Dr. Ritchi Morris is an expert/pioneer in the treatment of P.T.S.D. (Post Truamatic Stress Disorder).
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Dr. Ritchi Morris has worked with players from many professional sports and olympic athletes treating anbolic steroid and other illegal drug abuse. He asserts that anabolic steriods can be just as addictive as any other illegal or perscription drug.

The Effects of Steroid use on Depression among Athletes

by Ritchi Morris, Di. Sci., Ph.D., H.M.D., N.D.
Vital Quests, Associates for Health & Performance Improvement

ABSTRACT
The use of anabolic steroids has sparked quite a controversy over their advantages, disadvantages, benefits, and side effects. Several sparse efforts have promulgated research data in an attempt to explore the physiological and/or psychological results. However, much of these data have been obtained from either non-empirical (anecdotal/single case study) or quasi-empirical methods. This study explores the psychological side effects of depression in an empirical, standardized A.P.A. research design. While depression has been cited by surveys during the "off cycles," this study determines that depression also exists during periods of usage in statistically significant amounts. This seems to indicate that anabolic steroids may act as a mask for depression and possibly other psychological/emotional dysfunctions) during usage cycles.

The use of anabolic steroids has a dramatic effect upon athletic performance. But, traveling the steroid road involves paying tolls: undaunted physiological and psychological side effects. This study explores one of the most prominent, yet little documented psychological side effects - depression. The attraction of anabolic steroids is primarily their ability to quickly increase strength, speed, and body weight among athletes. Tricker, 0'Neill and Cook (1989) reported that body builders felt they needed steroids to win competitions. One of their subjects reported a two-year period with a low fat to steroid use, he could squat (a deep knee bend shoulders) 135 lbs.; after two years, he Pope and Katz suggest that the capacity for anabolic steroids to help athletes "bulk up" may actually be underestimated by the medical profession. This underestimation may be due to the underground dissemination of knowledge on various drug combinations for a variety of results (Perry, Andersen, & Yates, 1990). For, the mixing of several drugs simultaneously, known as "stacking," has become a common among steroid users. Pope and Katz (1988) wrote that weight gain of 90 pounds over a level. Prior with barbells on the could squat 655 lbs.

Pope and Katz (1988) found that many steroid users reported feelings of euphoria, heightened sex drive, and feelings of invulnerability during anabolic steroid use cycles. Kashkin and Kleber (1989) have documented increases in self-esteem, libido, and energy associated with anabolic steroid use. They refer to the psychic changes induced by anabolic steroids as "intoxication." It is not surprising that such physical and psychological changes would result in widespread use, despite the severe physiological and psychological contraindications In a study of the incidence of anabolic steroid use among 106 competitive body builders in Kansas and Missouri, Tricker O'Neill and Cock (1989) found that 10.3% of the female and 54.6% of the male users reported that they were using anabolic steroids. Because they used mailed survey questionnaires and had a 46% response rate, it is likely that their estimates of actual incidence is low, since steroid use without a prescription is illegal, and steroid users have evinced paranoia (Kashkin & Kleber, 1989 . Hays, Littleton, and Stillner (1990) reported that one c_° their pati reported that 80-90$ of the power lifters at his club were steroid users. The popularity of illicit anabolic steroid use was highlighted by Perry, Andersen, and Yates (1990), who indicated that there is a "self-help" book widely circulated throughout gyms in the U.S., entitled Underground Steroid Handbook, that describes the rules of steroid use and describes the various drugs and their properties. These data indicate widespread steroid use among male and female weightlifters and among other strength athletes.

The adverse psychological effects of using anabolic steroids has been reported by numerous researchers (Kashkin & Kleber, 1989). There have been reports of psychotic symptoms manifested among athletes reporting steroid use by virtually every researcher in the field (Brower et al., 1990 Hays et al., 1990; Kashkin & Kleber, 1989; Perry, Andersen, & Yates 1990). Yates Perry, and Andersen (1990), in a comparison 2C anabolic steroid using weightlifters with 2C non-using weightlifters, alcoholics, and 20 controls, suggested that anabolic steroid users were similar to alcoholics in their anti-social traits.

Although literature is limited, there is evidence to suggest that there is a relationship between anabolic steroid use and depression. Pope and Katz (1988) interviewed 41 body builders and football players who used steroids to determine the extent c_° their affective and psychotic symptoms. The researchers identified four symptoms meeting DSM-III-R criteria. Five 12.2*) of the subjects interviewed had developed major depression during steroid withdrawal and two subjects developed depression while off steroids. Perry, Andersen, and Yates (1990) in a study of 20 weightlifters, reported that described themselves as becoming depressed during their cycles. Symptoms of clinical depression were reported in 40-50% of their subjects. In a study of eight weightlifters, Brower et al. (1990) found that all eight reported withdrawal symptoms, and three were classified as depressed using DSM-III-R criteria.

