Substance / Medication-Induced Mood Disorder

Substance/medication-induced mood disorder is diagnosed after an individual uses a substance (e.g., a drug of abuse, a medication, or a toxin exposure) that leads to prominent mood symptoms: either depression or mania.

Depression

Mania

The diagnostic features of substance/medication-induced bipolar and related disorder are es sentially the same as those for mania, hypomania, or depression. A key exception to the diag nosis of substance/medication-induced bipolar and related disorder is the case of hypomania or mania that occurs after antidepressant medication use or other treatments and persists be yond the physiological effects of the medication. This condition is considered an indicator of true bipolar disorder, not substance/medication-induced bipolar and related disorder. Simi larly, individuals with apparent electroconvulsive therapy-induced manic or hypomanie ep isodes that persist beyond the physiological effects of the treatment are diagnosed with bipolar disorder, not substance/medication-induced bipolar ^ d related disorder.

Side effects of some antidepressants and other psychotropic drugs (e.g., edginess, ag itation) may resemble the primary symptoms of a manic syndrome, but they are funda mentally distinct from bipolar symptoms and are insufficient for the diagnosis. That is, the criterion symptoms of mania/hypomania have specificity (simple agitation is not the same as excess involvement in purposeful activities), and a sufficient number of symptoms must be present (not just one or two symptoms) to make these diagnoses. In particular, the appearance of one or two nonspecific sjonptoms—irritability, edginess, or agitation during antidepressant treatment—in the absence of a full manic or hypomanie syndrome should not be taken to support a diagnosis of a bipolar disorder.

Criterion A

A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or plea sure in all, or almost all, activities.

Criterion B

There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

  1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
  2. The involved substance/medication is capable of producing the symptoms in Criterion A.
Criterion C

The disturbance is not better explained by a depressive disorder that is not substance/medication-induced. Such evidence of an independent depressive disorder could include the following:

  • The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced depressive disorder (e.g., a his tory of recurrent non-substance/medication-related episodes).
Criterion D

The disturbance does not occur exclusively during the course of a delirium.

Criterion E

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.
Criterion A

A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive, or irritable mood, with or without depressed mood, or markedly diminished interest or pleasure in all, or almost all, activities.

Criterion B

There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

  1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
  2. The involved substance/medication is capable of producing the symptoms in Criterion A.
Criterion C

The disturbance is not better explained by a bipolar or related disorder that is not substance/medication-induced. Such evidence of an independent bipolar or related disorder could include the following:

  • The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced bipolar and related disorder (e.g., a history of recurrent non-substance/medication-related episodes).
Criterion D

The disturbance does not occur exclusively during the course of a delirium.

Criterion E

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specifiers

Specifiers

Specify the substance:

  • Alcohol
  • Caffeine
  • Cannabis
  • Phencyclidine
  • Other hallucinogen
  • Inhalant
  • Opioid
  • Sedative, hypnotic, or anxiolytic
  • Amphetamine (or other stimulant)
  • Cocaine
  • Other (or unknown) substance

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