Medicine:Roid rage

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Short description: Side effect of anabolic steroid use

Template:Infobox symptom

Roid rage (also known as steroid rage[1]) is a side effect of the use of anabolic steroids which is described as dramatic mood swings, increased feelings of hostility, impaired judgment, and increased levels of aggression.[2] The term "roid rage" became popular in the 1980s.[3]

Cause

Illegal anabolic steroids from a raid by the Drug Enforcement Administration

After supraphysiological use of anabolic-androgenic steroid which normally consists of long-term uncontrolled use of anabolic steroids (i.e. several injections over a period of time) roid rage can take place, which includes aggression[4][5] and emotional dysregulation which can lead to depression and paranoia.[6] Use of steroids like corticosteroid to treat pains can cause steroid induced psychotic episodes which include racing thoughts, anger, agitation, pressured hyperverbal speech and paranoia.[7]

Effects

The effects of roid rage, which is not only seen in humans who take large doses of anabolic steroids but also when the same or even lower doses are administered to animals like lab rats, include the heavy increase in aggression and the fight-or-flight response. This was shown in study of lab rats where when the nucleus accumbens and medial prefrontal cortex of a group of lab rats who were administered anabolic steroids showed no difference in tyrosine hydroxylase compared to regular lab rats but the caudate putamen, a brain area important for behavioral inhibition, motor control and habit learning, showed a significant decrease in tyrosine hydroxylase due to the testosterone.[8] Indecisiveness is linked to changes in the mesocorticolimbic dopamine system with anabolic steroids having an affect dopamine function in mesocorticolimbic circuitry. It is not understood how this specifically affects decision making exactly. This indecisiveness is shown in lab rats which then turns into aggression, i.e. roid rage.[9] Heavy signs of anxiety,[10] mania,[11] and paranoia were also present when "roid rage" becomes more present in the person taking in the anabolic steroids.[12] Psychopathy is heavily increased if a person has underlying disorders for it when roid rage is present, where research shows the connection between substance misuse/abuse of anabolic steroids to violence, repeated imprisonment, and disrespect for authority.[13]

Effects of roid rage have chances to be greatly increased in aggression and impulsiveness if the abuser of anabolic steroids has any underlying personality disorders such as borderline personality disorder.[14] Heavy use of anabolic steroids with roid rage can cause heavy distress as well depending on how long the steroids have been abused.[15]

During puberty (in adolescent males) the intake of anabolic steroids can alter mood and personality causing a heavier roid rage that can impact them for a long-term time range.[16] Due to puberty being a sensitive time period with hormones, anabolic steroids can cause a shift on testosterone production and induce unprovoked aggression whether the person may or may not still be using anabolic steroids.[17] This may lead to extreme violent tendencies even after a year of drug absence, which is more present in adolescents and young adults, anabolic steroids are linked directly to the heightened factor of violent tendencies.[18]

After tests were done comparing the use of methyltestosterone and stanozolol (both compounds of anabolic steroids) on castrated lab rats, both showed levels of heightened aggression, which shows that if males had a vasectomy it can still affect the levels of aggression they would have.[19]

Violence

When a person is experiencing roid rage and increased levels of aggression, they may become easily provokable and be prone to commit violent assaults.[20] Many times when a person has abused anabolic steroids and commits violent crimes, they do not maintain the same levels of judgement to their actions, which may lead to aggravated murders.[21] The abuse of other drugs can lead to a worsening effects of aggression and violence that a person may commit.[22]

According to anecdotal reports, wives and girlfriends of athletes who take anabolic steroids face violence when the users of anabolic steroids continue to use them; this includes verbal abuse and physical domestic abuse.[23]

Treatment

Certain drugs that minimise the amount of oestrogen created as the anabolic steroids break down could help lessen the aggression.[24] Anabolic steroid users can go into a psychosis when roid rage is induced, and even start experiencing suicidal ideation, some antipsychotic medications, such as haloperidol, have been used extensively to treat the psychosis induced roid rage, evidence also exists to support second-generation antipsychotics, lithium, selective serotonin reuptake inhibitors, tricyclic antidepressants (TCAs), and select antiepileptic drugs, including carbamazepine as well as valproic acid and its derivatives.[25]

In a season 8 episode of South Park, "Up the Down Steroid", the character Jimmy goes into a roid rage after use of anabolic steroids.[26]

In a season 7 episode of Family Guy, "Stew-Roids", the character Stewie Griffin develops roid rage after his father Peter Griffin gives him steroids in order to make him stronger at the gym.[27]

