- Catabolic steroids are also referred to as glucocorticoids, substances that naturally occur in the body and function in metabolism. These substances can also be manufactured artificially and used for numerous medicinal purposes. Catabolic steroids are not the subject of steroid abuse in sports and bodybuilding.
- Anabolic steroids are derived from androgens; which are often referred to as male hormones, although this is not technically correct. Numerous artificial anabolic steroids have been developed to assist in recovery of conditions where an individual has lost significant weight or muscle mass. This class of steroids is abused by bodybuilders, strength athletes, endurance athletes, etc., to enhance athletic performance.
Anabolic steroids are very useful in treating patients with severe burns that require assistance regenerating tissue, patients infected with the HIV virus who have lost significant weight, patients who have intestinal diseases that inhibit their ability to absorb food, and cancer patients who are losing weight and have appetite loss as a result of chemotherapy. Prednisone is a catabolic steroid that is used medicinally in the management of diseases or conditions that produce inflammation or immune system dysfunction. It is most commonly used to treat:
- Numerous types of arthritis
- Systemic lupus
- Allergic reactions
- Crohn’s disease
- Ulcerative colitis
Prednisone is sometimes part of the treatment plan for various types of lymphomas, leukemia, and bronchitis. It is also sometimes used to suppress the immune system of individuals who have organ transplants to lessen the chances of the body rejecting the new organ. The drug has significant medical utility, and it is not a drug that is highly sought after by bodybuilders, athletes, etc., because it is not an anabolic steroid. Prednisone is typically taken orally, but corticosteroids like prednisone can be used in topical medications.
The side effect profile of prednisone is relatively benign, and few individuals experience side effects. According to the Food and Drug Administration (FDA), the most common side effects of prednisone include:
- Retention of sodium and fluid that can result in issues with high blood pressure, weight gain, potassium loss, and feelings of general malaise
- Muscle weakness, nausea, and vomiting
- Thinning skin, acne, thinning hair, restlessness, and problems sleeping
- Cataracts or glaucoma
- Congestive heart failure or heart attack
- Pulmonary edema
- Decreased growth rate in children
- Exacerbation of diabetes or obesity
- Osteoporosis with long-term use
- Neurological effects that can include seizures
- Psychiatric side effects that can include anxiety, depression, mood swings, etc.
- Allergic reactions
For a full listing of all the potential side effects associated with the use of prednisone, refer to the link for the Food and Drug Administration above.
Although there are side effects associated with the use of any medication, prednisone is typically well tolerated in most individuals. There is a significant difference between experiencing a side effect and having a withdrawal syndrome associated with use of the drug. Side effects occur when a person is actively using the drug; withdrawal symptoms result once the person completely discontinues or suddenly significantly cuts down on the dose of the drug they are using.
Withdrawal Issues with Glucocorticoids Steroids like Prednisone
Administration instructions are typically to take the medication with food and take the dose as directed. Typically, when starting the drug, an individual will begin with an initial dose, and the dose will be adjusted depending on the response to the medication. Maximum effects typically occur after several days or more, and when it is time to discontinue the drug, this is typically done on a tapering schedule to allow an individual’s adrenal glands time to adjust to decreasing amounts of the drug in the system.
The adrenal glands also produce corticosteroid, and when an individual takes prednisone, these glands produce less of this steroid, which is important in the overall health and balanced functioning of an individual’s system. When an individual stops taking prednisone, they can experience a corticosteroid insufficiency if the drug is not tapered down (a sort of withdrawal syndrome). The withdrawal symptoms typically include:
- Decreased appetite, weight loss, and fatigue
- Nausea, vomiting, abdominal pain, and diarrhea
- Jitteriness, nervousness, and feelings of general malaise
The withdrawal syndrome is not potentially fatal although it can be exacerbated by stress. Individuals who undergo significant stress, such as an infection, surgery, etc., may need to engage in a lengthier tapering schedule.
Any overdose is a significant issue, and anyone who suspects that someone has overdosed on any medication should immediately contact emergency medical services. Prednisone overdose generally occurs accidentally when individuals take too much of the medication because they forgot how much they have taken; however, this does not make the issue any less serious.
Numerous symptoms can occur as a result of overdose, such as:
- Gastrointestinal issues, such as nausea, vomiting, stomach cramps, etc.
