What is Substance Induced Depression?

Published: 12/19/2013 | Author: Mark Harrigan

Many people take substances to experience feelings of euphoria or pleasure; however, feeling good is not always the result when drinking alcohol or taking prescription or illicit drugs. For some, the substance can cause symptoms of depression that are far worse than a hangover or a “comedown.” This is called substance induced depression and can be very distressing.¹

In this article:

• What is Substance Induced Depression?
• What Substances May Cause Substance Induced Depression?
• Signs of Substance Induced Depression
• Diagnosis of Substance-Induced Depression
• How is Treatment for Substance Induced Depression Chosen?
• Treatment for Substance Induced Depression
• Find a Treatment Program

What is Substance Induced Depression?

Substance induced depression was once listed in the Diagnostical and Statistical Manual as a separate mood disorder. The latest version is listed as a type of depressive disorder. The DSM-5 lists it as episodes of major depressive disorder that occur when you are misusing alcohol, substances, medications, or heavy metals or toxins. Symptoms may appear immediately after drinking or taking drugs or may not show up for weeks.²

Substance induced depression diagnostic criteria include the following:³

• Substances or medication can cause symptoms relevant to a mental disorder
• Disorder appears within a month of intoxication, withdrawal, or exposure to the substance or medication
• Condition did not occur before consumption of the substance or medication
• Disorder causes significant distress or impairment in major life areas
• Illness does not only happen during a delirium
• Disorder persists for at least a month after onset
• Another non-substance related mental illness does not better explain the disorder

What Substances May Cause Substance Induced Depression?

A substance can be anything that, when consumed, alters the functioning of the brain and behaviors. This includes medications prescribed by a doctor.

Substances that may cause depression include:⁴

• Alcohol
• Marijuana
• Cocaine
• Heroin
• Ketamine
• Methamphetamine
• LSD
• Nicotine and vaping

Medications that may potentially cause depression commonly treat the following:⁵

• Seizure prevention, such as gabapentin or topiramate
• Allergies, including over the counter and prescribed versions of cetirizine or Montelukast
• Anxiety, which benzodiazepines may treat
• Insomnia, for which a doctor may prescribe sleeping medicine such as Ambien or zolpidem
• Hormones and birth control, including any medicine with estrogen as an ingredient
• Blood pressure, typically treated with beta-blockers
• Acid reflux, including over-the-counter and prescribed medicines
• Pain medicines ranging from ibuprofen to opioids

Signs of Substance Induced Depression

Signs and symptoms of substance induced depression are similar to those of depression without an association with substances or medications. For many, however, the symptoms may be more severe. Signs can include the following:¹

• Feelings of sadness
• Sleep disturbances
• Feelings of guilt or shame
• Concentration problems or trouble staying focused
• Feeling hopeless or helpless
• Thoughts of suicide
• Agitation and easily irritated
• Sex drive decreased
• Mental and physical movements slow down
• Loss of interest in activities
• Appetite and weight changes

Diagnosis of Substance Induced Depression

When evaluating signs and symptoms to determine a diagnosis, doctors will use the same guidelines for depressive disorders and involve a substance or medication. Confirmation about the substance can happen through lab testing, or if it has been longer than one month, your doctor will base it on your description. Lab tests and imaging can rule out other disorders.¹

Major depressive disorder guidelines for diagnosis using the signs and symptoms include:⁶

• Having five or more symptoms for at least two weeks
• Having either a depressed mood or loss of interest or pleasure in activities you once found enjoyable
• Having secondary symptoms of weight and appetite changes, sleep disturbances, psychomotor problems, lack of energy, difficulty concentrating, feelings of guilt, and suicidal ideations
• Experiencing significant distress and impairment due to symptoms
• Lacking symptoms of mania or hypomania

How is Treatment for Substance Induced Depression Chosen?

For some people, substance induced depression will be considered co-occurring depression with alcohol or drug misuse. For others, substance induced depression may be a one-time event. The professional performing the evaluation will explore specific areas to determine treatment needs, including the acuteness of symptoms, history of substance induced depression, co-occurring drug use, current physical health, cognitive impairment, and protective factors to figure out the proper treatment.⁷

Acuteness of Symptoms

A professional must diagnose the severity of your current symptoms for you to receive the correct treatment. The following questions can help with treatment decisions:

• How severe are your symptoms?
• Do you need medical emergency care?
• Are you in active withdrawal?
• Do you have suicidal ideations?
• Do you have a history of acute symptoms?