Although there is ample evidence to indicate that depression is associated with anabolic steroid use among strength athletes of all genders, races and ethnic backgrounds, there is some confusion about exactly when it occurs and the amount: whether such depression is more prevalent during the competitive cycle (when the drugs are taken) or during the non-competitive withdrawal cycle (when the drugs are not taken). Brower et al. (1990) identified the depression as part of the symptoms of withdrawal only. The one depressive case reported by Pope and Katz (1987) also developed depression during withdrawal only (when off the drug). Conversely, Perry, Yates, and Andersen (1990) reported high levels of depression among 20 weightlifters when they were in their competitive cycles and using the drugs. Hays et al. (1990) single case also reported depression during the competitive cycle. Because of methodological shortcomings, it has been impossible to discern precisely when depression is likely to occur among anabolic steroid users. Brower et al. reported findings from only eight subjects, Pope and Katz(1987) and Hays et al. (1990) provided accounts on single anecdotal cases. Perry, Yates, and Andersen (1990) used retrospective reports. None of these researchers compared steroid users with non-users for depression in a standardized A.P.A. empirical research format.

This study attempts to steroid use and depression overcome the weaknesses of levels of depression among not use steroids to enhance performance.
the Institute for Personality and Ability Testing Depression Scale during the middle c_' during the middle of their non-competitive cycle.
clarify the relationship between using methodological techniques that earlier studies This study compares athletes who used and athletes who did All Subjects completed (I PAT) their competitive cycle and Hypothesis

This study was based on the hypothesis that 1) steroid users have significantly higher depression levels during BOTH the competitive and non-competitive cycles than the control group of non-users; and that 2) significantly higher levels of depression would be found in both male and female users when compared to same Method

Subjects
Subjects were male and female professional athletes. The males were either professional baseball, football or track and field athletes. The females were track and field athletes, body builders, and weightlifters. The initial sample consisted of 11 subjects who used steroids to enhance performance, and nine subjects who did not use the performance-enhancing drug. Attrition in the steroid-user group resulted when several subjects indicated that they could not stay off the drug. One natural subject did not complete both a dminis tr a tions of the depression scale. Thus, 16 of the original 20 athletes completed the depression scales twice, and their data were retained for analysis. The 16 subjects consisted of eight steroid users and eight non-users. There were four males and four females in each group.

Instrument
The IPAT Depression Scale (Krug & Laughlin, 1976) served as the measure of depression. The scale consists of 40 items withtrue-uncertain-false item format. The scale is scored using either an uncorrected version or corrected version. The cor-rected raw score, used for data analysis purposes in this study, is the sum of the item scores, 1's and 2's, obtained with a key.

Reliability and validity of the IPAT Depression Scale has been reported. Reliability for the scale was calculated on more than 2,000 subjects in homogeneous groups. Coefficient alpha, a measure of internal consistency reliability, yielded coefficients ranging from .85 for adult normals to .93 for samples of depressives and clinical patients excluding depressives. Parallel split-half reliability coefficients ranged from .89 for adult normals to .95 for clinic patients.

Predictive and discriminant validity for the scale were examined. A correlation of .88 was found, between the uncorrected version of the scale and a measure of pure depression, establish ing the predictive validity of the scale. To examine discriminant validity, t-tests were carried out comparing the depression scores of normal subjects and depressives. Results revealed significant differences between the two groups ON depression. In addition, correlation coefficients calculated between the scores on the IPAT Depression Scale and the NffMPI, and the CAQ (Clinical Analysis Questionnaire) were generally consistent in direction with expectations.

Procedure
Subjects were assessed on the IPAT Depression scale twice: once the middle of the "on" or competitive cycle and once approximately three months later, in the middle of the "off" or non-competitive cycle. A 2 x 2 repeated measure analysis of variance was carried out with scores on the IPAT Depression Scale as the dependent variables. Between subjects factors were Within subjects factors were times and the interactions time and group and time and sex.

Results
Table 1 presents the results of data analysis. Table 1 shows the means and standard deviations for the :PAT Depression Scale cycles with scores categorized by group and the non-users had lower mean depression scores than the steroid user group during both the competitive and non-competitive cycles (F = 17.51, p < .o1) Neither sex, time, nor interactions between time and sex or group accounted for significant amounts of variation.

Means and Standard Deviations for the IPAT Depression Scale
Group (n) Competitive Non-Competitive
Steroid Users
Males 4    
M
SD
  32.75
10.44
38.25
23.25
Females 4    
M
SD
  28.00
11.86
32.50
12.55
TOTAL 8    
M
SD
  30.38
10.65
35.37
17.57
Non-Users
Males 4    
M
SD
  12.25
4.50
15.00
4.32
Females 4    
M
SD
  17.00
11.34
15.75
7.50
TOTAL 8    
M
SD
  14.63
8.38
15.38
5.68

 

Summary of Analysis of Variance
Source SS df MS F
Between Subjects
Group
Sex
Error
2256.13
12.50
1898.25
1
1
13
2556.13
12.50
146.02
17.51*
.09
Within Subjects
Time
Time x Group
Time x Sex
Error (Time)
66.13
36.13
12.50
1750.25
1
1
1
13
66.13
36.13
0.09
134.63
0.49
0.27
0.09
*p < .01

