that neuro-transmitters in the brain are depleted and short-circuited by steroid use.

Final Thoughts and Some Direction

The obvious answer would be to discontinue using anabolic steroids. Dues to societies thirst for performance and the look of giants that will not happen in our lifetime. It makes no difference that the drugs are illegal. A good article just appeared in the April 14, 1994 issue of Sports Illustrated, entitled Bigger, Stronger, Faster, as a further indication of where we are at today in the world. Perhaps there will be individuals who read this article that will continue on a cycle but would benefit from a mental boost or a calming effect. The need to restore depleted neuro-transmitters to their normal function cannot be achieved by eating foods alone. Research has demonstrated that the utilization of three nutrients in particular can have a beneficial effect on the restoring normal brain biochemistry. This is just a suggestion for further discussion.

A. The active form of the vitamin B-6 (Pyriodoxal 5 Phosphate), 20 mgs. per capsule or caplet, 2 caps 30 minutes before breakfast, 2 caps mid-morning and 2 caps prior to retiring.

B. The amino acid L-Tyrosine, 800 mgs per capsule or caplet, 2-3 capsules 30 minutes prior to breakfast and 2-3 capsules mid-morning. *It is important to remember not to take Tyrosine with food and to take it before noon. The bodies’ natural levels of Tyrosine are highest in the morning. This process acts as a precursor to the neuro-transmitters epinephrine and norepinephrine, which have been depleted as a result of either steroid, alcohol or cocaine usage.

C. The amino acid L-Tryptophan, 500 mg. capsules, 2 early evening or after training, and 2-3 capsules @ 500 mgs. ea. prior to retiring. Tryptophan is now by prescription only in the United States. Tryptophan is the pre-cursor to the neuro-transmitter serotonin, which assists the brain in preparation for deep relaxation and sleep.

References:

American College of Sports Medicine, Position Paper on Anabolic Steroids, 1992.
Interview with Dr. Ritchi Morris, Ph.D. Vital Quests: Performance Improvement Associates.914.333.9455 3. Bigger, Stronger, Faster, Sports Illustrated, April 14, 1997
Goldman, R. Death In The Locker Room, 1986.
Tyson & Associates, Hawthorne, Ca., 1997. 310.675.1080
Aatron Medical Laboratory, 1997 7. J. Clinical Nutrition, 1987,46, 78-85.
Annitto, William J., M.D. and Layman, William A., M.D. (1980). “Anabolic Steroids and Acute Schizophrenic Episode.” Journal of Clinical Psychology, 41:4, 143-144.
Conacher, G.N., M.B., CH.B, M.R.C. Psych. and Workman, D.G., M.D. (1989).
“Violent Crime Possibly Associated with Anabolic Steroid Use.” American Journal of Psychiatry, 146:5, 679.
Corrigan, Brian (1996). “Anabolic Steroids and the Mind.” The Medical Journal of Australia, 165:222-226, http://www.library.usyd.edu.au/MJA.
Dalby, J. Thomas, PhD (1992). “Brief Anabolic Steroid Use and Sustained Behavioral Reaction.” American Journal of Psychiatry, 149:2, 272.
Lubell, Adele (1989). “Does Steroid Abuse Cause — or Excuse — Violence?”
The Physician and Sports Medicine, Volume 17, Number 2, 176-185.
Nuwer, Hank. (1990). Steroids. New York: F. Watts.
Parrott, A.C., B.Sc., PhD and Choi, P.Y.L., B.Sc., PhD and Davies, M. (1994).
“Anabolic Steroid Use by Amateur Athletes: Effects Upon Psychological
Mood States.” The Journal of Sports Medicine and Physical Fitness, September 1994, 292-298.
Perry, Paul J., PhD and Alexander, Bruce, Pharm. D. and Ellingrod, Vivki L., Pharm. D.
(1997). “Steroid Induced Mental Disturbances.” The Virtual Hospital: Clinical Psychopharmacology Seminar, http://indy.radiology.uiowa.edu/Providers/Conferences/CPS/27.html.
Pope, Harrison G., M.D. and Katz, David L., M.D. (1988). “Affective and Psychotic Symptoms Associated with Anabolic Steroid Use.” American Journal of Psychiatry, 145:4, 487-490.
Pope, Harrison G., M.D. and Katz, David L., M.D. (1990). “Homicide and Near Homicide by Anabolic Steroid Users.” Journal of Clinical Psychology, 51:1, 28-30.
Svare, Bruce, PhD (1990). “Anabolic Steroids and Behavior: A Preclinical Research Prospectus.” Anabolic Steroid Abuse. Rockville, MD: National Institute on Drug Abuse.