Substance or medication-induced depressive disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Substance-induced depressive disorder is characterized by a persistent depressed mood that developed during or after substance intoxication or withdrawal or after exposure to a medication.

Differential Diagnosis

Substance- or medication-induced depression must be differentiated from:

• Depressive disorder due to another medical condition
• Primary depressive disorder
• Substance intoxication and withdrawal

Epidemiology and Demographics

Prevalence

The prevalence of substance or medication-induced depressive disorder is 260 per 100,000 (0.26%) of the overall population.

Risk Factors

Risk factors for the development of substance- or medication-induced depressive disorder include:

• Antisocial behavior
• Alcohol or drug use disorders
• Family history of substance use disorders
• History of drug induced depression
• History of stressful life events
• History of major depressive disorder
• Psychosocial stressors
• Specific type of medication

• Effavirenz
• High estrogen/Progesterone in OCP
• Interferon alpha
• Prednisone

Diagnostic Criteria

DSM-V Diagnostic Criteria for Substance/Medication-Induced Depressive Disorder

“

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities. AND 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 substance intoxication or withdrawal or after exposure to a medication. 2. The involved substance/medication is capable of producing the symptoms in Criterion A. AND 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 non-substance/medication-induced depressive disorder (e.g., a history of recurrent non-substance/medication-related episodes). AND D. The disturbance does not occur exclusively during the course of a delirium. AND 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.

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References

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