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

Substance-Induced Mood Disorder DSM-5-TR Criteria

According to the Diagnostic and Statistical Manual for Mental Disorders 5, Text Revision (DSM-5-TR), the diagnosis of substance-induced mood disorder falls under the broader category of substance/medication-induced depressive disorder and substance/medication-induced bipolar and related disorder. The criteria for diagnosing a substance-induced mood disorder are as follows:

Prominent Mood Symptoms

The individual must display significant mood disturbances, characterized by either:

• Depressed mood (e.g., feeling sad, empty, or hopeless), or
• Mania (e.g., elevated, expansive, or irritable mood).

Evidence that Symptoms Are Substance-Induced

There must be clear evidence from history, physical examination, or laboratory findings that:

• The mood disturbance developed during or soon after substance intoxication, substance withdrawal, or exposure to a medication known to cause mood disturbances.
• The substance or medication involved is capable of producing the mood symptoms observed.

Exclusion of Other Causes

The disturbance should not be better explained by another mood disorder that is unrelated to substance use. This can be confirmed by the following:

• Timing of onset: The symptoms should begin after exposure to the substance or withdrawal.
• If the mood disturbance persists beyond the expected duration of intoxication or withdrawal, another mood disorder diagnosis should be considered.

Significant Impairment

The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Exclusion of Delirium

The mood disturbance must not occur exclusively during a delirium (a severe state of confusion and disorientation).

Specifiers:

When diagnosing a substance-induced mood disorder, the following specifiers may be used to indicate the substance involved:

• With onset during intoxication: If the symptoms arise while the person is under the influence of the substance.
• With onset during withdrawal: If the symptoms occur during withdrawal from the substance.

Symptoms of Substance-Induced Manic Disorder:

These symptoms mirror those of a manic or hypomanic episode and are related to the use of substances or withdrawal.

• Elevated or irritable mood (feeling unusually happy, euphoric, or angry)
• Inflated self-esteem or grandiosity
• Decreased need for sleep (feeling rested after only a few hours)
• Increased talkativeness or pressure to keep talking
• Racing thoughts or flight of ideas
• Distractibility
• Increased goal-directed activity (at work, socially, or sexually) or physical restlessness
• Engaging in risky behaviors (e.g., reckless spending, unsafe sex, substance use)

Additional Symptoms:

• Mood swings: Shifts between depressive and manic-like symptoms may occur, especially with certain substances.
• Irritability or agitation, often linked to intoxication or withdrawal phases.
• Anxiety: Substance-induced mood disorders can sometimes feature anxiety symptoms alongside mood disturbances.

The symptoms of substance-induced mood disorder reflect the mood disturbances typically seen in depression or mania, but the use, intoxication, or withdrawal from substances triggers them. Understanding the pattern of use and timing of symptoms is crucial in identifying whether a mood disorder is substance-induced.

Pharmacological Treatment

Medications can play a key role in stabilizing mood and managing withdrawal symptoms. The choice of medication depends on the type of mood disturbance (depression or mania) and the substance involved.

For Substance-Induced Depression:

• Antidepressants: Medications like SSRIs (e.g., fluoxetine, sertraline) or SNRIs (e.g., venlafaxine, duloxetine) can help manage depressive symptoms once the substance is discontinued.
• Non-habit-forming anxiolytics: In cases where anxiety is prominent, medications like buspirone may be prescribed.

For Substance-Induced Mania:

• Mood stabilizers: Medications such as lithium, valproate, or lamotrigine can help control manic symptoms.
• Antipsychotics: Second-generation antipsychotics (e.g., olanzapine, quetiapine) may be used to manage severe mania, agitation, or psychosis.

For Withdrawal Symptoms:

• Benzodiazepines: Used short-term to manage withdrawal from alcohol or sedatives, though they must be carefully managed due to addiction risk.
• Clonidine or buprenorphine: Sometimes used to manage opioid withdrawal symptoms.
• Disulfiram or naltrexone: Medications for long-term recovery from alcohol or opioid dependence to prevent relapse.

Psychotherapy and Counseling

Psychotherapy is crucial in addressing both the mood disorder and the substance use disorder (SUD). Evidence-based therapies include:

Cognitive Behavioral Therapy (CBT):

• CBT helps patients identify negative thought patterns contributing to mood disturbances and substance use.
• It teaches coping mechanisms to manage triggers for substance use and improve emotional regulation.

Dialectical Behavior Therapy (DBT):

• DBT is especially useful for individuals with co-occurring substance use and mood dysregulation.
• DBT focuses on mindfulness, emotional regulation, and distress tolerance.

