What is substance-induced mood disorder?

Substance use and mood disorders, like depression and bipolar disorder, share a complex relationship. For some people, the use of or withdrawal from drugs, alcohol, or medication can directly lead to or worsen mood disorder symptoms, which may improve once you’re no longer using these substances. Up to 60% of people with alcohol use disorder and 55% of those with an opioid use disorder also experience substance-induced depression.

Not everyone who experiences both substance use and a mood disorder has substance-induced mood disorder, and it’s not the same thing as co-occurring substance use disorder and mood disorder. It’s essential to receive a diagnosis from a healthcare provider, as both conditions can increase the risk of suicide.* 

*A note on safety: The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. If it’s an emergency, call 911. 

How can substances affect mood?

Substances like drugs and alcohol often have a cyclical relationship with mood. The more you use these substances, the worse you feel — but the worse you feel, the more likely you are to use these substances. 

Research shows that people with depression are twice as likely to have a substance use disorder than people without depression. People with bipolar disorder have an even higher risk — they’re seven times more likely to have a substance use disorder. 

Using drugs, alcohol, and even some prescription medications can directly lead to mood episodes. 

Stimulants

Stimulants like cocaine and methamphetamines are known for boosting energy, motivation, and mood, and sometimes even lead to feelings of euphoria or a “high.” However, this heightened state can sometimes tip into mania. Over time, heavy stimulant use can also lead to a “crash” that brings on feelings of depression, anxiety, or irritability, creating a cycle that can be difficult to break.

Depressants (sedatives)

Depressants, including sedatives and alcohol, can create a temporary sense of calm and relaxation. But with heavy or long-term use, they can lead to depressive symptoms and mood swings. During withdrawal, these effects can be even more severe.

Opioids

Opioids like heroin and prescription pain medication can provide pain relief and feelings of euphoria, but long-term use often leads to mood swings and depressive symptoms — especially during withdrawal. While they might temporarily lift mood, the aftermath of using opioids can leave you feeling emotionally devastated and vulnerable to deeper depressive episodes.

Hallucinogens and dissociatives

Hallucinogens and dissociatives can cause intense emotional highs, but they also carry a risk of anxiety, depressive episodes, and even drug-induced psychosis. Although psychedelic drugs are increasingly used to support mental health, it’s important to always have the supervision of a professional. A “bad trip” can lead to extreme emotional distress, and the use of these drugs may be risky for people with bipolar disorder. 

Steroids and other performance-enhancing drugs

Anabolic steroids and performance enhancers can lead to extreme mood changes, ranging from depression to aggression and irritability. Withdrawal from these substances can also trigger serious depressive symptoms.

Antidepressants and other psychiatric medications

Some psychiatric medications can negatively affect your mood, especially during dosage changes or withdrawal. Unfortunately, even though these medications are meant to alleviate mental health conditions, they can sometimes lead to initial mood disturbances before they take effect. 

Some people also report emotional “flatness” with these antidepressant medications. However, not everyone has the same experience with medications, and many people find significant relief from their symptoms. It’s important to work with your provider to determine the best option for your circumstances and needs, as they can help navigate any challenges that arise.

Over-the-counter medications and common prescriptions

Certain over-the-counter and prescribed medications can lead to substance-induced mood disorders. If a medication you’ve been prescribed is causing you to have symptoms of depression or mania, tell your healthcare provider right away. Never stop taking prescribed medication without medical supervision. 

Symptoms of substance-induced mood disorder

Substance use and mood are frequently and almost inherently interlinked. But according to the American Psychological Association, substance-induced mood disorder is only diagnosed when someone experiences depression or bipolar disorder symptoms as a direct physiological result of drugs, prescription medications, or other environmental toxins like gasoline. These disorders can develop either during intoxication or withdrawal.

In the Diagnostic and Statistical Manual of Mental Disorders, the text that health professionals use to make psychiatric diagnoses and treatment decisions, there are two types of substance-induced mood disorders: substance-induced depressive disorder and substance-induced bipolar disorder.

To meet the criteria for a substance-induced mood disorder (rather than an independent mood disorder), the symptoms of either must have developed during or shortly after substance intoxication or withdrawal (or being exposed to a medication). It must also be known that the substance you’re using is capable of causing the mood disorder symptoms that you’re experiencing.

Signs of substance-induced depressive disorder

Symptoms of substance-induced depression are identical to those of major depressive disorder and include: 

• Feeling sad or down most of the time
• Losing interest in activities you used to enjoy
• Experiencing significant changes in your appetite or weight
• Having trouble with sleep — either falling asleep or sleeping too much
• Feeling restless or finding yourself moving or speaking more slowly than usual
• Lacking energy or feeling fatigued, even after resting
• Experiencing feelings of worthlessness or guilt 
• Having trouble concentrating or making decisions
• Having suicidal thoughts or feeling that life isn’t worth living*

These symptoms must occur in the context of substance use or withdrawal and significantly impact your day-to-day functioning. 

Signs of substance-induced bipolar disorder

Substance-induced bipolar disorder can cause symptoms of either type of bipolar disorder, including:

• Experiencing mood swings from very high (mania or hypomania) to very low (depression)
• Feeling overly happy, energetic, or irritable for long periods during manic episodes
• Engaging in unhealthy behaviors, like spending sprees, unprotected sex, or reckless driving
• Finding it hard to concentrate or make decisions
• Having racing thoughts or feeling like your mind is going too fast to keep up
• Sleeping less than usual but not feeling tired 
• Experiencing depressive symptoms, such as feelings of sadness, hopelessness, or a lack of interest in activities

Like with substance-induced depressive disorder, these symptoms must occur in the context of substance use or withdrawal and can make it hard to function in everyday life.  

