Editing Mood disorder (section)

=== Substance-induced ===

A mood disorder can be classified as substance-induced if its etiology can be traced to the direct physiologic effects of a [[psychoactive drug]] or other chemical substance, or if the development of the mood disorder occurred contemporaneously with [[substance intoxication]] or [[Drug withdrawal|withdrawal]]. Also, an individual may have a mood disorder coexisting with a [[substance abuse]] disorder. Substance-induced mood disorders can have features of a manic, hypomanic, mixed, or depressive episode. Most substances can induce a variety of mood disorders. For example, [[stimulant]]s such as [[amphetamine]], [[methamphetamine]], and [[cocaine]] can cause manic, hypomanic, mixed, and depressive episodes.<ref>{{cite web | url=http://www.faqs.org/patents/app/20120321644#b | title=Methods for Diagnosing Mood Disorders | publisher=faqs.org | access-date=26 November 2013 | url-status=live | archive-url=https://web.archive.org/web/20131203062559/http://www.faqs.org/patents/app/20120321644#b | archive-date=3 December 2013}}</ref>{{unreliable source?|date=November 2013}}

==== Alcohol-induced ====

High rates of major depressive disorder occur in heavy drinkers and those with [[alcoholism]]. Controversy has previously surrounded whether those who abused alcohol and developed depression were self-medicating their pre-existing depression. Recent research has concluded that, while this may be true in some cases, alcohol misuse directly causes the development of depression in a significant number of heavy drinkers. Participants studied were also assessed during stressful events in their lives and measured on a ''Feeling Bad Scale.'' Likewise, they were also assessed on their affiliation with '' deviant '' peers, unemployment, and their partner's substance use and criminal offending.<ref>{{cite journal |vauthors=Fergusson DM, Boden JM, Horwood LJ |title=Tests of causal links between alcohol abuse or dependence and major depression |journal=Arch. Gen. Psychiatry |volume=66 |issue=3 |pages=260–6 |date=March 2009 |doi=10.1001/archgenpsychiatry.2008.543 |pmid=19255375 |doi-access=free }}</ref><ref>{{cite journal |vauthors=Falk DE, Yi HY, Hilton ME |title=Age of Onset and Temporal Sequencing of Lifetime DSM-IV Alcohol Use Disorders Relative to Comorbid Mood and Anxiety Disorders |journal=Drug Alcohol Depend |volume=94 |issue=1–3 |pages=234–45 |date=April 2008 |pmid=18215474 |doi=10.1016/j.drugalcdep.2007.11.022 |pmc=2386955 }}</ref><ref name="Schuckit MA, Smith TL, Danko GP, et al 2007 805–12">{{cite journal |vauthors=Schuckit MA, Smith TL, Danko GP |title=A comparison of factors associated with substance-induced versus independent depressions |journal=J Stud Alcohol Drugs |volume=68 |issue=6 |pages=805–12 |date=November 2007 |pmid=17960298 |doi= 10.15288/jsad.2007.68.805|s2cid=17528609 |display-authors=etal}}</ref> High rates of suicide also occur in those who have alcohol-related problems.<ref>{{cite journal |vauthors=Chignon JM, Cortes MJ, Martin P, Chabannes JP |title=[Attempted suicide and alcohol dependence: results of an epidemiologic survey] |language=fr |journal=Encephale |volume=24 |issue=4 |pages=347–54 |year=1998 |pmid=9809240 }}</ref> It is usually possible to differentiate between alcohol-related depression and depression that is not related to [[alcohol (drug)|alcohol]] intake by taking a careful history of the patient.<ref name="Schuckit MA, Smith TL, Danko GP, et al 2007 805–12"/><ref name="pmid9210745">{{cite journal |vauthors=Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL |title=Comparison of induced and independent major depressive disorders in 2,945 alcoholics |journal=Am J Psychiatry |volume=154 |issue=7 |pages=948–57 |date=July 1997 |pmid=9210745 |doi= 10.1176/ajp.154.7.948|citeseerx=10.1.1.461.7953 }}</ref><ref>{{cite journal |vauthors=Schuckit MA, Tipp JE, Bucholz KK |title=The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls |journal=Addiction |volume=92 |issue=10 |pages=1289–304 |date=October 1997 |pmid=9489046 |doi= 10.1111/j.1360-0443.1997.tb02848.x|display-authors=etal}}</ref> Depression and other mental health problems associated with alcohol misuse may be due to distortion of brain chemistry, as they tend to improve on their own after a period of abstinence.<ref>{{cite journal |vauthors=Wetterling T, Junghanns K |date= December 2000 |title=Psychopathology of alcoholics during withdrawal and early abstinence|journal=Eur Psychiatry |volume=15 |issue=8 |pages=483–8 |pmid=11175926 |doi=10.1016/S0924-9338(00)00519-8 |s2cid= 24094651 }}</ref>