References

  1. ↑ Pope, Harrison G.; Katz, David L. (1987). "Bodybuilder's Psychosis" (in en). The Lancet 329 (8537): 863. doi:10.1016/S0140-6736(87)91642-4. PMID 2882266. https://linkinghub.elsevier.com/retrieve/pii/S0140673687916424. 
  2. ↑ Mulube, M. (1996-09-21). "Personality changes due to 'roid rage'" (in en). The BMJ 313 (7059): 707. doi:10.1136/bmj.313.7059.707. ISSN 0959-8138. https://www.bmj.com/lookup/doi/10.1136/bmj.313.7059.707. 
  3. ↑ Lenehan, Patrick (2003). Anabolic Steroids. Boca Raton: CRC Press. p. 23. ISBN 978-0-415-28030-3. 
  4. ↑ Chegeni, Razieh; Pallesen, Ståle; McVeigh, Jim; Sagoe, Dominic (2021). "Anabolic-androgenic steroid administration increases self-reported aggression in healthy males: a systematic review and meta-analysis of experimental studies" (in en). Psychopharmacology 238 (7): 1911–1922. doi:10.1007/s00213-021-05818-7. ISSN 0033-3158. PMID 33745011. 
  5. ↑ Bertozzi, Giuseppe; Sessa, Francesco; Albano, Giuseppe Davide; Sani, Gabriele; Maglietta, Francesca; Roshan, Mohsin H. K.; Volti, Giovanni Li; Bernardini, Renato et al. (2018). "The Role of Anabolic Androgenic Steroids in Disruption of the Physiological Function in Discrete Areas of the Central Nervous System" (in en). Molecular Neurobiology 55 (7): 5548–5556. doi:10.1007/s12035-017-0774-1. ISSN 0893-7648. PMID 28971285. 
  6. ↑ Gonçalves-Pinho, M.; Quarenta, J.; Almeida, A. (2021). "P.0060 From roid rage to depression - a case report" (in en). European Neuropsychopharmacology 53: S44. doi:10.1016/j.euroneuro.2021.10.065. https://linkinghub.elsevier.com/retrieve/pii/S0924977X21008361. 
  7. ↑ Benyamin, Ramsin M.; Vallejo, Ricardo; Kramer, Jeffery; Rafeyan, Roueen (2008). "Corticosteroid induced psychosis in the pain management setting". Pain Physician 11 (6): 917–920. doi:10.36076/ppj.2008/11/917. ISSN 1533-3159. PMID 19057637. 
  8. ↑ Wood, Ruth I.; Armstrong, Abigail; Fridkin, Vlad; Shah, Vivek; Najafi, Allison; Jakowec, Michael (2013). "'Roid rage in rats? Testosterone effects on aggressive motivation, impulsivity and tyrosine hydroxylase" (in en). Physiology & Behavior 110-111: 6–12. doi:10.1016/j.physbeh.2012.12.005. PMID 23266798. 
  9. ↑ Wallin, Kathryn G.; Alves, Jasmin M.; Wood, Ruth I. (2015). "Anabolic–androgenic steroids and decision making: Probability and effort discounting in male rats" (in en). Psychoneuroendocrinology 57: 84–92. doi:10.1016/j.psyneuen.2015.03.023. PMID 25900595. 
  10. ↑ Sanjuan, Pilar M.; Langenbucher, James L.; Hildebrandt, Tom (2016-07-03). "Mood symptoms in steroid users: the unexamined role of concurrent stimulant use" (in en). Journal of Substance Use 21 (4): 395–399. doi:10.3109/14659891.2015.1040089. ISSN 1465-9891. PMID 27524938. 
  11. ↑ Cooke, Robert G.; Krüger, Stephanie; Shugar, Gerald (1996). "Comparative evaluation of two self-report mania rating scales" (in en). Biological Psychiatry 40 (4): 279–283. doi:10.1016/0006-3223(95)00392-4. PMID 8871774. https://linkinghub.elsevier.com/retrieve/pii/0006322395003924. 
  12. ↑ Mhillaj, Emanuela; Morgese, Maria G.; Tucci, Paolo; Bove, Maria; Schiavone, Stefania; Trabace, Luigia (2015-08-26). "Effects of anabolic-androgens on brain reward function". Frontiers in Neuroscience 9: 295. doi:10.3389/fnins.2015.00295. ISSN 1662-453X. PMID 26379484. 
  13. ↑ Nelson, Bryan S.; Hildebrandt, Tom; Wallisch, Pascal (2022-06-01). "Anabolic–androgenic steroid use is associated with psychopathy, risk-taking, anger, and physical problems" (in en). Scientific Reports 12 (1): 9133. doi:10.1038/s41598-022-13048-w. ISSN 2045-2322. PMID 35650220. Bibcode: 2022NatSR..12.9133N. 
  14. ↑ Schaive, Chad; Tobias S. Kohler, Tobias S. x (2016). "An inside perspective on anabolic steroid abuse". Translational Andrology and Urology (AME) 5 (2): 220–224. doi:10.21037/tau.2016.03.08. PMID 27141450. 
