Many psychiatric side effects have been noted with steroid administration. Occurring in about 6% of all patients on steroids, they are not uncommon. The English-language literature from 1951 to the present reveals numerous case reports and reviews but few prospective, controlled studies exploring this issue. This paper reviews the various psychiatric presentations and the relationship to patient profile, steroid type, dosage, and therapy duration. In 90% of cases, symptoms are reversible with steroid termination; some patients require psychopharmacologic treatment. Prophylaxis with lithium carbonate has met with good response in a few anecdotal reports and one prospective study.