Substance-Induced Mood Disorder: Diagnosis, Symptoms, and Treatment

Substance-induced mood disorder, the broad diagnosis that includes opioid-induced depressive disorder, describes the condition that occurs when an individual experiences persistent depressive symptoms following the dosage reduction or withdrawal of a substance, like an opioid medication. This disorder can occur after both prescription and illicit drug usage. While it can be challenging to diagnose accurately, it is a serious but treatable mental disorder that can cause significant distress and impairment.

Diagnosing Substance-Induced Mood Disorder

According to the Diagnostic and Statistical Manual for Mental Disorders 5, Text Revision (DSM-5-TR), several criteria need to be met to receive a diagnosis of substance-induced mood disorder. Mental health professionals need to do a thorough and comprehensive assessment to differentiate the symptoms from an independent depressive episode or an episode caused by another medical issue. It is critical to conduct a full physical evaluation, including laboratory blood tests, to rule out other organic causes for the depressive symptoms.

Diagnostic Criteria include:

Prominent, persistent, and significant mood disturbance that first occurred after reduction of or withdrawal from a substance capable of inducing depressive symptoms – and continues after the initial withdrawal period
Absence of evidence that the depressive episode is independent of the substance use or began before taking the medication

Mental health professionals may also take a full psychiatric history of immediate family members. Having a close family history of depressive episodes increases the risk of the individual suffering from depression, independent of the medication usage or withdrawal.

For the full list of diagnostic criteria for substance-induced mood disorder, enroll in this video course!

To qualify, symptoms of substance-induced mood disorder must be having a significant impact on the individual’s well-being and quality of life. Depressive symptoms might look different from one person to the next, but to meet diagnostic criteria of substance-induced mood disorder, the symptoms must cause “clinically significant distress” or impair functioning. It is important to gauge the degree in which the symptoms are interfering with one’s daily life.

Mental health professionals may use self-reporting scales, such as the Beck Depression Inventory, to aid in the assessment process. These easy-to-use scales allow individuals to identify which symptoms they are experiencing, including additional symptoms they might not have realized were clinically significant.

Symptoms include:

Depressive thoughts
Frequent crying
Emotional disturbances that are inconsistent with the individual’s behavior prior to the substance withdrawal

Treatment of Substance-Induced Mood Disorder

Treating substance-induced mood disorder requires a multi-faceted approach. For many people with substance-induced mood disorder, combining psychotherapy and drug counseling has been more effective than just one or the other. Cognitive-behavioral therapy (CBT) and motivational interviewing, or Motivational Enhancement Therapy (MET), are both prudent treatment options for this condition.

Like all other mood disorders, communication and support are critical for effective treatment and recovery. Over 50% of opioid prescriptions are given to individuals with pre-existing depression and other mood disorders. All patients receiving opioid therapy should be educated on the medication’s risks and carefully monitored during and after treatment. Those suffering from substance-induced depressive disorder are at risk for suicidal thoughts and behaviors, so maintaining open communication lines is essential to help mitigate this risk.

Learn more about the diagnostic criteria and treatment options for substance-induced mood disorder in this course, and view a clinical vignette displaying key symptoms and features of this condition.

Written by Jessica Dzubak, MSN, RN

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Resources:

U.S. Dept. HHS (2010) Substance Abuse Treatment Advisory, v.9(1).

APA Practice Guidelines (2006) Treatment of Patients with Substance Use Disorders

American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed, text revision). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.

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Woody, GE, McLellan AT, Luborsky, L, O’Brien, CP. Twelve-month follow-up of psychotherapy for opiate dependence. Am J Psychiatry. 1987 May;144(5):590-6.

Miller, W.R., and Rollnick, S. Motivational Interviewing: Preparing People To Change Addictive Behavior. New York: Guilford Press, 1991

Lundahl, B. W., Kunz, C., Brownwell, C., Tollefson, D., Burke, & B.L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Welfare Practice, 20(2), 137-160.