The use of prescribed steroids, including in inhalers, is linked to changes in the structure and volume of white and gray matter in the brain, suggests the findings of the largest study of its kind, published in the open access journal BMJ Open.

The associations found might help to explain the neuropsychiatric effects, such as anxiety, depression, mania, and delirium frequently seen after long term use, say the researchers.

Their immunosuppressive properties mean that glucocorticoids, a class of synthetic steroids, are among some of the most frequently prescribed drugs. They are used to treat a wide variety of medical conditions.

The estimated annual population prevalence in high income countries of systemic (infusions and tablets) medical steroid use is thought to range between 0.5% and 3%.

While very effective, both systemic and inhaled steroids are associated with many potentially serious metabolic, cardiovascular, and musculoskeletal side effects, as well as neuropsychiatric effects.

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