Substance or Medication Induced Depressive Disorder DSM-5 (ICD-9-CM and ICD-1O-CM)
DSM-5 Category: Depressive Disorders
Introduction
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, provides a complex and comprehensive iteration of substance related disorders resulting from the use of a wide array of drugs. These include tobacco, alcohol, caffeine, marijuana, hallucinogens, opiates and inhalants, sedatives, or stimulants (American Psychiatric Association, 2013). Unknown substances may also trigger the disorder. Research points to the belief that substance-induced mood disorders (SIMDs) have been reported as early as the 1950s but may date back much further; to a time when psychiatry and medicine were in their infancy.
The DSM 5 explains that there are two separate types of substance-related disorders. There are those that are conditions of use and those that are induced with the abuse of substances. In the first case, the illness manifests with continued abuse in the face of presenting problems while the latter opens the door to a wide variety of physical and psychological problems including but not limited to psychosis, withdrawal, anxiety, and sexual dysfunction.
Symptoms of Substance/Medication-Induced Depressive Disorder
Substance/Medication induced depression is particularly troubling because of its wide variety of causes. Each case is extremely individualized. It may be occurring due to the person’s decision to abuse an illegal substance or it may be the result of improper use of a medication that has been prescribed by a physician. It manifests itself in an equally extensive list of symptoms that include (but are not limited to) oversleeping, listlessness, social and emotional disengagement, sadness, suicidal thoughts, fatigue, a sense of hopelessness, and irritability (Moran, 2013). As this list indicates, there are a complex series of symptoms that may present differently in each instance of Substance/Medication induced depressive disorder. The only way to ensure proper diagnosis is to consult with medical and psychology professionals with an expertise in this field.
Diagnosis
Substance/Medication induced depressive disorder has an array of associated cormorbidity and risk presentations. For example, individuals with a family history of depression, mood disorder or substance abuse may be more inclined to suffer from this condition. Concurrent or associated problems may include a diagnosis of bipolar disorder, dysthymia or depressive disorder.
Psychologist Based Treatment of Substance/Medication-Induced Depressive Disorder
Alcohol, substance and/or medication dependency is in itself a depressing experience. It is characterized by relief that comes in the form of continued abuse; and is a cycle that requires outside support to break (Grobler, 2013). It is also a disorder for which there is no cure. Due to its insidious and often powerful but unexpected presentation in sufferers; the most realistic expectation is that the disorder be brought under control through a combination of psychologist and pharmacological based treatments tailored to the symptoms. The need for psychotherapy at some level may be ongoing; or intermittent and returned to when a patient is inclined to return to destructive habits. Regular physicals and sensitivity to one’s own personal weaknesses are both helpful in preventing relapses. The more willing a patient is to accept that Substance/Medication induced depressive disorder is a condition that will require continuous monitoring; the more likely he or she is to get on with their life.
The most common forms of therapeutic intervention includes the application of cognitive therapy that may be especially beneficial when used in tandem with antidepressants. Too, interpersonal therapy (IPT) combined with facets of cognitive therapy have also proven suitable.
Pharmacological Treatment of Substance/Medication-Induced Depressive Disorder
Despite the fact that the origin of this ailment is a form of a substance, pharmacological treatments have proved surprisingly beneficial with deliberate oversight by the prescribing professional. As is true with all aspects of this disorder, pharmaceutical therapy is complicated and individualized. Often the patient will be expected to go through some form of total detoxification of two to four weeks in order to cleanse their system of all substances before a drug treatment can begin. The most common choice of drug therapy is antidepressants and mood elevators such as SSRIs. Also, there are a number of pharmacotherapies that have proved beneficial in treating alcohol abuse as well such as Disulfiram.
Prognosis
A diagnosis of Substance/Medication induced depressive disorder carries with it lifetime challenges. This is due in part to the presence of comorbidity of a variety of factors that worsens the prognosis for this affliction; particularly without medical intervention (Khazaal, Gay-Febrey, Neflet et al. 2013). Too, there is a tendency for a high rate of relapse and the cyclical nature of the disorder exacerbates a positive outlook. Finally, there is the additional risk towards self-harm that may not be present in other illnesses. A positive prognosis is more likely with ongoing medical, psychological and family support.
Functioning with Substance/Medication Induced Depressive Disorder
There is no question that Substance/Medication induced depressive disorder can interfere with day to day living. For one thing, symptoms may be considerably more pronounced, and lasts for much longer than a singular abuse event (such as binge-drinking that results in a hangover the following day). Unaddressed, the disorder may manifest itself in occasions of declining mental acquity, attention deficit and/or learning problems. Motor and social skills may be impaired as well. This depends in part on the time frame of abuse; the longer it has lingered the greater impact it may have. Learning to take command of one’s life and function with the disorder begins by seeking treatment with certified professionals in the areas of mental health and medicine. Persons with Substance/Medication induced depressive must create a healthy lifestyle that excludes exposure to the variety of substances and/or medicines that can be abused. This may mean that the individual will have to develop a new set of friends, be forthcoming with family members about the ways in which they can support the person who is avoiding substances and medicine; and perhaps find other employment. All of this is intended to create a framework for life that excludes exposure to drinking, smoking and drug abuse.
Also, the more the patient with Substance/Medication induced depressive disorder is willing to adopt healthy lifestyle habits such as eating properly and exercising on a regular basis, the more likely he or she will be able to avoid a return to substance abuse that instigated the depression. Finally, continued reliance on medical professionals will help to cement a healthier and more satisfying way of life.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Grobler, G. (2013). Major depressive disorder. South African Journal of Psychiatry, Vol. 19, Iss. 3.
Khazaal, Y.; Gex-Fabry, M,; Nallet, A.; Weber, B.; Favre, S.; Voide, R. (2013). Affective temperaments in alcohol and opiate addictions. The Psychiatric quarterly; Vol. 84, Iss. 4.
Moran, M. (2013).DSM-5 Updates Depressive, Anxiety, and OCD Criteria. Psychiatric News, Volume 48, Issue 4.
Nemeroff, C.; Berk, M.; Malhi, G.; Preisig, M. Brüne, M.; &Lysaker, P. (2013). DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC medicine; Vol. 11, Is. 1.
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