Depressive symptoms can commonly occur during substance intoxication and withdrawal. If the severity of mood symptoms warrants independent clinical attention, a diagnosis of substance-induced depressive disorder should be considered instead of solely attributing it to substance intoxication or withdrawal.

Substance Intoxication and Withdrawal as Differential Diagnoses to Substance/Medication-Induced Depressive Disorder

A substance/medication-induced depressive disorder is distinguished from an independent depressive disorder by the presence of depressive symptoms occurring apart from substance or medication use. If the depressive syndrome does not occur when the substance or medication is being used, it should be diagnosed as an independent depressive disorder.

Independent Depressive Disorder as a Differential Diagnosis to Substance/Medication-Induced Depressive Disorder

When individuals have medical conditions and take medications, clinicians should consider whether mood symptoms are caused by the medical condition itself or the medication. The patient's history is crucial for making this determination. Adjustments in medical treatment may be needed to determine the causative agent. If both substance use or withdrawal and another medical condition contribute to the disturbance, both diagnoses may be given. When there is insufficient evidence to attribute the symptoms to substance use, another medical condition, or if they are independent, a diagnosis of other specified depressive disorder or unspecified depressive disorder is used.

Depressive Disorder due to Another Medical Condition as a Differential Diagnosis to Substance/Medication-Induced Depressive Disorder 

- Substance intoxication and withdrawal.
- Independent depressive disorder.
- Depressive disorder due to another medical condition.


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A disorder that occurs when a specific substance causes depressed mood or markedly diminished interest or pleasure in all, or almost all, activities due to its physiological effects. 

Substance/Medication-Induced Depressive Disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by a depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.

B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
1-  The symptoms in Criterion A developed during or soon after the substance intoxication or withdrawal or after exposure to or withdrawal from a medication.
2-  The involved substance/medication is capable of producing the symptoms in Criterion A.

C. The disturbance is not better explained by a depressive disorder that is not substance/medication-induced. Such evidence of an independent depressive disorder could include the following:
-  The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent nonsubstance/medication-induced depressive disorder (e.g., a history of recurrent non-substance/medication- related episodes).

D. The disturbance does not occur exclusively during the course of delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: This diagnosis should be made instead of a diagnosis of substance
intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

[DSM-5-TR] Diagnostic Criteria of Substance/Medication-Induced Depressive Disorder

Among individuals with substance use disorders, it has been found that the occurrence of depressive episodes caused by alcohol and stimulant use is reported to be 40% or more over their lifetime. However, the lifetime prevalence of substance/medication-induced depressive disorder, excluding cases of non-substance-induced depressive disorder, is only 0.26%. 

Prevalence of Substance/Medication-Induced Depressive Disorder 

A depressive disorder linked to substance use typically emerges while the individual is actively using the substance or experiencing withdrawal if there is a withdrawal syndrome associated with that substance. Often, the depressive symptoms begin within a few weeks or a month of heavy substance use. Once the substance is stopped (through abstinence), the depressive symptoms usually improve within days to several weeks, depending on the substance's half-life and the presence of withdrawal symptoms. If the symptoms persist beyond the expected withdrawal period (about four weeks) for a specific substance, other potential causes for the depressive mood symptoms should be explored.

Development and Course of Substance/Medication-Induced Depressive Disorder 

Some risk factors for developing substance/medication- induced Depressive Disorder are; 
- Antisocial personality disorder 
- Schizophrenia 
- Bipolar disorder 
- History of stressful life events in the past 12 months 
- History of prior drug-induced depressions 
- Family history of substance use disorders.

Furthermore, the chemical nature and drug interactions of certain substances in our body make remission less likely due to withdrawal risks (such as alcohol). In addition, factors such as poverty, race and  other marginalization factor might be perpetuating to this disorder.

Risk and Prognostic Factors of Substance/Medication-Induced Depressive Disorder  

 Sex and Gender can be differential in the prevalence or risks of developing certain diagnosis

Related Diagnostic Issues of Substance/Medication-Induced Depressive Disorder

Blood and urine tests are not reliable in determining substance/medication-induced depressive disorder. This is due to the depressive symptoms being able to last longer than the presence of a substance on a system, and the mere consumption of a substance is not enough to determine the causality of substance/medication-induced depressive disorder. 

Diagnostic Markers of Substance/Medication-Induced Depressive Disorder

Individuals who consume substances such as alcohol are at higher risk of depressive episodes that can lead to a higher risk of suicide attempt.

Substance/Medication-Induced Depressive Disorder Association with Suicidal Thoughts or Behavior 

Differential Diagnoses to Substance/Medication-Induced Depressive Disorder

In a study comparing two groups, one with independent major depressive disorder (without substance use disorder) and the other with substance/medication-induced depressive disorder, the second group had higher rates of other mental disorders. They were more likely to have issues like tobacco use, gambling, and antisocial personality disorder, but less likely to have persistent depressive disorder. Compared to individuals with major depressive disorder and substance use disorder, those with substance/medication-induced depressive disorder were more likely to have alcohol or substance use disorder but less likely to have a persistent depressive disorder.

Comorbid Diagnoses to Substance/Medication-Induced Depressive Disorder

This includes the intersection of connections and/or research related to substance / medication-induced depressive disorder in other fields of study and research. Such fields include:
Behavioral Neuroscience
Clinical Psychology
Health Psychology



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