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Prednisone anxiety: Why it happens and how to cope

Why corticosteroids like prednisone may cause anxiety and what to do about it
Leandra Beabout
By | Dec. 31, 2024 Medically reviewed by Leslie Greenberg, MD
A prescription bottle with an exclamation mark on the label: Can prednisone cause anxiety?

Key takeaways

  • Prednisone is a prescription corticosteroid used to treat inflammation and overactive immune responses.

  • Prednisone is known to cause mood-related side effects such as anxiety. 

  • People on high doses of prednisone are more likely to experience prednisone-induced anxiety.

  • Talk to your healthcare provider if you’re experiencing moderate to severe anxiety while taking prednisone. 

In this article:

Prednisone is an FDA-approved prescription medication to treat a range of common conditions characterized by inflammation caused by the immune system. It belongs to a class of drugs called corticosteroids (sometimes called glucocorticoids). Like other steroids, prednisone reduces swelling, redness, and other symptoms caused by immune system reactions. And like other drugs, prednisone is not without its side effects, and some people have reported anxiety while on prednisone. 

What is anxiety?

Anxiety isn’t just a feeling of being anxious or stressed out. Some people experience what’s called “general anxiety,” which the American Psychological Association describes as “persistent, excessive worries that don’t go away even in the absence of a stressor.” Like stress, anxiety can include racing thoughts, feeling panicky, a fast heart rate, and even social avoidance. However, unlike stress, anxiety and panic attacks can’t be traced to a clear and logical reason for the feelings. It is fuelled internally rather than externally.

Can prednisone cause anxiety?

Yes, anxiety is a common side effect of prednisone and other corticosteroids, such as dexamethasone and cortisone. 

In two large meta-analyses of corticosteroid treatment, 28% of users reported mild to moderate psychiatric reactions, including but not limited to anxiety. A 2023 retrospective study of 3,138 prednisone users also found that oral corticosteroids like prednisone can induce anxiety, panic disorder, depression, and delirium.

Bottom line: Anxiety is just one of several common mental health side effects of prednisone.

Prednisone anxiety: Why it happens

So, why might prednisone-induced anxiety? Below, Daniel Kim, DO, a board-certified family physician with Medical Offices of Manhattan and LabFinder contributor, and Inna Melamed, Pharm.D., functional medicine practitioner and author of Digestive Reset, explain.

How prednisone affects the body

“Prednisone is a synthetic version of cortisol, which controls our ‘flight or fight’ response in the brain,” Dr. Kim says. “It can increase our blood pressure, heart rate, and alertness, which in turn can increase our feelings of anxiety.” Corticosteroids like prednisone can also alter levels of the mood-regulating hormones dopamine and serotonin, according to Dr. Melamed.

Ultimately, prednisone artificially and temporarily alters stress- and mood-related hormone levels. This disruption has been known to cause psychiatric complications, including anxiety and sleep difficulties as well as delirium or even dementia.

Who is most likely to experience anxiety on prednisone?

People on high doses of prednisone are more likely to experience corticosteroid-induced anxiety than people on low doses of prednisone. Individuals who already live with anxiety may experience worsening anxiety when taking prednisone. 

Dr. Kim suggests that other risk factors may include a current psychiatric disorder or a medical history of anxiety disorder. He also says people with chronic illnesses are at a higher risk because they are likely to be on prednisone more often or for longer. The more time a corticosteroid has to impact an individual’s hormones, the more likely they are to experience side effects, including anxiety.

“It is not fully conclusive, but there are some indications that women may experience anxiety more often than men when on prednisone,” Dr. Kim adds.

RELATED: 6 prednisone side effects in women

Can coming off prednisone cause anxiety?

Unfortunately, yes. Anxiety is a common prednisone side effect, but it is also a less common symptom of prednisone withdrawal. Other signs of corticosteroid withdrawal include extreme fatigue, body aches, fever, and gastrointestinal discomfort.

It is essential to taper off prednisone gradually—and with the guidance of a healthcare provider. This gives the adrenal system time to adjust to pre-prednisone cortisol production levels.

What to do about prednisone side effects like anxiety

Prednisone is not intended to be a long-term medication. The good news is that anxiety symptoms and other side effects of corticosteroids, such as weight gain or high blood pressure, should subside after you finish your prescription. 

“Prednisone stays in the system for up to a day,” says Dr. Melamed. “If the therapy was stopped and any side effect continues, including anxiety, then consider seeking help within a few days, especially if the anxiety is severe.”

Below, the experts suggest how to manage prednisone side effects like anxiety during treatment. 

Natural remedies for anxiety

Dr. Kim recommends communicating your side effects closely with your healthcare provider. He also suggests Using natural techniques to manage anxiety, such as exercise, support groups, therapy, and good sleep hygiene.

It’s also a good idea to avoid alcohol and caffeine while taking prednisone. Alcohol can exacerbate psychiatric symptoms, and caffeine can worsen prednisone side effects. 

Dosage adjustments 

High or prolonged doses of prednisone are more likely than low doses to cause side effects such as anxiety, mood swings, and other mood changes. Dr. Melamed recommends consulting a healthcare professional “immediately” if prednisone anxiety is severe enough to interfere with daily functioning. In such cases, a dose adjustment might be appropriate. 

Never discontinue or adjust prednisone dosage without medical guidance. Prednisone must be tapered gradually to avoid triggering withdrawal symptoms.

Prednisone alternatives 

In some cases, a prednisone alternative can be prescribed to patients concerned about prednisone-induced anxiety. The best prednisone alternative depends on the condition it is being used to treat. For instance, Dr. Melamed says an NSAID like Motrin for inflammation or an antirheumatic drug like methotrexate for arthritis can be used with much less risk of mood-related side effects. 

However, she also says prednisone is still “the drug of choice” and is “the last resort” for many prescribers. If a person’s medical condition is severe enough to warrant corticosteroid therapy, there might not be an equally effective alternative. 

Regardless of whether it is possible to reduce dosage or switch to a different prescription drug, it’s essential to seek medical advice if prednisone side effects become severe. Report new symptoms of mood disorders or steroid-induced behavioral changes to your prescriber as soon as possible.