Introduction
Drug-Induced Mood Disorder is a psychiatric condition characterized by mood disturbances that are directly caused by the physiological effects of a substance—either during intoxication, withdrawal, or as a side effect of prescribed medications. These mood changes can include depressive, manic, or mixed features and may mimic primary mood disorders. A comprehensive psychiatric evaluation is essential to differentiate drug-induced symptoms from primary psychiatric conditions and to guide appropriate treatment.
Purpose of the Evaluation
To identify mood symptoms caused by substance use or medication
To differentiate drug-induced mood disorders from primary mood disorders
To assess risk factors such as suicidality or psychosis
To guide detoxification, medication adjustment, and psychiatric care
To support recovery and prevent recurrence
Common Substances Associated with Drug-Induced Mood Disorders
Illicit Substances
Cocaine: Can cause manic or depressive symptoms
Methamphetamine: Associated with mania, psychosis, and depression
Cannabis: May trigger anxiety or depressive symptoms
Alcohol: Depressive symptoms during intoxication or withdrawal
Hallucinogens: Mood instability and perceptual disturbances
Prescription Medications
Corticosteroids (e.g., prednisone): Can induce mania or depression
Interferon: Associated with depressive symptoms
Beta-blockers: May cause fatigue and depressive mood
Benzodiazepines: Withdrawal may lead to anxiety and depression
Antidepressants: May trigger mania in susceptible individuals
Diagnostic Criteria (DSM-5)
Drug-Induced Mood Disorder is classified under Substance/Medication-Induced Depressive or Bipolar Disorder. Key criteria include:
Prominent and persistent mood disturbance (depressed or elevated mood)
Evidence that the symptoms developed during or soon after substance use
The substance is capable of producing the symptoms
Symptoms are not better explained by a primary mood disorder
Significant distress or impairment in functioning
Components of a Comprehensive Psychiatric Evaluation
1. Identifying Information
Name, age, gender, occupation
Date of evaluation
Referral source (e.g., emergency department, family, physician)
2. Chief Complaint
Patient’s own words describing symptoms
Example: “I’ve felt extremely anxious and depressed since I started taking steroids.”
3. History of Present Illness (HPI)
Onset and progression of mood symptoms
Timing in relation to substance use or medication changes
Impact on functioning
Previous psychiatric history
4. Substance Use History
Type of substance or medication
Dosage, frequency, and duration
Route of administration
History of intoxication, withdrawal, or overdose
5. Past Psychiatric History
Previous diagnoses and treatments
Hospitalizations
Suicide attempts or self-harm
Family history of mood disorders
6. Medical History
Chronic illnesses
Neurological conditions
Medications and allergies
7. Social History
Living situation
Employment and education
Relationships and support systems
Legal issues
Cultural and spiritual background
Mental Status Examination (MSE)
Domain Description
Appearance May show signs of intoxication or withdrawal
Behavior Agitation, sedation, cooperation
Mood Depressed, anxious, euphoric
Affect Blunted, labile, congruent
Speech Slurred, pressured, coherent
Thought Process Disorganized, tangential
Thought Content Suicidal ideation, paranoia
Perception Hallucinations (especially with withdrawal)
Cognition Impaired attention, memory
Insight Often poor regarding substance effects
Judgment Impaired decision-making
Risk Assessment
Suicidal or homicidal ideation
Risk of overdose or withdrawal complications
Risk to others (e.g., impaired driving)
Access to substances or weapons
Diagnostic Tools
Urine drug screen
Blood tests for medication levels
Structured interviews (e.g., SCID)
Mood rating scales (e.g., PHQ-9, YMRS)
Formulation
A biopsychosocial summary explaining how biological, psychological, and social factors contribute to the disorder.
Example: “Patient’s depressive symptoms appear to be linked to corticosteroid use for autoimmune disease, compounded by social isolation and a history of depression.”
Treatment Plan
Pharmacological
Discontinuation or adjustment of offending medication
Detoxification protocols if needed
Initiation of mood stabilizers or antidepressants (if appropriate)
Monitoring for side effects and interactions
Psychotherapy
Cognitive Behavioral Therapy (CBT)
Motivational Interviewing (MI)
Psychoeducation about substance effects
Supportive Interventions
Case management
Peer support groups
Family therapy
Referrals
Addiction specialists
Psychiatry for medication management
Social services for housing, employment, or legal support
Documentation Tips
Use objective, descriptive language
Include direct quotes from the patient
Document timing of symptoms relative to substance use
Ensure confidentiality and informed consent
Conclusion
Drug-Induced Mood Disorder is a complex condition that requires careful assessment to distinguish it from primary mood disorders. A comprehensive psychiatric evaluation helps clinicians identify the root cause of symptoms, guide safe and effective treatment, and support long-term recovery. Collaboration among medical, psychiatric, and social support systems is essential for optimal outcomes.