==== Benzodiazepine-induced ====
[[Benzodiazepine]]s, such as [[alprazolam]], [[clonazepam]], [[lorazepam]] and [[diazepam]], can cause both depression and mania.{{sfn|American Psychiatric Association|2013|p={{page needed|date=October 2021}}}}

Benzodiazepines are a class of medication commonly used to treat anxiety, panic attacks and insomnia, and are also [[Substance abuse|commonly misused and abused]]. Those with anxiety, panic and sleep problems commonly have negative emotions and thoughts, depression, suicidal ideations, and often have comorbid depressive disorders. While the [[anxiolytic]] and [[hypnotic]] effects of benzodiazepines may disappear as [[Drug tolerance|tolerance]] develops, depression and impulsivity with high suicidal risk commonly persist.<ref name=":0">{{Cite journal|title = Long-term use of benzodiazepines: tolerance, dependence and clinical problems in anxiety and mood disorders|journal = Pharmacopsychiatry|date = July 1996|issn = 0176-3679|pmid = 8858711|pages = 127–134|volume = 29|issue = 4|doi = 10.1055/s-2007-979558|first1 = S.|last1 = Michelini|first2 = G. B.|last2 = Cassano|first3 = F.|last3 = Frare|first4 = G.|last4 = Perugi| s2cid=19145509 }}</ref> These symptoms are "often interpreted as an exacerbation or as a natural evolution of previous disorders and the chronic use of sedatives is overlooked".<ref name=":0" /> Benzodiazepines do not prevent the development of depression, can exacerbate preexisting depression, can cause depression in those with no history of it, and can lead to suicide attempts.<ref name=":0" /><ref>{{Cite journal|title = Recent developments in the psychopharmacology of anxiety disorders|journal = Journal of Consulting and Clinical Psychology|date = August 1996|issn = 0022-006X|pmid = 8803355|pages = 660–668|volume = 64|issue = 4|first1 = R. B.|last1 = Lydiard|first2 = O.|last2 = Brawman-Mintzer|first3 = J. C.|last3 = Ballenger|doi=10.1037/0022-006x.64.4.660}}</ref><ref>{{Cite journal|title = Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology|journal = Journal of Psychopharmacology|date = November 2005|issn = 0269-8811|pmid = 16272179|pages = 567–596|volume = 19|issue = 6|doi = 10.1177/0269881105059253|first1 = David S.|last1 = Baldwin|first2 = Ian M.|last2 = Anderson|first3 = David J.|last3 = Nutt|first4 = Borwin|last4 = Bandelow|first5 = A.|last5 = Bond|first6 = Jonathan R. T.|last6 = Davidson|first7 = J. A.|last7 = den Boer|first8 = Naomi A.|last8 = Fineberg|first9 = Martin|last9 = Knapp|s2cid = 15685770|url = http://tud.qucosa.de/api/qucosa%3A26469/attachment/ATT-0/|access-date = 5 July 2019|archive-date = 30 April 2019|archive-url = https://web.archive.org/web/20190430005347/http://tud.qucosa.de/api/qucosa%3A26469/attachment/ATT-0/|url-status = dead}}</ref><ref name=Ashton1987>{{Cite journal |title=Benzodiazepine withdrawal: outcome in 50 patients|journal=British Journal of Addiction|date=June 1987|issn=0952-0481|pmid=2886145|pages=665–671|volume=82|issue=6|first=C. H.|last=Ashton|doi=10.1111/j.1360-0443.1987.tb01529.x |url=http://www.benzo.org.uk/ashbzoc.htm}}</ref><ref>{{Cite journal|title=Treatment of recent trauma survivors with benzodiazepines: a prospective study|journal=The Journal of Clinical Psychiatry|date=September 1996|issn=0160-6689|pmid=9746445|pages=390–394|volume=57|issue=9|first1=E. |last1=Gelpin|first2=O.|last2=Bonne|first3=T.|last3=Peri|first4=D.|last4=Brandes|first5=A. Y.|last5=Shalev}}</ref> Risk factors for suicide and suicide attempts while using benzodiazepines include high dose prescriptions (even in those not misusing the medications), benzodiazepine intoxication, and underlying depression.{{sfn|American Psychiatric Association|2013|p={{page needed|date=October 2021}}}}<ref>{{Cite journal |title=Prevalence and trends of benzodiazepine use among Veterans Affairs patients with posttraumatic stress disorder, 2003–2010|journal=Drug and Alcohol Dependence|date=July 2012|issn=1879-0046|pages=154–161 |volume=124|issue=1–2|first1=Eric J. |last1=Hawkins|first2=Carol A.|last2=Malte|first3=Zac E.|last3=Imel |first4=Andrew J.|last4=Saxon|first5=Daniel R.|last5=Kivlahan|doi=10.1016/j.drugalcdep.2012.01.003 |pmid=22305658 |url=https://zenodo.org/record/1258903}}</ref><ref>{{Cite journal|title=Comorbid Anxiety as a Suicide Risk Factor Among Depressed Veterans|journal=Depression and Anxiety|date=January 2009|issn=1091-4269|pmc=2935592|pmid=19544314 |pages=752–757|volume=26|issue=8|doi=10.1002/da.20583|first1=Paul N. |last1=Pfeiffer|first2=Dara|last2=Ganoczy|first3=Mark|last3=Ilgen|first4=Kara|last4=Zivin|first5=Marcia |last5=Valenstein}}</ref>

