Substance - Induced Mood Disorders- Symptoms, Risk Factors, and Treatment.

What Are Substance-Induced Mood Disorders?

It is very normal for a person to experience a hangover on the subsequent morning after alcohol consumption the previous night, but few people experience depression and can become maniacs, mood disorders that are evaluated only in association with the use of the substance of abuse are termed as substance-induced mood disorders.

Substance-induced mood disorders result from the long-term use of substances of abuse, including alcohol, opioids, cocaine, or addictive medications like interferon ( IFN), corticosteroids, digoxin, and antiepileptic drugs, that are used to treat conditions such as epilepsy, arthritis, etc. These disorders include depression, anxiety, hallucinations, and other mental health disorders. Various theories have proven that these substances alter the transmission of neurotransmitters to critical neural circuits. It is also believed that substance-induced mood disorders result in changes in cerebral structures.

What Is the Pathophysiology of Substance-Induced Mood Disorders?

The pathophysiology of substance-induced disorders is still subject to ongoing debate. Drug-induced mood symptoms lead to changes in cerebral structures, including the frontal cortex, olfactory tubercle, amygdala, nucleus accumbens, hippocampus, and hypothalamus. These mood symptoms induced by drugs involve modifications in serotonergic, corticotropin-releasing factor (CRF), dopaminergic, and neuropeptide Y (NPY) neurotransmitter activity.

At What Point Does a Substance-Induced Mood Disorder Begin?

In certain instances, symptoms and indications may emerge almost instantly—sometimes even during intoxication. In other cases, symptoms arise during withdrawal. In cases of withdrawal-related depression, the individual's mood typically improves within a few days of discontinuing the drug. However, substance-induced depression may initiate during withdrawal and persist or intensify as the individual undergoes the detoxification process.

What Are the Drugs That Cause Substance-Induced Mood Disorders?

Various psychoactive substances have the potential to induce substance/medication-induced mood disorders. Among these are alcohol, phencyclidine, and other hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, amphetamines, and other stimulants, as well as cocaine.

What Are the Symptoms of Mood Disorders?

The signs and symptoms of mood disorders differ from one person to another, not everybody experiences the same symptoms, but there are few behavioral changes or certain characteristics that can help in the diagnosis.

An individual with a history of substance abuse is most likely to develop symptoms like,

• Hallucinations include seeing and hearing things that are not present.

• Delusions, where a person experiences he is being called or watched. It also includes religious delusions where it is believed that the almighty is sending special messages.

• Inability to distinguish between reality and fantasy.

• Inability to take care of oneself, like forgetting to bathe or eat.

• Feeling that someone is trying to harm them constantly.

• Difficulty in communication, slurred speech, unclear thoughts.

• Expressionless face.

• Hypersensitive to sensory impulses.

How Are Substance-Induced Mood Disorders Diagnosed?

Distinguishing between primary mental disorders and substance-induced mental disorders can pose a challenge for doctors due to the similarity of symptoms they often present. To diagnose a substance-induced mental disorder, a doctor must initially establish that the individual is using or being exposed to a substance or medication capable of causing such a disorder. Once this is confirmed, the symptoms must meet the following criteria:

• Resulting in significant impairment of functioning or distress.

• Manifest within one month of intoxication with, withdrawal from, or exposure to a substance or medication.

• Not have existed before substance or medication use or exposure.

• Not solely occur during active delirium caused by a substance or medication.

Before making a diagnosis of substance-induced mental disorder, a doctor may also need to observe or assess the individual's symptoms after they have ceased using, taking, or being exposed to the suspected substance.

Can Substance-Induced Mood Disorders Be Treated?

Treatment for substance-induced mood disorders mainly depends on an appropriate diagnosis which can be done only with a definitive history. Substance-induced disorders are generally diagnosed when an individual visits with the chief complaint of anxiety or depression.

When diagnosed, a team of experts helps in finding the best available treatment option which includes medications, therapies, rehabilitation, etc. The choice of treatment is made based on chronicity, frequency, and drug used for the abuse. Irrespective of the treatment modality, the first and foremost step during the treatment is discontinuing substance abuse. Some patients recover with just one method of treatment while others may require a combination of the treatment options available.

• Medicinal Treatment: No definitive medicinal treatment is available to treat substance abuse, experts prescribe medications to control the symptoms and promote discontinuing the abusive substances. Those with prescribed medicinal substance abuse are controlled by altering the doses, prescribing alternate medications, etc.

• Therapy: It has been considered one of the most effective means of treatment for individuals with mood disorders, this treatment mainly emphasizes counseling and altering the thought process of an individual so that the urge to consume the substance of abuse is avoided. Various therapies include cognitive behavior therapy, psychotherapy, etc.

• Rehabilitation: These centers are where a person undergoes observation, and extensive counseling and activities are carried out to distract an individual from abuse. This is recommended for individuals who have a severe mood disorder or addiction that cannot be treated with the above treatment modalities. Rehabilitation is also considered an adjunct option to many other treatments as it is also used in the remission period of the disorder to prevent relapse. Rehabilitation is most commonly used for people with alcohol and illegal substance-induced mood disorders.

What Are the Complications of Substance-Induced Mood Disorders?

The most critical complication associated with substance-induced mood disorders is the risk of suicide. Research indicates that suicide attempts are more prevalent in affective disorders triggered by substance use. One study suggested a nearly four-fold heightened risk of suicide attempts when the mood disorder arises in conjunction with substance use.

What Are the Differential Diagnosis of Substance-Induced Mood Disorders?

Distinguishing transient substance-induced disorders from primary psychiatric conditions can be achieved by observing behavior during a period of abstinence, noting the temporal relationship between substance intake and symptoms. Additionally, a family history of primary psychiatric illness may aid in differentiation. When considering substance-induced symptoms of mania, the process may be more intricate due to the strong likelihood of mood symptom onset following substance use.

What Is the Prognosis of Substance-Induced Mood Disorders?

In theory, mood symptoms should improve following a period of sobriety. Sustaining abstinence stands as the most reliable predictive factor for future episodes. Consequently, factors that encourage sobriety also enhance remission. Familial support, psychotherapy, financial stability, and medication adherence are all factors that foster sobriety. Conversely, environments that elevate the risk of substance use are linked to poorer prognoses.

Conclusion:

Substance-induced mood disorders are mainly caused by to consumption of abusive OTC medications, prescribed medications, alcohol, and illegal substances in quantities more than recommended. For a person to develop a mood disorder might not take a year, but it is difficult to overcome the addiction once developed. A common presentation of the patient is being disoriented, having a hangover, sleeplessness, etc. Treatment options include medications, therapy, rehabilitation, etc.