A new study has found an association between the use of systemic glucocorticoid medications, both oral and inhaled, to treat asthma, allergies or arthritis, with the appearance of changes in the structure and volume of the white and gray matter of the brain, which could explain why long-term use of these drugs can cause neuropsychiatric side effects such as anxiety and depression.
Glucocorticoids, from the family of corticosteroids or corticosteroids, a type of synthetic steroids, are drugs that regulate the response of the immune system and reduce inflammation, and are often used to combat pathologies such as asthma, arthritis, or Alzheimer’s disease. Chron. The most common include beclomethasone for asthma and betamethasone for arthritis, and are classified as inhaled or systemic (affecting the whole body), the latter including pills or injections.
The study has been published in BMJ Open and has been carried out by researchers at the Leiden University Medical Center (LUMC), in the Netherlands, who compared the images obtained by means of a brain scan in people who use glucocorticoids with those of individuals who do not. they use. These scientists analyzed the brain scans of 222 people taking systemic steroids and 557 people taking inhaled steroids, comparing them with those of 24,106 non-users.
“Glucocorticoids include prednisone and various asthma inhalers,” said doctoral student Merel van der Meulen, one of the authors of the paper, who noted that white matter had a different structure in the brains of glucocorticoid users, compared to those not using these drugs.
Systemic steroids affect the brain more than inhaled steroids
“We also saw that the effects were greater in systemic users, people who take or receive the drugs injected, than in users of inhaled glucocorticoids,” Van der Meulen says. These effects could be more intense in people who use these drugs long-term, further analysis suggests. Systemic glucocorticoid users also found that the caudate nucleus – an area of the cervix involved in learning and emotional processing – was larger compared to non-users. Inhaled steroid use was, however, associated with a smaller amygdala. This area of the brain plays an important role in responding to external threats.
Systemic glucocorticoid users had slower processing speed than nonusers, and experienced more depressive symptoms, apathy, restlessness, and fatigue
Onno Meijer, Professor of Molecular Neuroendocrinology of Corticosteroids, finds it interesting that the most intense changes are found in the white matter of the brain. “With psychological and psychiatric complaints, such as we see with glucocorticoid use, we quickly think of nerve cells, which are found in the gray matter. We also know that these cells are very sensitive to glucocorticoids. But it is striking that the visible structural differences are precisely in the white matter, where the nerves are located”, he declared.
Van der Meulen and his colleagues also conducted psychological tests and questionnaires, which allowed them to verify, for example, that users of systemic glucocorticoids had a slower processing speed than non-users, and that they reported experiencing more depressive symptoms, apathy, restlessness and fatigue. Inhaled steroid users only reported more fatigue, and to a lesser extent, than systemic steroid users.
“Although the findings are associations, and we cannot yet say for sure whether these changes in the brain are actually caused by glucocorticoid use, another cause seems unlikely,” Meijer said. For him, this is one more reason to be careful with these commonly used drugs. “Given the widespread use of these drugs, both physicians and patients need to be aware of their potential effects on the brain.”
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