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 

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


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



Interdisciplinary Connections & Research Related to Substance/Medication-Induced Depressive Disorder

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. 

Alma College

The DSM-5-TR separates Depressive Disorders into the following specific disorders: 
- Disruptive Mood Dysregulation Disorder
- Major Depressive Disorder (MDD)
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
- Substance / Medication-Induced Depressive Disorder
- Depressive Disorder Due to Another Medical Condition
- Other Specified Depressive Disorder
- Unspecified Depressive Disorder
- Unspecified Mood Disorder
- Specifiers for Depressive Disorders


[DSM-5-TR] List of Depressive Disorders 

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

Disruptive Mood Dysregulation Disorder is primarily characterized by chronic, severe, and persistent irritability that manifests in temper outbursts and/or persistent irritable and angry moods amongst children and adolescents. These symptoms are present in a non-episodic format and are consistently present in the individual as opposed to going through episodic bouts of anger and irritability. 

Disruptive Mood Dysregulation Disorder

Major depressive disorder is a type of depressive disorder characterized by distinct episodes involving deep sadness and a loss of interest or enjoyment in previously pleasurable activities, among other related symptoms.

Major Depressive Disorder

Premenstrual Dysphoric Disorder or PMDD is categorized as a mood disorder. It is marked by a slew of symptoms that occur the week prior to the start of menses. Its existence as a disorder and its inclusion in the DSM is highly controversial. 

Premenstrual Dysphoric Disorder

Substance/Medication-Induced Depressive Disorder

Complications from pre-existing conditions like chronic illness can lead to the development of a Depressive Disorder Due to Another Medical Condition, which is a prominent and persistent period of low mood and interest. 

Depressive Disorder Due to Another Medical Condition

Persistent depressive disorder, also known as dysthymia, is a depressive disorder identified by a long-term, chronic state of sadness.

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