Motivational Interviewing (MI):

• This therapy helps individuals resolve ambivalence and validates emotions about their substance use, which builds motivation for change.

Pharmacological Treatment

Medications can play a key role in stabilizing mood and managing withdrawal symptoms. The choice of medication depends on the type of mood disturbance (depression or mania) and the substance involved.

For Substance-Induced Depression:

• Antidepressants: Medications like SSRIs (e.g., fluoxetine, sertraline) or SNRIs (e.g., venlafaxine, duloxetine) can help manage depressive symptoms once the substance is discontinued.
• Non-habit-forming anxiolytics: In cases where anxiety is prominent, medications like buspirone may be prescribed.

For Substance-Induced Mania:

• Mood stabilizers: Medications such as lithium, valproate, or lamotrigine can help control manic symptoms.
• Antipsychotics: Second-generation antipsychotics (e.g., olanzapine, quetiapine) may be used to manage severe mania, agitation, or psychosis.

For Withdrawal Symptoms:

• Benzodiazepines: Used short-term to manage withdrawal from alcohol or sedatives, though they must be carefully managed due to addiction risk.
• Clonidine or buprenorphine: Sometimes used to manage opioid withdrawal symptoms.
• Disulfiram or naltrexone: Medications for long-term recovery from alcohol or opioid dependence to prevent relapse.

Psychotherapy and Counseling

Psychotherapy is crucial in addressing both the mood disorder and the substance use disorder (SUD). Evidence-based therapies include:

Cognitive Behavioral Therapy (CBT):

• CBT helps patients identify negative thought patterns contributing to mood disturbances and substance use.
• It teaches coping mechanisms to manage triggers for substance use and improve emotional regulation.

Dialectical Behavior Therapy (DBT):

• DBT is especially useful for individuals with co-occurring substance use and mood dysregulation.
• DBT focuses on mindfulness, emotional regulation, and distress tolerance.

Motivational Interviewing (MI):

• This therapy helps individuals resolve ambivalence and validates emotions about their substance use, which builds motivation for change.

Relapse Prevention Therapy:

• It helps individuals develop strategies to prevent relapse by recognizing triggers and building healthier coping strategies.

Supportive Care and Lifestyle Modifications

• Psychoeducation: Teaches the patient and their family about the nature of substance-induced mood disorders and the role of substance use in mood regulation.
• Support groups: Participation in peer support groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), can provide ongoing support in maintaining sobriety.
• Holistic approaches: Techniques like mindfulness, meditation, exercise, and nutrition can enhance mood and support recovery.

Aftercare and Relapse Prevention

Long-term recovery from a substance-induced mood disorder requires ongoing monitoring and support:

• Continued medication and psychotherapy may be needed to maintain mood stability and prevent relapse.
• Sober living environments or recovery communities provide structured, drug-free settings to support ongoing recovery.
• Regular follow-ups with healthcare providers to monitor for any re-emergence of mood symptoms or substance use.

Treatment for substance-induced mood disorder involves discontinuing the substance, managing withdrawal, stabilizing the mood with appropriate medications, and addressing both the substance use and mood symptoms through psychotherapy and dual-diagnosis programs. Ongoing support, lifestyle changes, and relapse prevention strategies are essential for long-term recovery and mental health stability.

• It helps individuals develop strategies to prevent relapse by recognizing triggers and building healthier coping strategies.

Supportive Care and Lifestyle Modifications

• Psychoeducation: Teaches the patient and their family about the nature of substance-induced mood disorders and the role of substance use in mood regulation.
• Support groups: Participation in peer support groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), can provide ongoing support in maintaining sobriety.
• Holistic approaches: Techniques like mindfulness, meditation, exercise, and nutrition can enhance mood and support recovery.

Aftercare and Relapse Prevention

Long-term recovery from a substance-induced mood disorder requires ongoing monitoring and support:

• Continued medication and psychotherapy may be needed to maintain mood stability and prevent relapse.
• Sober living environments or recovery communities provide structured, drug-free settings to support ongoing recovery.
• Regular follow-ups with healthcare providers to monitor for any re-emergence of mood symptoms or substance use.

Treatment for substance-induced mood disorder involves discontinuing the substance, managing withdrawal, stabilizing the mood with appropriate medications, and addressing both the substance use and mood symptoms through psychotherapy and dual-diagnosis programs. Ongoing support, lifestyle changes, and relapse prevention strategies are essential for long-term recovery and mental health stability.