The diagnostic features of substance/medication-induced depressive disorder include the symptoms of a depressive disorder, such as major depressive disorder; however, the de- pressive symptoms are associated with the ingestion, injection, or inhalation of a sub- stance (e.g., drug of abuse, toxin, psychotropic medication, other medication), and the depressive symptoms persist beyond the expected length of physiological effects, intoxi- cation, or withdrawal period. As evidenced by clinical history, physical examination, or laboratory findings, the relevant depressive disorder should have developed during or within 1 month after use of a substance that is capable of producing the depressive disor- der (Criterion B1). In addition, the diagnosis is not better explained by an independent depressive disorder. Evidence of an independent depressive disorder includes the de- pressive disorder preceded the onset of ingestion or withdrawal from the substance; the depressive disorder persists beyond a substantial period of time after the cessation of sub- stance use; or other evidence suggests the existence of an independent non-substance/ medication-induced depressive disorder (Criterion C). This diagnosis should not be made when symptoms occur exclusively during the course of a delirium (Criterion D). The de- pressive disorder associated with the substance use, intoxication, or withdrawal must cause clinically significant distress or impairment in social, occupational, or other impor- tant areas of functioning to qualify for this diagnosis (Criterion E).
Some medications (e.g., stimulants, steroids, L-dopa, antibiotics, central nervous system drugs, dermatological agents, chemotherapeutic drugs, immunological agents) can induce depressive mood disturbances. Clinical judgment is essential to determine whether the medication is truly associated with inducing the depressive disorder or whether a primary depressive disorder happened to have its onset while the person was receiving the treatment. For example, a depressive episode that developed within the first several weeks of beginning alpha—methyldopa (an antihypertensive agent) in an individ- ual with no history of major depressive disorder would qualify for the diagnosis of med- ication-induced depressive disorder. In some cases, a previously established condition (e.g., major depressive disorder, recurrent) can recur while the individual is coincidentally taking a medication that has the capacity to cause depressive symptoms (e.g., L-dopa, oral contraceptives). In such cases, the clinician must make a judgment as to whether the med- ication is causative in this particular situation.
A substance/medication-induced depressive disorder is distinguished from a primary depressive disorder by considering the onset, course, and other factors associated with the substance use. There must be evidence from the history, physical examination, or labora— tory findings of substance use, abuse, intoxication, or withdrawal prior to the onset of the depressive disorder. The withdrawal state for some substances can be relatively pro- tracted, and thus intense depressive symptoms can last for a long period after the cessation of substance use.
In a nationally representative U.S. adult population, the lifetime prevalence of substance/ medication-induced depressive disorder is 0.26%.
A depressive disorder associated with the use of substance (i.e., alcohol, illicit drugs, or a set while the individual is using the substance or during withdrawal, if there is a with— drawal syndrome associated with the substance. Most often, the depressive disorder has its onset within the first few weeks or 1 month of use of the substance. Once the substance is discontinued, the depressive symptoms usually remit within days to several weeks, de- pending on the half—life of the substance/medication and the presence of a withdrawal syndrome. If symptoms persist 4 weeks beyond the expected time course of withdrawal of a particular substance/medication, other causes for the depressive mood symptoms should be considered.