History of Substance Induced Depression

Clinicians will need to measure your mental health and substance misuse to see if there are two separate disorders or one disorder with an uncommon occurrence. They may ask questions:

• How severe is your alcohol use disorder or substance use disorder?
• How severe is your depressive disorder?

Co-Occurring Drug Use

Co-occurring drug use refers to the misuse of more than one substance. For example, someone may misuse alcohol and heroin. Questions regarding this may include:

• Do you use intravenous drugs?
• Do you take substances that can cause psychiatric symptoms?

Current Physical Health

Any treatment recommendations depend on whether your body can handle the recommendations. Certain medication treatments may be more dangerous than helpful if you have untreated issues. Questions regarding physical condition include:

• Are you malnourished?
• Are your liver, kidneys, and other organs functioning properly?
• Do you have a physical disability?
• Do you have an infectious disease?
• Are you pregnant?

Cognitive Impairment

Your level of cognitive abilities can impact some treatments. If you have any damage to the brain or have problems with memory, concentration, and focus, this information can help form a treatment plan. Questions include:

• Is the misuse of substances affecting cognitive impairments?
• Have you had concussions or head trauma, whether they have been treated or not?

Protective Factors

Every person has risk factors or things that make them more likely to have substance induced depression. They also have protective factors or things that may prevent or reduce the likelihood of substance induced depression. The questions below determine if you have protective factors, also called recovery capital:

• Do you have a job?
• How much education do you have?
• What is your financial situation?
• Do you have a healthy living environment supportive of recovery?
• Do you have a healthy support system?

Treatment for Substance Induced Depression

Using the information provided above and various assessment tools for substance misuse and mental health disorders, your clinician will determine a level of care to treat your substance induced depression symptoms. The first decision is whether you need inpatient or outpatient treatment.

Inpatient treatment is for those who need medical supervision or access to clinical staff around the clock until they are stable. If medication is necessary to help with withdrawal, inpatient detox is the best choice. If withdrawal symptoms are manageable but you are not emotionally stable, or relapse will likely occur, you may want to opt for inpatient.⁸

Outpatient treatment is for anyone with a healthy, supportive living environment, reliable transportation to and from the facility, and a flexible schedule that allows you to attend therapy during the day.

At each level of treatment for substance induced depression, integrated therapies are beneficial. Meaning you benefit more from treatment that addresses all your needs, not just the mental health or substance misuse. Integrated treatments are available.⁷

Behavioral Therapies

At every level of care, behavioral therapies exist due to their proven benefits. To improve mental health and substance misuse, you must change your thought processes. Your thoughts influence your feelings, which influence your behaviors. If you have obsessive thoughts about relapsing, this could cause you to feel stressed and anxious, which may increase your risk of relapsing.

Behavioral therapies teach you to replace cravings and negative thoughts with positive, healthy versions and distractions. Behavioral treatments for substance induced depression may include:⁹

• Cognitive behavioral therapy: Helps examine the connection between thoughts, feelings, and behaviors to create change and build coping skills
• Dialectical behavior therapy: Helps improve emotional regulation, distress tolerance, and interpersonal skills, as well as teaches mindfulness
• Contingency management: Helps patients avoid relapse by providing them with tangible rewards for abstinent behaviors like a substance-free urine test
• Motivational interviewing: Helps resolve ambivalence about change and entering addiction treatment
• Trauma-focused therapy: Recognizes the role a traumatic experience has played in a person’s mental, physical, and emotional health and examines the connection between the trauma and a person’s behavior
• Family systems therapy: Helps patients rectify their issues within their family unit, improve understanding, and communication

Medication-Assisted Treatment (MAT)

Many people need medication to get them through the initial days of withdrawal or medication maintenance to help prevent relapse in the long run. Medications help reduce cravings, so you can focus on learning the skills that will help you stay sober. Medication-assisted treatment refers to the combination of taking an addiction treatment medication and receiving counseling to help promote behavioral change.

