Definition

Drug-induced mood disorder is a type of mood disorder triggered by the use of substances like alcohol, drugs, or certain medications. It can manifest as either depression or mania. Depression involves profound feelings of sadness, while mania is characterized by excessive enthusiasm, joy, and/or anger.

Mood disorders due to substances/drugs can be severe and last about one month after drug use or drug withdrawal. In depressive disorders, there can be a loss of interest or pleasure in life.

Causes

Various types of psychoactive substances or drugs can cause drug-induced mood disorders, including:

• Depressants such as alcohol, sedative-hypnotics, and painkillers can induce euphoria (excitement), decreased control, or mood instability. In the withdrawal phase, agitation (anger), irritability, and dysphoria (unhappiness) can occur.
• Stimulants such as cocaine and amphetamines can resemble bipolar disorder with symptoms of euphoria, feeling energized, no appetite, feeling great, and paranoia (excessive fear). In the withdrawal phase, anhedonia (difficulty enjoying pleasure), apathy (not caring), decreased mood, and suicidal ideation can occur.
• Meanwhile, drugs that can cause substance-induced depression are steroid drugs, L-dopa, antibiotics, central nervous drugs, dermatology drugs, chemotherapy, immunology drugs or for the immune system, antiviral drugs, cardiovascular drugs, retinoic acid derivatives, antidepressants, anti-seizures, anti-migraine drugs, antipsychotics, hormonal drugs, and smoking cessation drugs.

Risk factor

Factors that increase the risk of developing this disorder include:

• Family history of mood disorders or substance use disorders
• Patients with primary mood disorders such as major depression, persistent depression, or bipolar
• Women. Women are known to be more at risk of experiencing depression in early adolescence
• Geriatric or elderly patients. Geriatrics tend to consume more medical drugs than younger people.

Symptoms

Symptoms and signs of a drug-induced depressive disorder include:

• Feeling sad
• Insomnia
• Feeling guilty
• Feeling hopeless
• Easily offended
• No power
• Psychomotor retardation
• Decreased libido
• Decreased appetite
• Suicidal ideation

Meanwhile, for drug-induced manic disorders, the signs and symptoms are:

• Feeling great and famous
• Always feel energized
• Impulsive
• Speak loudly
• Quick thinking
• Changing sexual partners
• Easily offended
• Insomnia

Diagnosis

Before diagnosing a substance-induced mood disorder, a physician will thoroughly assess the patient's history of alcohol or drug use. This is crucial because there are various types of mood disorders, and it's important to determine if the symptoms existed before substance use. If the symptoms predate substance usage, it suggests that the disorder is not solely related to drug or alcohol use.

Symptoms can develop some time after starting the medication. Certain symptoms begin as the drug user reaches the "peak" of their consumption. In addition, withdrawal symptoms from drugs often manifest. However, mood problems brought on by drug withdrawal often get better a few days after the medication is stopped. In contrast, drug withdrawal may create mood problems related to substance abuse, which may last until the individual goes through detoxification.

In general, a diagnosis is not established in the case of pre-substance use mood disorders or symptoms that persist for a duration exceeding one month following cessation of substance use. For a diagnosis to be established, it is necessary to identify severe symptoms unrelated to intoxication or withdrawal. For instance, the individual may experience substantial mood fluctuations that have a profound impact on their existence, induce considerable distress, or hinder certain facets of their functioning.

Management

If a substance-induced mood disorder is identified, it's typically advised to discontinue the substance causing the issue. However, physicians must carefully weigh the risks of abruptly stopping the medication, considering the patient's underlying medical condition. If the patient requires medication for their condition, doctors may explore alternative drugs with similar therapeutic effects but lower potential for toxicity. If no alternatives exist, they may opt to reduce the dosage of the drug or shorten the duration of treatment as medically appropriate.

Gradual drug reduction should also be considered, especially if the drug can cause a withdrawal syndrome, such as benzodiazepines or serotonergic antidepressants. If symptoms do not subside within 4 weeks after the drug is completely stopped, consider other causes of the mood disorder. A closely monitored retrial of a drug may be considered in certain circumstances, such as if the drug is effective in treating a serious medical illness.

Teach patients about the following, especially if substance abuse occurs:

• Causes of mood disorders. Patients and families must know the cause of mood disorders so they can prevent additional episodes, and families can help monitor the patient if a recurrence occurs
• Prognosis, or the possibility of the next course of the disease, is usually related to recovery
• Avoid causative agents

If a substance or drug causes mood disorders, stopping the use of the drug will usually return the patient's condition to the condition before using the substance or drug. Improvement in symptoms occurs gradually but usually takes less than 4 weeks. Symptoms that have not improved within 4 weeks after stopping drug use may indicate a primary mood disorder. Close monitoring should be carried out until symptoms disappear completely.

Complications

The following are complications of drug-induced mood disorders:

• Having problems with other people
• Lost work time
• Murder. In some rare situations, someone who is depressed or manic can become a murderer. If the patient has hurt himself or others, the patient must be hospitalized.
• Prolonged hospital stay
• Suicide

Routine assessment of suicide risk is mandatory for every patient with depression or mania. Other risk factors for suicide include agitation, psychosis, past suicide attempts, family history of suicide, and other psychiatric illnesses.

Prevention

Preventive treatment may be recommended for drug-induced mood disorders if the drug being used poses significant risks. When considering preventive treatment, the following points should be taken into account:

• Patient Medical History: A history of previous affective episodes indicates an increased risk of drug-induced mood disorders.
• The level of risk of mood disorders related to the medication being used.

Some types of preventive medicine include:

• Selective serotonin-reuptake inhibitor (SSRI) antidepressants to prevent depression induced by IFN-alpha drugs
• Antipsychotic drugs to prevent symptoms of mania induced by steroid drugs

Drug-induced depression or mania can worsen and become life-threatening. Suicide cases are prone to occur. If the patient experiences symptoms of a mood disorder after use of the medication, discontinue the medication and avoid the medication if possible.

When to see a doctor?

If you or someone you know displays symptoms of mood disorders following drug or substance use, seek prompt medical attention from a doctor or psychiatrist. If symptoms worsen and thoughts or behaviors of self-harm, harm to others, suicide, or violence emerge, contact your local emergency services or take the individual to the nearest emergency room without delay.