These two terms are frequently confused.

Cortisol is a hormone produced naturally by the body's adrenal glands. It suppresses inflammation, provides energy, and regulates our daily rhythm, ensuring we become active in the morning. Acute stress causes the body's cortisol levels to rise temporarily.

Cortisone, in medicine, is a collective term for all medications that mimic the effects of cortisol to target and curb inflammation. It is used to treat many inflammatory and autoimmune conditions—such as asthma, rheumatism, neurodermatitis, or certain eye inflammations. Active ingredients like prednisone or prednisolone offer significant anti-inflammatory benefits. However, their dosage must be carefully managed to minimize any psychiatric side effects from the cortisone.

Many people are prescribed cortisone because it reliably controls inflammation. At the same time, studies show that tablets and infusions can influence mood, sleep, and cognitive function. Affected individuals frequently describe sleep disturbances, inner restlessness, increased ruminating, as well as sadness and anxiety.

The frequency of these effects depends primarily on the dosage and the duration of the treatment, with initial signs often beginning within the first few days to weeks of starting the intake or treatment. In many cases, the symptoms subside once the dose is reduced, and at the very latest after the treatment ends.

With localized forms of cortisone—such as inhalation sprays, creams, nasal sprays, or eye drops—significantly less of the active ingredient enters the bloodstream. Consequently, the risk of developing a full-blown cortisone-induced depression is generally lower compared to taking tablets, though restlessness or sleep problems can still occur.

Not everyone who takes cortisone is affected to the same extent. Numerous factors can influence how severely cortisone dampens mood or contributes to depression:

• Previous Mental Health Conditions: Individuals who have previously experienced depression or an anxiety disorder often react more sensitively to cortisone because the balance of messenger substances in their brain falls out of sync more easily.
• High Dose or Long Duration: The higher the dosage and the longer the medication is taken, the greater the risk of experiencing cortisone-induced side effects in the brain, such as concentration problems, irritability, and low mood.
• Method of Administration: Tablets and infusions act throughout the entire body and, compared to sprays, creams, or drops, increase the likelihood of psychiatric side effects.
• Lack of Sleep: Poor or insufficient sleep makes a person more susceptible to mood swings. Cortisone can then further disrupt sleep patterns.
• Other Medications: Some medicines accelerate or slow down the breakdown of cortisone, while others directly affect mood themselves. Therefore, all medications combined with cortisone—including over-the-counter products—should be reviewed by a doctor. Medications for epilepsy or tuberculosis, as well as St. John's wort (a herbal remedy for low mood), accelerate the breakdown of cortisone and reduce the risk of depressive side effects. Conversely, antifungal medications or grapefruit products slow down its breakdown and increase the risk.
• Age and Gender: Older individuals and women report mood swings somewhat more frequently. Many people type "high cortisol symptoms in women" into search engines: yes, in women, the symptoms of an excessively high cortisol level can lead to sleep disturbances, increased irritability, or changes in the menstrual cycle.
• Physical Strain: Severe inflammation—meaning a pronounced immune response with swelling, redness, severe pain, or fever, such as during an acute flare-up of rheumatism, severe bronchitis, or pneumonia—as well as pain or ongoing stress further increase susceptibility to depressive moods when taking cortisone simultaneously.

The most important step is always to speak with your treating doctor. In the meantime, there are immediate steps you can implement in your daily life, as well as measures that must be directed by your doctor.

Immediate Steps for Daily Life

• Take it in the Morning: Unless it goes against your doctor's recommendations, you could take your tablet in the morning, as this mimics the body's natural daily rhythm and can help you fall asleep more easily in the evening.
• Prioritize Sleep: Maintain fixed bedtimes, keep your bedroom dark, and avoid screens in the evening.
• Daylight and Exercise: Spend 20 to 30 minutes in the fresh air and move every day, as this helps stabilize your mood.
• Limit Caffeine and Alcohol: Reduce your intake of coffee, energy drinks, and alcohol, because they can worsen restlessness and disrupt your sleep.

Possible Actions by Your Doctor

• Carefully Reduce the Dose: The dosage could be lowered in small, gradual steps. You must never abruptly stop taking cortisone on your own, as doing so can lead to serious complications.
• Review Timing: The exact time of intake could be reviewed and, if necessary, moved to the early morning.
• Compare Alternatives: Switching to a different cortisone preparation can be useful if it is better tolerated.
• Change the Method of Administration: If medically feasible, a switch from tablets to a spray or cream could be considered to reduce the overall strain on the body.
• Introduce Accompanying Therapies: Cognitive Behavioral Therapy (CBT)—featuring targeted dialogue and exercises—can be considered. This can take the form of traditional, in-person talk therapy or a Digital Health Application (DiGA) like deprexis.

Digital help can make daily life easier. deprexis is a Digital Health Application (DiGA) that offers exercises based on Cognitive Behavioral Therapy (CBT). It helps interrupt ruminating, structure your day, and stabilize your sleep. A doctor can prescribe deprexis, and health insurance funds cover the costs.