The long-term use of benzodiazepines may have a similar effect on the brain as [[alcoholic beverage|alcohol]], and are also implicated in depression.{{sfn|Semple|Smyth|Burns|Darjee|2007|p=540}} As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of [[serotonin]] and [[norepinephrine]], are believed to be responsible for the increased depression.{{sfn|Collier|Longmore|2003|p=366}}<ref>{{cite web | author= Professor Heather Ashton | year= 2002 | url= http://www.benzo.org.uk/manual/bzcha03.htm | title= Benzodiazepines: How They Work and How to Withdraw}}</ref><ref>{{cite journal |vauthors=Lydiard RB, Laraia MT, Ballenger JC, Howell EF |title=Emergence of depressive symptoms in patients receiving alprazolam for panic disorder |journal=Am J Psychiatry |volume=144 |issue=5 |pages=664–665 |date=May 1987 |pmid=3578580 |doi=10.1176/ajp.144.5.664}}</ref><ref>{{cite journal |vauthors=Nathan RG, Robinson D, Cherek DR, Davison S, Sebastian S, Hack M |date=January 1985 |title=Long-term benzodiazepine use and depression |journal=Am J Psychiatry |volume=142 |issue=1 |pages=144–145 |pmid=2857068 |doi=10.1176/ajp.142.1.144-b |url=http://ajp.psychiatryonline.org/cgi/reprint/142/1/144a |access-date=21 March 2009 |archive-date=16 May 2008 |archive-url=https://web.archive.org/web/20080516053102/http://ajp.psychiatryonline.org/cgi/reprint/142/1/144a |url-status=dead }}</ref><ref>{{Cite journal|title = Addiction: Part I. Benzodiazepines—side effects, abuse risk and alternatives|journal = American Family Physician|date = April 2000|issn = 0002-838X|pmid = 10779253|pages = 2121–2128|volume = 61|issue = 7|first1 = L. P.|last1 = Longo|first2 = B.|last2 = Johnson}}</ref><ref>{{Cite book |title = Psychiatry, third edition |veditors=Tasman A, Kay J, Lieberman JA |publisher = John Wiley & Sons|year = 2008|location = Chichester, England|pages = 2603–2615}}</ref> Additionally, benzodiazepines can indirectly worsen mood by worsening sleep (i.e., benzodiazepine-induced sleep disorder). Like alcohol, benzodiazepines can put people to sleep but, while asleep, they disrupt sleep architecture: decreasing sleep time, delaying time to [[REM sleep]], and decreasing [[Slow-wave sleep|deep sleep]] (the most restorative part of sleep for both energy and mood).<ref>{{Cite journal|title = The diagnosis and management of benzodiazepine dependence|journal = Current Opinion in Psychiatry |date = May 2005|issn = 0951-7367|pmid = 16639148|pages = 249–255|volume = 18|issue = 3|doi = 10.1097/01.yco.0000165594.60434.84|first = Heather|last = Ashton|s2cid = 1709063 }}</ref><ref name=brt05>{{Cite journal|title = Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse|journal = Behaviour Research and Therapy|date = January 2005|issn = 0005-7967|pmid = 15531349|pages = 1–14|volume = 43|issue = 1|doi = 10.1016/j.brat.2003.12.002|first1 = Charles M.|last1 = Morin|first2 = Lynda|last2 = Bélanger|first3 = Célyne|last3 = Bastien|first4 = Annie|last4 = Vallières}}</ref><ref name=jpr04>{{Cite journal|title = Chronic benzodiazepine usage and withdrawal in insomnia patients|journal = Journal of Psychiatric Research|date = June 2004|issn = 0022-3956|pmid = 15003439|pages = 327–334|volume = 38|issue = 3|doi = 10.1016/j.jpsychires.2003.10.003|first1 = Dalva|last1 = Poyares|first2 = Christian|last2 = Guilleminault|first3 = Maurice M.|last3 = Ohayon|first4 = Sergio|last4 = Tufik}}</ref> Just as some antidepressants can cause or worsen anxiety in some patients due to being activating, benzodiazepines can cause or worsen depression due to being a [[central nervous system]] depressant—worsening thinking, concentration and problem solving (i.e., benzodiazepine-induced neurocognitive disorder).{{sfn|American Psychiatric Association|2013|p={{page needed|date=October 2021}}}} However, unlike antidepressants, in which the activating effects usually improve with continued treatment, benzodiazepine-induced depression is unlikely to improve until after stopping the medication.<ref name=brt05 /><ref name=jpr04 />

