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

Substance-induced mood disorder, a 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 prescription or 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.

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.

    Substances That Can Induce Mood Disorders:

    • Alcohol
    • Opioids
    • Sedatives, hypnotics, or anxiolytics
    • Amphetamines or other stimulants
    • Cocaine
    • Hallucinogens
    • Inhalants
    • Phencyclidine (PCP)
    • Other substances or medications (including prescription drugs like steroids, antidepressants, or antihypertensive medications)

    To diagnose substance-induced mood disorder per DSM-5-TR, the mood symptoms (depression or mania) must be directly linked to substance use, intoxication, or withdrawal, cause significant distress or impairment, and not be attributable to another mood disorder or occur exclusively during delirium. This criterion helps ensure that the diagnosis focuses specifically on the substance’s role in mood disruption, rather than misattributing the symptoms to primary mood disorders like major depression or bipolar disorder.

    What are the Symptoms of Substance-Induced Mood Disorder?

    The symptoms of substance-induced mood disorder can vary depending on the substance involved and whether the symptoms align more with depression or mania. This disorder occurs when mood disturbances, such as depressive or manic symptoms, are directly linked to substance use, intoxication, or withdrawal. Below are the typical symptoms associated with depressive and manic presentations of substance-induced mood disorder:

    Symptoms of Substance-Induced Depressive Disorder:

    These symptoms occur in relation to substance use and resemble major depressive episodes.

    • Persistent depressed mood (feeling sad, hopeless, or empty)
    • Loss of interest or pleasure in most activities (anhedonia)
    • Fatigue or loss of energy
    • Changes in sleep patterns (insomnia or hypersomnia)
    • Appetite or weight changes (either loss or gain)
    • Feelings of worthlessness or excessive guilt
    • Difficulty concentrating or making decisions
    • Psychomotor agitation (restlessness) or retardation (slowed movements)
    • Thoughts of death or suicidal ideation

    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.

    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.

    What are the Treatments for Substance-Induced Mood Disorder?

    Substance-induced mood disorder requires a comprehensive treatment plan that addresses both the mood disturbance and the underlying substance use. Treatment modalities focus on stabilizing the mood, managing withdrawal symptoms, preventing relapse, and providing long-term mental health support. Treatment approaches typically include a combination of medical, psychological, and behavioral interventions.

    Discontinuation of the Substance

    • Immediate cessation of the substance causing the mood disorder is the primary intervention.
    • In some cases, medically supervised detoxification may be required to safely manage withdrawal symptoms, particularly with substances like alcohol, benzodiazepines, or opioids.
    • Gradual tapering might be necessary to avoid severe withdrawal symptoms, depending on the substance.

    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.

    References

    American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

    Marco Di Nicola, Pepe, M., Modica, M., Pierluigi Lanzotti, Panaccione, I., Moccia, L., & Janiri, L. (2020). Mixed States in Patients with Substance and Behavioral Addictions. Psychiatric Clinics of North America, 43(1), 127–137. https://doi.org/10.1016/j.psc.2019.10.012

    Revadigar, N., & Gupta, V. (2022, November 14). Substance Induced Mood Disorders. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555887/

    Elissa Singson, MSN, APRN, PHN, CPNP-AC is an infectious disease pediatric nurse practitioner, health writer, and mother of two. She writes content to empower healthcare professionals, patients, and families with health and medical knowledge. She also loves to share tips on work productivity and efficiency to prevent healthcare provider burnout.