- A sensation of itching or burning skin
- Extremely elevated blood pressure and potential for cardiac issues
- Feeling sedated, lethargic, or being extremely sleepy
- Irritability, agitation, and even psychosis
- The potential for seizures
Overdose effects can lead to significant brain or other organ damage, and they can be fatal in some individuals. Symptoms of overdose should be addressed immediately by a qualified medical professional.
- Physical Dependence, Abuse, Addiction
Based on the clinical criteria for a substance use disorder (which covers both substance abuse and addiction) as defined by the American Psychiatric Association (APA), there are definite boundaries between an individual who has physical dependence on a drug, an individual who abuses or is addicted to a drug, and an individual who is simply taking a drug or medication for medicinal reasons. The diagnostic criteria for a substance use disorder specified by APA are followed by all other major organizations that collect data, assess, and treat individuals with substance use disorders.
- Having a substance use disorder (addiction) requires that the individual uses the drug for nonmedicinal reasons, suffers significant distress or impairment in their life as a result of their drug use, and meets specific diagnostic criteria.
- Physical dependence on a drug (having both tolerance and withdrawal) can occur in individuals who have substance use disorders and individuals who use drugs medicinally.
- One does not have to develop physical dependence on a drug to be diagnosed with a severe substance use disorder.
- It is quite possible to be using a drug for medicinal reasons and to develop physical dependence to it, although individuals who abuse drugs often have much higher tolerance and more severe withdrawal symptoms.
Thus, simply having physical dependence on a drug may or may not be a sign that a person has developed an addiction (a substance use disorder). It is quite possible for an individual who is taking a medication under the supervision of a physician to develop physical dependence on the medication and not be classified as having a substance use disorder (addiction). Because these issues are complicated, the formal diagnosis of a substance use disorder can only be made by a licensed mental health clinician.
Prednisone is not a significant drug of abuse. Although its use does require a prescription from a physician, it is not listed as a controlled substance by the United States Drug Enforcement Administration (DEA), and it is not followed as a potential substance of abuse by the Substance Abuse and Mental Health Services Administration (SAMHSA). There are no official government reports or surveys of prednisone misuse or abuse in the yearly summary of drug use and misuse by SAMHSA. Because it is not an anabolic steroid, it is not a drug that is typically abused to enhance sports performance.
This is not to say that misuse or abuse of prednisone does not exist. In fact, many people suffering from severe addictions will attempt to take any drug they think can produce psychoactive effects. That being said, prednisone does not produce euphoria or the other effects that most drug abusers seek and is not a significant drug of abuse. The types of steroids that are more likely to be drugs of abuse are anabolic steroids.
There is a significant difference between misuse and abuse of the medication. The misuse of the medication occurs when an individual who is taking it for medicinal reasons takes too much or takes it more often than prescribed. Many times, misuse occurs accidentally or because individuals do not believe the medication is working for them. Abuse of a drug is a chronic situation where an individual uses a drug beyond its medicinal intentions and, as mentioned above, is diagnosed according to specific symptomatic criteria.
There are older case studies in the research literature of prednisone or corticosteroid abuse, but these studies represent very rare occurrences. As mentioned previously, any medication, even a drug like aspirin, can be abused, but corticosteroid abuse is rare. In addition, some studies appear to be reporting cases of incorrect prescription as instances of abuse. Prednisone is a drug that is more likely to be misused by individuals who already have a prescription for it than it is to be abused by individuals seeking psychoactive effects, such as euphoria, significant stimulation, sociability, etc.
- There are some scattered reports on the Internet of individuals who report abusing prednisone; however, these are rare. Any individual who is prescribed the medication should not concerned that prednisone is a significant drug of abuse or its use will result in an addiction. Prednisone could conceivably be abused by an individual with easy access to the drug and with a polysubstance abuse syndrome, but its use would most likely add little to the sought-after effects of other drugs of abuse in most cases.
- If a person were to chronically abuse the drug, there is a significant chance that they could experience severe tolerance, significant side effects, and withdrawal symptoms. Such an individual would require a formal assessment by an addiction medicine physician or psychiatrist, a formal withdrawal management program (medical detox), medical management during recovery, and intensive aftercare, including substance use disorder therapy, peer group participation, and social support.