In a long-term follow-up study of patients dependent on benzodiazepines, it was found that 10 people (20%) had taken drug overdoses while on chronic benzodiazepine medication despite only two people ever having had any pre-existing depressive disorder. A year after a gradual withdrawal program, no patients had taken any further overdoses.<ref name=Ashton1987/>

Just as with intoxication and chronic use, [[benzodiazepine withdrawal syndrome|benzodiazepine withdrawal]] can also cause depression.<ref>{{cite journal |vauthors=Fyer AJ, Liebowitz MR, Gorman JM, Campeas R, Levin A, Davies SO, Goetz D, Klein DF |date=March 1987 | title = Discontinuation of Alprazolam Treatment in Panic Patients | journal = Am J Psychiatry | volume = 144 | issue = 3 | pages = 303–8 | pmid = 3826428| url = http://www.benzo.org.uk/alprazolam.htm | access-date = 10 December 2008 | doi=10.1176/ajp.144.3.303}}</ref><ref>{{cite journal | journal = Psychosomatics | date = March–April 1997 | volume = 38 | issue = 2 | pages = 160–1 | title = Protracted benzodiazepine withdrawal syndrome mimicking psychotic depression | author = Modell JG | pmid = 9063050 | url = http://psy.psychiatryonline.org/cgi/reprint/38/2/160.pdf | archive-url = https://wayback.archive-it.org/all/20080625161217/http://psy.psychiatryonline.org/cgi/reprint/38/2/160.pdf | url-status = dead | archive-date = 25 June 2008 | doi = 10.1016/S0033-3182(97)71493-2 | access-date = 21 March 2009 }}</ref><ref>{{cite journal |author=Lader M |title=Anxiety or depression during withdrawal of hypnotic treatments |journal=J Psychosom Res |volume=38 |issue=Suppl 1 |pages=113–23; discussion 118–23 |year=1994 |pmid=7799243 |doi= 10.1016/0022-3999(94)90142-2}}</ref> While benzodiazepine-induced depressive disorder may be exacerbated immediately after discontinuation of benzodiazepines, evidence suggests that mood significantly improves after the acute withdrawal period to levels better than during use.<ref name=":0"/> Depression resulting from withdrawal from benzodiazepines usually subsides after a few months but in some cases may persist for 6–12 months.<ref>{{cite journal | journal = Psychiatric Annals |date=March 1995 | volume = 25 | issue = 3 | pages = 174–179 | title = Protracted Withdrawal From Benzodiazepines: The Post-Withdrawal Syndrome | author = Ashton CH | url = http://www.benzo.org.uk/pha-1.htm | doi=10.3928/0048-5713-19950301-11}}</ref><ref>{{cite web| author= Professor Heather Ashton| year= 2004| url=http://www.benzo.org.uk/pws04.htm| title= Protracted Withdrawal Symptoms From Benzodiazepines | publisher= Comprehensive Handbook of Drug & Alcohol Addiction}}</ref>