 

Discussion
The results of the present study suggest that athletes who use anabolic steroids have higher levels of depression during both their use and non-use cycles when compared to their counter parts who do not use steroids. Several theories have been offered to account for this depression. Kashkin and Kleber (1989) suggested that depression may have a consequence of withdrawal similar to the postpartum depression associated with hormonal level changes. They also suggest that there may be a delayed withdrawal depression resulting from loss of muscle mass. Pope and Katz (1988) noted that many subjects used human chorionic gonadotropin to restimulate their endogenous testosterone production and minimize the effects of withdrawal. Kashkin and Kleber suggested that hormonal therapy was indicated for withdrawal symptoms. As noted above, Brower et al. (1990) associated depression with withdrawal only.

Since the data in this study were collected at midpoints of the competitive and non-competitive cycles, they suggest that withdrawal may be an intensifying factor, and that depression may either be constant for athletes on steroids independent of cycle or that a complex combination of physiological and socialpsychological factors result in different casual sequences in competitive and non-competitive cycles. Kashkin and Kleber (1989), Tricker, et al. (1989), and Perry, Andersen, and Yates (1990) have documented severe mood swings among steroid users. {ashkin and Kleber and Perry et al. have posited that steroid use car. result in bipolar disorders. Therefore, it is not surprising that steroid users might report depression symptoms in the competitive stage. It is possible that steroid use, especially the "stacking" of various drugs, results in violent mood swings. During the non-competitive off-drug cycle, depression may be more likely associated with withdrawal and loss of self-esteem as physical powers diminish.

The IPAT allows respondents to also report their subjective feelings. A content analysis of perceptions of the respondents indicates that they feel much better when using steroids than when they are not using them. For example, a female power lifter stated while on steroids, "I can hold my own with even the males in my class. I'm going for the top.... I can handle any pressure, any competition. I'll be the female (Muhammed) Ali of power lifting!!!" On the off cycle, she wrote, "Washed out and half myself. It's hard to believe I can get so weak so quickly. It's like I don't even want to train 'cause I don't want to know this part. Oh, Lord, let me just sleep through this time and make me strong and tough again!"

These responses are quite typical of the steroid-using group. Their responses are rife with inflated, even grandiose ideation during their usage cycles. Diametrically opposite feelings of weariness, lethargy, low self-esteem, insecurities, etc. are reported during their off cycles. Although the IPAT depression scores register higher levels of depression during the non-competitive cycle, it is clear that steroid users are more depressed than non-users throughout the whole cycle. This suggests that the steroids may not only contribute to depression, but they may also mask the symptoms during periods of use. This may account for reports of severe mood swings and indicators of bipolar disorders by the aforementioned researchers.

Predicated upon the results obtained in this study, it appears that people who use steroids develop a depression syndrome during their usage cycle which may increase when these people cease taking the anabolic steroids. The findings of this study are limited by the small sample size and, therefore, must be considered suggestive. It must be emphasized, by way of justification for the small N, that it is exceedingly difficult to obtain subjects who wish to admit to anabolic steroid usage in view of the greatly increased adverse publicity/pressure extant.

There are two appropriate recommendations: 1) Future research should use larger samples to examine the effects of steroid use on depression and other psychological symptomatology such as aggression, paranoia, and bipolar dysfunction; 2) Research should also be conducted for the possibility that steroid use may mask symptoms of psychological disorders.

References

Brower, K.J., Eliopulos, G.A., Blow, F.C., Catlin, D.H., & Beresford, T.P. (1990). Evidence for physical and psychological dependence on anabolic androgenic steroids in eight weightlifters. American Journal of Psychiatry, 147, 510-512.

Hays, L.R., Littleton, S., & Stillner, V. (1990). Anabolic steroid dependence. American Journal of Psychiatry, 147, 122.

Krug, G. & Laughlin, J. (1976). Personal Assessment Inventory. Champaign, IL: Institute for Personality and Ability Testing, Inc.

Perry, P.J., Yates, W.R., & Andersen, K.H., (1990). Psychiatric symptoms associated with anabolic steroids; A controlled, retrospective study. Annals of Clinical Psychiatry, 2, 11-17.

Perry, P.J., Andersen, K.H., & Yates, W.R. (1990). Illicit anabolic steroid use in athletes. The American Journal of Sports Medicine, 18, 422-428.

Pope, Jr., H.G., & Katz, D.L. (1987). Bodybuilder's psychosis. Lancet, 1, 863.

Pope, Jr., H.G. & Katz, D.L. (1988). Affective and psychotic symptoms associated with anabolic steroid use. American Journal of Psychiatry, 145, 487-490.

Tricker, R., O'Neill, M.R., & Cook, D. (1989). The incidence of anabolic steroid use among competitive bodybuilders. Journal of Drug Education, 19, 313-325.

Yates, W.R., Perry, P.J., & Andersen, K.H. (1990). Illicit anabolic steroid use: A controlled personality study. Acta_ Psychiatrica Scandinavica, 81, 548-550.