Cortico-steroids are a common therapeutic agent in cancer medicine. They are used for symptom control (for example in managing cerebral oedema after brain irradiation), for prevention of side effects (for example in minimizing post chemotherapy nausea), and as an important component of chemotherapy (for example in chemotherapy of lymphoma). Steroids are also often used in the palliative care phase of cancer treatment, for management of nausea, poor appetite, weight loss, fatigue and low energy. While notorious for the protean side effects associated with their use, steroids are unusual in their capacity to produce a range of psychological and psychiatric side effects, including insomnia, increased anxiety symptoms, depressive episodes and (rarely) psychotic episodes. Every clinician is familiar with these side effects, and they are listed in product information, but there is remarkably little systematically collected evidence about them, few research papers and little consensus about best management. This paper will review available data, and current guidelines for management of psychiatric and psychological side effects. We will also propose a series of potential research questions, and a brief study protocol.