Currently, the Food and Drug Administration (FDA) has approved medications for the treatment of opioid use disorder and alcohol use disorder. Opioid use disorder medications include:¹⁰

• Methadone: A full opioid agonist that alleviates opioid withdrawal symptoms and cravings without causing a high
• Buprenorphine: A partial opioid agonist that relieves cravings and withdrawal symptoms. It has a ceiling effect, which means that the effects plateau at moderate doses, reducing the risk of overdose.
• Suboxone: A combination medication comprised of buprenorphine and naloxone, a medication that reverses the effects of an opioid overdose. The addition of the naloxone deters medication misuse because injecting it will cause the person to go into immediate withdrawal.

Alcohol use disorder medications include:¹¹

• Naltrexone: Binds to receptors in the brain responsible for the rewarding effects of alcohol, which reduces the desire to drink
• Acamprosate: Reduces post-acute withdrawal symptoms like insomnia and anxiety
• Disulfiram: Causes unpleasant effects like flushing and rapid heartbeat when a person taking it drinks alcohol

Peer Support

Peer support plays a significant role in the treatment of substance induced depression. The more support you have, the better your chances of overcoming the disorder. Support groups include:¹²

• 12 Step facilitation groups
• SMART Recovery groups
• Family therapy
• Family 12 Step facilitation groups
• Gender, identity, PTSD, and other specific groups

Find a Treatment Program

When searching for a treatment program for substance induced depression, look for a co-occurring or dual diagnosis treatment facility. This means they treat both mental health disorders and substance misuse. There are specific aspects of a treatment program that must focus on co-occurring disorders. Ask a treatment facility how each of the following offers co-occurring services:¹³

• Program structure, including the programs available, how they are set up, the balance between mental health and substance misuse, and even how they bill insurance companies.
• Assessments must be able to diagnose both mental health and co-occurring disorders.
• Treatment options for co-occurring disorders, stating how they treat co-occurring disorders.
• Continuing care refers to the programs and activities they connect you with before you leave the program.
• Staff training for co-occurring disorders should include education and experience with mental health and substance use disorders, not one or the other.

We understand that searching for a treatment program can be daunting, especially when trying to cope with substance induced depression. However, you want to find the right treatment as soon as possible.

We can help you shorten the search time for a treatment program by connecting you to a treatment support specialist. We are here 24/7, so you can call 888-647-0051 (Who Answers?) anytime.

Resources

1. Revadigar N, Gupta V. (2021). Substance-Induced Mood Disorders. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
2. American Psychological Association Dictionary of Psychology. (2022). Substance-Induced Mood Disorder.
3. Center for Substance Abuse Treatment. (2020). Substance Use Disorder Treatment for People With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series, No. 42. SAMHSA Publication No. PEP20-02-01-004. Rockville, MD: Substance Abuse and Mental Health Services Administration.
4. National Institute on Drug Abuse. (2020). Commonly Used Drug Charts.
5. Tello, Monique. (2018). Depression: Common Medication Side Effect? Harvard Health Publishing.
6. Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Frontiers in Psychiatry, 9, 450.
7. Yule, A. M., & Kelly, J. F. (2019). Integrating Treatment for Co-Occurring Mental Health Conditions. Alcohol Research: Current Reviews, 40(1), arcr.v40.1.07.
8. National Institute on Drug Abuse. (2020). Types of Treatment Programs.
9. National Institute on Drug Abuse. (2020). Behavioral Therapies.
10. Chou R, Korthuis PT, Weimer M. (2016). Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US). (Technical Briefs, No. 28.).
11. Bradford, T, W. and Onyxsko, M. (2016). Medications for Alcohol Use Disorder. American Family Physician 93(6): 457-465.
12. Donovan, D. M., Ingalsbe, M. H., Benbow, J., & Daley, D. C. (2013). 12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview. Social Work in Public Health, 28(3-4), 313-332.
13. Padwa, H., Larkins, S., Crevecoeur-Macphail, D. A., & Grella, C. E. (2013). Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs. Journal of Dual Diagnosis, 9(2), 179-186.