*A note on safety: If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If it’s an emergency, call 911. 

Substance-induced mood disorder vs mood disorder with substance use

Substance-induced mood disorder is only diagnosed when the substance is the direct physiological cause of the mood disorder symptoms. It’s also common to have co-occurring mood disorder and substance use disorder, which is when you live with two independent but co-occurring conditions. 

It’s important to differentiate between the two and get the right diagnosis because these conditions are treated differently.

In addition, substance-induced mood disorder can come with unique risks. For example, one study found that 60% of people who had made a suicide attempt had substance-induced depression, compared with 13% who had an independent mood disorder. 

It may be helpful to explore two separate examples to illustrate the difference between substance-induced mood disorder and a co-occurring substance use and mood disorder. 

Example 1: Substance-induced mood disorder 

Jess doesn’t have a history of depression or other mood disorders but began using methamphetamine recreationally. She experienced heightened energy and confidence. But over a few months, she began to notice fluctuations in energy and motivation and a significantly worse mood between uses. She begins feeling extremely euphoric, sleeping very little, and taking on too many projects at once. Her friends grow concerned as Jess becomes increasingly restless and impulsive.

When Jess stops using meth, her mood symptoms begin to subside after a few weeks. Her mental health provider explains that the methamphetamine use likely triggered a substance-induced bipolar disorder — a mood condition that directly results from the substance itself, rather than an underlying mental health issue. 

Example 2: Co-occurring mood disorder and substance use disorder

Sam has experienced symptoms of major depressive disorder since his teenage years. To manage his depressive episodes, Sam occasionally drinks alcohol and has noticed it can help him feel better. Over time, however, Sam’s drinking habits have become more frequent and intense. He’s started relying on alcohol to self-soothe and found himself drinking daily. 

Sam has co-occurring disorders: His depression was present before his alcohol use escalated and is considered a separate, underlying condition. Sam’s alcohol use disorder and mood disorder interact, with each condition intensifying the other — but his depression wasn’t a direct result of substance use.

What causes substance-induced mood disorders?

By definition, either intoxication or withdrawal from certain substances like drugs and medications can cause substance-induced mood disorders. 

Certain risk factors can make you more vulnerable to using substances in the first place, which may increase your risk for developing substance-induced mood disorders. These risk factors include:

• Genetics: A family history of substance use or mood disorders can increase your likelihood of experiencing similar issues. Genetic factors can even influence how your body metabolizes substances and how you respond to them.
• History of mental health disorders: If you have a personal or family history of mental health issues, you may be more likely to turn to substances as a coping mechanism.
• Trauma or stressful life events: Experiencing trauma, abuse, or significant life stressors — especially during childhood — can increase your risk of substance use. 
• Social environment and peer influence: Being in environments where substance use is common, having friends who use substances, or having easy access to substances can also increase your risk.

Comprehensive care for mood disorders and substance use

If you have substance-induced mood disorder, and not co-occurring substance use disorder and mood disorder, stopping the use of the substance can improve your mood symptoms. Substance-induced mood disorders are typically temporary. The mood disorder is directly caused by intoxication or withdrawal from the substance — so mood disorder symptoms should generally subside when the substance has left your system.

Of course, to simply stop using the offending substance is often much easier said than done. If you’ve developed an addiction to a substance that’s negatively affecting your mood, it’s important to seek help from a therapist or a certified alcohol and drug counselor. Some methods that can help you break an addiction to these substances include:

• Motivational interviewing: This counseling style can help you identify your reasons for wanting to stop using substances and resolve any ambivalence you have about this decision.
• Cognitive behavioral therapy (CBT): This therapy method helps you identify — and, when necessary, change — unhelpful thinking patterns that may be worsening both mood disorder symptoms as well as problems with addiction.
• Acceptance and commitment therapy: Rather than using substances to escape your painful emotions and life events, this type of therapy teaches you how to use mindfulness and other skills to accept painful emotions and life events.
• 12-step groups: There are peer-led support groups for people who live with substance use disorder in virtually every area. Although 12-step groups like Narcotics Anonymous aren’t psychotherapy, many people find them helpful. 

If you’ve used the substance in large quantities over a long period of time, your mood disorder symptoms might last longer. Sometimes, depending on how severe the substance-induced mood episode was, medication may be prescribed to help you stabilize while overcoming dependence on the substance. 

It’s crucial to work with your healthcare provider to determine if medication is the right option for you — particularly if your substance-induced mood disorder symptoms are a result of medication. Be honest with your provider, and they can create a treatment plan that works for you and your needs.

Additionally, a therapist can support you in coping with the aftereffects of a substance-induced mood episode and help you navigate the challenges of recovery.

Find care with Rula

Substance-induced mood disorder is a complex condition stemming from the direct physiological effects of drugs or medications, which makes it different from co-occurring mood and substance use disorders. While the presence of mood disorder symptoms sometimes makes substance use recovery more complex, with the right support you can stop using these substances (and, with time, stop experiencing mood-related symptoms). Getting help through therapy can make it easier to stop using these substances. With time and commitment, you can also feel better emotionally. Recovery is achievable, and many people discover that therapy helps not just with quitting substances but also with personal growth and feeling good overall.

Rula has helped hundreds of thousands of patients find affordable, quality, in-network therapy. Meet with a therapist about substance-induced mood disorder via live video as soon as tomorrow.

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