What is Substance-Induced Mood Disorders?
While some people consume illegal drugs or certain prescribed medications to improve their mood, many surprisingly end up experiencing mood disorders after taking these substances. Instead of feeling the typical pleasure or the expected hangover, some people might develop symptoms of mania or depression. When mood disorders only appear in connection with substance use, they are labelled as substance-induced.
Such induced mood disorders can include conditions like bipolar disorder and depression. These disorders were once categorized under the title of ‘substance-induced mood disorders’ in a previous diagnostic manual, DSM-IV. But, in the latest version, the specification ‘substance-induced’ is now applied to different mood disorders. Conditions like depression and bipolar disorder are often seen alongside substance use disorders and are common in the general population.
This subject considers both depression and bipolar disorders that are caused by substance use, and discusses how these can be separated from mood disorders that exist with substance abuse disorders. For this topic, the term ‘substance-induced mood disorders,’ although no longer an independent category in the newest diagnostic manual, refers to both depression and bipolar disorders prompted by substance use.
What Causes Substance-Induced Mood Disorders?
Substance-induced disorders can happen during either the use or withdrawal of drugs or alcohol. Almost half of the episodes of depression in the general population follow periods of heavy drinking. Other substances that are commonly linked with these disorders are cocaine and opioids, particularly heroin.
Certain medicines can also cause abnormal mood states. These include drugs like interferon, corticosteroids, digoxin, and antiepileptic drugs. Either substances or these medications can lead to states of extreme happiness or mania, or depression.
Scientists believe that these substances change the way signals are transmitted in key pathways in the brain, such as the mesolimbic tract and the Papez circuit. Recent studies have also shown that our genes may make us more likely to both substance use disorders and mood disorders.
Risk Factors and Frequency for Substance-Induced Mood Disorders
The prevalence of depression caused by substance use throughout a person’s lifetime is estimated to be between 0.26% and 1%. Among individuals struggling with alcohol use, 40-60% are thought to suffer from this type of depression. Similarly, about 55% of individuals with opioid use disorder who are outpatient participants have been reported to have depression induced by substance use. Among those with major depression, 16.5% are also battling an alcohol use disorder and 18% a drug use disorder. Furthermore, 61% of individuals with bipolar I disorder are known to have issues related to substance use throughout their life.
Signs and Symptoms of Substance-Induced Mood Disorders
People with substance-induced mood disorders often experience similar symptoms to those with independent mood disorders, regardless of whether they also have substance use issues. These symptoms come in direct response to using the substance. Once severe intoxication or withdrawal ends, which may take up to a month, these symptoms usually disappear.
When someone is depressed, they may feel sad, sleepless, guilty, or helpless. They may also have thoughts of suicide, move or think slowly, easily lose focus, become irritable, lose their sex drive, feel a lack of energy, or lose their appetite.
If they are in a state of mania, they might have an inflated self-image, trouble focusing, impulsivity, rapid speech, racing thoughts, be sexually promiscuous, feel irritable, be sleepless, and have increased energy.
The type of substance being used can also influence the symptoms. For instance:
- Depressants, like alcohol, sedatives, or painkillers, can cause feelings of great happiness, poor impulse control, or unstable moods during the intoxication phase. Then, in the withdrawal phase, they may lead to irritability, restlessness, and unhappiness.
- Stimulants, like cocaine or amphetamines, can mimic conditions like bipolar disorder by causing euphoria, increased energy, lack of appetite, exaggerated feelings of self-worth, and paranoia. Withdrawal from stimulants can result in an inability to feel pleasure, lack of interest or enthusiasm, feeling depressed, and thoughts of suicide.
Testing for Substance-Induced Mood Disorders
A substance-induced mood disorder mimics the mood disorder it is related to. This means that a mood disorder caused by a substance will look a lot like a naturally occurring mood disorder. So, a substance-induced depression would seem like regular depression, and a substance-induced bipolar disorder would seem like a regular bipolar disorder.
The diagnosis of these substance-induced mood disorders requires the person to admit taking a substance or a positive lab test proving they’ve taken a substance. One of the easiest ways to tell if a mood disorder is caused by a substance or is a natural occurrence is by how long the mood disorder lasts. Usually, the symptoms of a substance-induced mood disorder will go away after the person stops taking the substance and the effects of the substance have fully worn off, usually up to a month.
For a substance-induced depressive disorder, the person could experience feelings of intense sadness or have no interest at all in their usual activities. For a substance-induced bipolar disorder, the person may have high energy, feel excessively happy, irritated, or have no interest at all in their usual activities. In both cases, the diagnosis needs to be confirmed by exploring the person’s history, physical examination, or lab findings. Lab results, imaging, and a detailed history should also rule out other causes of the mood disorder.
Treatment Options for Substance-Induced Mood Disorders
When someone has a mood disorder caused by substance use, it’s expected that their mood symptoms will improve once they stop using that substance. But sometimes, the symptoms can be severe enough that they need medication. Healthcare professionals use their judgment, patient history, and other relevant information to decide whether to manage symptoms during the withdrawal process using a ‘watch and wait’ approach, or whether to treat the mood disorder directly.
Given the relative safety of most antidepressants, some research suggests using these medications to alleviate depression symptoms in those who are also using substances. For manic symptoms, healthcare guidelines recommend certain antipsychotic medications, like quetiapine or olanzapine. These medicines tend to work faster than mood stabilizers.
The most critical part of treatment, however, is stopping consumption of the substance causing the problem. The specific treatment approach will vary depending on the patient’s specific substance use.
What else can Substance-Induced Mood Disorders be?
Sometimes, it can be hard to tell the difference between mental health issues that are caused temporarily by using substances and those that are a primary part of a person’s health. Doctors can learn more by watching how a person’s symptoms change when they stop using a substance. This way, they can see if the symptoms might have been caused by the substance. There’s a good chance that mood symptoms some people experience, such as mania, are linked to substance use.
Also, knowing if a person has a family history of mental health issues can help doctors determine if the symptoms are part of a primary mental health disorder or are caused by substance use. This process might be a little more complicated when mania symptoms are involved, as these are often closely linked with substance use.
What to expect with Substance-Induced Mood Disorders
Theoretically, maintaining sobriety should decrease mood symptoms. Staying sober is often the best predictor of future wellbeing. So, anything that encourages a sober lifestyle, like family support, therapy, financial stability, and sticking to prescribed medication, can help improve the chances of recovery.
Conversely, environments that increase the risk of using substances can lead to a less favorable outcome.
Possible Complications When Diagnosed with Substance-Induced Mood Disorders
The greatest risk associated with mood disorders caused by substance use is suicide. Research shows that suicide attempts are more frequent in mood disorders that are triggered by substance use. In fact, one study found that the risk of attempted suicide increases nearly four times when the mood disorder starts in the context of substance use.
Preventing Substance-Induced Mood Disorders
To prevent mood disorders caused by substance use and to educate patients, it’s recommended to:
- Avoid alcohol or illegal drugs.
- Stay away from people or environments that encourage the use of alcohol or illegal drugs.
- Consider attending support groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) to assist in recovering from alcohol and drug problems.
- Always inform your doctor about any new medication a different doctor prescribes, as some medications might lead to episodes of manic behavior or depression.
- If you’re worried about over-the-counter medicines, reach out to your doctor, as some of these drugs can intensify the effects of other medications, possibly leading to manic episodes or depression.
- Maintain a healthy diet, limit caffeine, and stop smoking.
Pay attention to changes in mood like depression or mania after starting a new medication or substance use. If you notice these changes, make sure to discuss them with your primary care doctor or psychiatrist.
