Substance/Medication Induced Depressive Disorder

Question 1

criterion A for substance/medication induced depressive disorder

Answer 1

a prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities

Question 2

criterion B for substance/medication induced depressive disorder

Answer 2

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

Question 3

criterion C for substance/medication induced depressive disorder

Answer 3

the disturbance is not better explained by a depressive disorder that is not sub/med induced

Question 4

what would suggest a disorder was NOT sub/med induced

Answer 4

“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 history of recurrent non-substance/medication-related episodes).

Question 5

criterion D for substance/medication induced depressive disorder

Answer 5

disturbance does not occur exclusively during the course of a delirium

Question 6

criterion E for substance/medication induced depressive disorder

Answer 6

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

Question 7

when should the diagnosis of substance/medication induced depressive disorder be made instead of substance intoxication or withdrawal

Answer 7

only when symptoms in criterion A (depression) predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention

Question 8

list some medications that can induce depressive mood disturbances

Answer 8

stimulants

antidepressants

anticonvulsants

anti-migraine agents (triptans)

antipsychotics

steroids

L-dopa

antibiotics

CNS drugs

dermatological agents

chemotherapeutic drugs

immunological agents

Question 9

in the case of substance/medication induced depressive disorder, when does the depressive disorder most often have its onset

Answer 9

within the first few weeks or 1 month of use of the substance

once substance is discontinued the depressive symptoms usually remit within days to several weeks–> depends on half life of the substance/medication and the presence of a withdrawal syndrome

Question 10

when should you consider a different etiology for a suspected substance/medication induced depressive disorder

Answer 10

is the symptoms persist 4 weeks beyond the expected time course of withdrawal of a particular substance/medication

Question 11

name an ANTIVIRAL agent associated with substance/medication induced depressive disorder

Answer 11

efavirenz

especially at high plasma concentrations

Question 12

name CARDIOVASCULAR agents associated with substance/medication induced depressive disorder

Answer 12

clonidine

guanethidine

methyldopa

reserpine

Question 13

name a RETINOIC ACID DERIVATIVE associated with substance/medication induced depressive disorder

Answer 13

isotretinoin

has a warning by the FDA for risk for suicide (association remains debated)

Question 14

list HORMONAL agents associated with substance/medication induced depressive disorder

Answer 14

corticosteroids

OCPs

gonadotropin releasing hormone agonists

tamoxifen

Question 15

name an SMOKING CESSATION agent associated with substance/medication induced depressive disorder

Answer 15

varenicline

Question 16

name an IMMUNOLOGICAL agent associated with substance/medication induced depressive disorder

Answer 16

interferon

Question 17

name temperamental risk factors for substance/medication induced depressive disorder

Answer 17

hx MDD

hx drug induced depression

psychosocial stressors

Question 18

how does drug-induced or treatment-emergent suicidality differ from other types of suicidality

Answer 18

it represents a MARKED CHANGE in thoughts and behaviour from a persons baseline

is usually TEMPORARY associated with initiation of a substance

must be distinguished from underlying primary mental disorders

Question 19

did a meta analysis show increased suicide risk/SI with antidepressants?

Answer 19

not when pooled across all adult age groups

HOWEVER–> slightly increased risk in age 18-24–> not significantly elevated risk

*treatment emergent suicide is an “extremely rare treatment emergent phenomenon”

Question 20

ddx substance/medication induced depressive disorder

Answer 20

substance intoxication and withdrawal

primary depressive disorder

depressive disorder due to another medical condition

Question 21

compared with those with MDD and no comorbid substance use disorder those with substance/medication induced depressive disorder have higher rates of what other psychiatric comorbidities

Answer 21

have higher rates of comorbidity with ANY DSM mental disorder

also

are more likely to have specific DSM disorders of:

pathological gambling

paranoid, histrionic and antisocial personality disorder

*less likely to have PDD