  15. ↑ Chegeni, Razieh; Notelaers, Guy; Pallesen, Ståle; Sagoe, Dominic (2021-06-04). "Aggression and Psychological Distress in Male and Female Anabolic-Androgenic Steroid Users: A Multigroup Latent Class Analysis". Frontiers in Psychiatry 12. doi:10.3389/fpsyt.2021.629428. ISSN 1664-0640. PMID 34149470. 
  16. ↑ Lumia, Augustus R.; McGinnis, Marilyn Y. (2010). "Impact of anabolic androgenic steroids on adolescent males" (in en). Physiology & Behavior 100 (3): 199–204. doi:10.1016/j.physbeh.2010.01.007. PMID 20096713. https://linkinghub.elsevier.com/retrieve/pii/S003193841000020X. 
  17. ↑ Cunningham, Rebecca L.; Lumia, Augustus R.; McGinnis, Marilyn Y. (2013-07-26). "Androgenic anabolic steroid exposure during adolescence: Ramifications for brain development and behavior" (in en). Hormones and Behavior 64 (2): 350–356. doi:10.1016/j.yhbeh.2012.12.009. PMID 23274699. 
  18. ↑ Beaver, Kevin M.; Vaughn, Michael G.; DeLisi, Matt; Wright, John Paul (2011-09-20). "Anabolic-Androgenic Steroid Use and Involvement in Violent Behavior in a Nationally Representative Sample of Young Adult Males in the United States" (in en). American Journal of Public Health 98 (12): 2185–2187. doi:10.2105/AJPH.2008.137018. ISSN 0090-0036. PMID 18923108. 
  19. ↑ Clark, Ann S.; Barber, Diana M. (1994). "Anabolic-androgenic steroids and aggression in castrated male rats" (in en). Physiology & Behavior 56 (5): 1107–1113. doi:10.1016/0031-9384(94)90351-4. PMID 7824579. 
  20. ↑ Piacentino, Daria; Kotzalidis, Georgios; Casale, Antonio; Aromatario, Maria; Pomara, Cristoforo; Girardi, Paolo; Sani, Gabriele (2015-04-13). "Anabolic-androgenic Steroid use and Psychopathology in Athletes. A Systematic Review". Current Neuropharmacology 13 (1): 101–121. doi:10.2174/1570159x13666141210222725. ISSN 1570-159X. PMID 26074746. PMC 4462035. https://www.eurekaselect.com/article/63923. 
  21. ↑ Pope, Harrison G.; Kanayama, Gen; Hudson, James I.; Kaufman, Marc J. (2021). "Review Article: Anabolic-Androgenic Steroids, Violence, and Crime: Two Cases and Literature Review" (in en). The American Journal on Addictions 30 (5): 423–432. doi:10.1111/ajad.13157. ISSN 1055-0496. PMID 33870584. 
  22. ↑ Klötz, Fia; Petersson, Anna; Isacson, Dag; Thiblin, Ingemar (2007). "Violent crime and substance abuse: A medico-legal comparison between deceased users of anabolic androgenic steroids and abusers of illicit drugs" (in en). Forensic Science International 173 (1): 57–63. doi:10.1016/j.forsciint.2007.01.026. PMID 17337333. https://linkinghub.elsevier.com/retrieve/pii/S0379073807000606. 
  23. ↑ Choi, Precilla; Pope, Harrison (1994-03-01). "Violence Toward Women and Illicit Androgenic-Anabolic Steroid Use" (in en). Annals of Clinical Psychiatry 6 (1): 21–25. doi:10.3109/10401239409148835. ISSN 1040-1237. PMID 7951641. http://www.informaworld.com/openurl?genre=article&doi=10.3109/10401239409148835&magic=crossref%7C%7CD404A21C5BB053405B1A640AFFD44AE3. 
  24. ↑ Hamzelou, Jessica (2011-04-09). "Should steroid users be given drugs to treat 'roid rage'?" (in en). New Scientist 210 (2807): 12. doi:10.1016/S0262-4079(11)60777-X. Bibcode: 2011NewSc.210...12H. https://linkinghub.elsevier.com/retrieve/pii/S026240791160777X. 
  25. ↑ Huynh, Grace; Reinert, Justin P. (2021). "Pharmacological Management of Steroid-Induced Psychosis: A Review of Patient Cases" (in en). Journal of Pharmacy Technology 37 (2): 120–126. doi:10.1177/8755122520978534. ISSN 8755-1225. PMID 34752563. 
  26. ↑ Schorn, Peter (August 26, 2006). "South Park: The Complete Eighth Season DVD Review". http://www.ign.com/articles/2006/08/29/south-park-the-complete-eighth-season. 
  27. ↑ "Family Guy – Stew-Roids". https://tv.yahoo.com/family-guy/show/stew-roids/episode/205378. 



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