Substance/Medication-Induced Depressive Disorder

While the symptoms of substance/medication-induced mood disorders tend to vary depending on the specific substance or medication involved, major depressive disorder¹ is often characterized by persistent sadness, loss of interest or pleasure in activities, and changes in energy and sleep patterns that significantly impact a person's daily functioning. Combined, these changes may lead to various cognitive, behavioral, and physical symptoms.

For example, the symptoms of substance-induced mood disorders (e.g., substance-induced bipolar disorder)² may be different from substance-induced depressive or anxiety disorders. 

Cognitive and behavioral symptoms

The cognitive and behavioral symptoms of substance-induced depressive disorder may include the following: 

• Persistent sadness or thoughts of hopelessness
• Reduced interest or pleasure in previously enjoyed activities
• Difficulty concentrating, making decisions, or thinking clearly
• Recurrent thoughts of death or suicide
• Preoccupation with obtaining and using the substance
• Rationalizing and justifying substance use despite negative consequences
• Denial of the impact of substance use on mental health
• Social withdrawal and isolation from friends and family
• Neglect of responsibilities at work, school, or home
• Engaging in risky behaviors while under the influence
• Failed attempts to cut down or quit substance use

Physical symptoms

Physical manifestations of depression caused by substance use might include the following: 

• Unexplained aches and pains
• Changes in physical appearance or personal hygiene
• Frequent illnesses due to weakened immune function
• Fatigue and loss of energy
• Drastic changes in sleep patterns, either sleeping too much or too little
• Marked changes in appetite or weight

Substance/medication-specific symptoms

Symptoms that may be directly caused by substance or medication use might involve the following: 

• Symptoms that emerge shortly after starting or stopping a particular substance or medication
• Increased tolerance³ to the substance, leading to the use of higher doses to relieve symptoms of depression
• Increased severity of depression symptoms with higher doses, prolonged use, or withdrawal
• Depression symptoms that improve with substance cessation or medication adjustment

Note that substance-induced or medication-induced depression often co-occurs with other mental health conditions like major depressive disorder, generalized anxiety disorder, and certain mood disorders. For this reason, seeking a comprehensive evaluation with a mental health or addiction specialist can be crucial in determining the appropriate and effective method of treatment.

The primary cause of SMIDD is the consumption of specific substances or medications, which can directly impact brain chemistry and lead to the onset of depressive symptoms. Some substances commonly associated with SMIDD include alcohol, opioids, sedatives, stimulants, and certain prescription medications. Other causes and risk factors for this condition include:

• Vulnerability to mental health disorders: Individuals with a pre-existing history of depression or other mental health conditions are more susceptible to developing substance/medication-induced depressive disorder. Substance use may exacerbate underlying mental health challenges or incite the onset of depressive symptoms.
• Biological factors: Genetic predisposition⁴ plays a role in the development of substance use disorders and depressive disorders. Certain individuals may have a higher genetic susceptibility to experiencing SMIDD when exposed to specific substances.
• Psychosocial factors: Environmental factors, such as trauma, chronic stress, or a history of adverse childhood experiences, can contribute to the development of substance use disorders and depression. These factors may increase the likelihood of using substances as a coping mechanism, leading to SMIDD.

Often, the primary goal of treating SMIDD is to alleviate depressive symptoms and improve overall mood, function, and emotional well-being. Additionally, effective SMIDD treatment aims to identify the root cause of the disorder and address the possibility of co-occurring mental health conditions.

Medication

A healthcare professional may opt to modify an individual’s medication regimen if it is implicated in causing mood disturbances or depressive symptoms. In addition, several medications can be used to treat substance/medication-induced depressive disorder, including but not limited to:

• Antidepressants: Antidepressant medications may be prescribed to alleviate depressive symptoms associated with SMIDD. However, careful consideration may be given to potential drug interactions and symptom overlap. 
• Medications for substance use disorders: In cases where substance dependence is a significant concern, medications may be used to manage withdrawal symptoms and/or reduce cravings depending on the substance(s) being used.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Other treatment options

Other treatment options for this condition may include the following: 

• Detoxification: In cases of severe substance dependence, medically supervised detoxification may be required to manage withdrawal symptoms safely. Detoxification may be done in a hospital or inpatient setting. 
• Integrated treatment: Integrated treatment programs address substance use disorders and mental health conditions concurrently. This approach may offer a holistic and comprehensive approach to recovery.

Self-care

Self-care practices that may be helpful to cope with depression symptoms at home include the following: 

• Healthy lifestyle changes: Encouraging individuals to adopt a healthy lifestyle may significantly improve their overall well-being. For example, regular exercise, balanced nutrition, and sufficient sleep can be crucial to one’s health.
• Stress management techniques: Adopting stress-reduction techniques like mindfulness, meditation, or yoga may aid individuals in managing emotional distress more effectively.
• Avoiding risk factors for use: Identifying and avoiding risk factors related to substance use and depressive symptoms can be crucial in preventing relapse and maintaining stability.

By addressing the underlying issues and seeking professional help, those living with SMIDD may make significant strides in their journey toward recovery and improved mental health. Through open and honest communication with medical and mental health professionals, individuals can develop a personalized treatment plan, working toward substance and symptom management.

Seeking support from a mental health professional with expertise in SMIDD or related mood disorders may help individuals address and reframe recurrent thoughts and behaviors that arise from substance or medication use that might lead to depressive symptoms.

Certain online therapy platforms, such as BetterHelp, offer the ability to connect individuals with mental health professionals who meet their specific needs, potentially mitigating the impact of SMIDD and providing valuable guidance in managing the condition effectively. Through an online platform, clients can meet with a therapist via phone, video, or live chat. 

Additional resources for substance/medication-induced depressive disorder include the following: 

• Substance Abuse and Mental Health Services Administration (SAMHSA)
• American Addiction Centers (AAC)
• Mental Health America (MHA)
• National Alliance on Mental Illness (NAMI)

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Using minor samples, recent research examining the effects of behavioral and psychosocial therapies on co-occurring alcohol use disorder and depressive disorders found modest improvements in depression and drinking through treatments including behavioral activation and group therapy attendance. 

Still, experts purport a need for further research and better treatment options. Considering disorder heterogeneity and subgroup differences could lead to more targeted and personalized approaches to improve outcomes for those living with SMIDD.

Below are several key statistics on substance/medication-induced depressive disorder (SMIDD):

1. SMIDD is estimated to affect a significant portion of individuals with substance use disorders, with approximately 21% of individuals experiencing co-occurring depression and substance use. 
2. Certain substances have a higher likelihood of inducing depressive symptoms, with alcohol being one of the most commonly associated substances in SMIDD cases. 
3. Research indicates that SMIDD may affect men and women differently, with women experiencing a higher incidence of depression associated with substance use compared to men.
4. Over 60% of individuals receiving integrated treatment for SMIDD show significant improvements in their condition.