Substance/Medication-Induced Depressive Disorder 179
tors common to all drugs incl ude history of major depressive disorder, history of drug-
induced depression, and psychosocial stressors.
Environmental.  There are also risks factors pertaini ng to a specific type of medication
(e.g., increased immune activation prior to treatment for hepatitis C associated with inter-
feron-alfa-induced depression); high doses (greater than 80 mg/day prednisone-equiva-
lents) of corticosteroids or high plasma conc entrations of efavirenz; and high estrogen/
progesterone content in  oral contraceptives.
Course modifiers. In a representative U.S. adult popu lation, compared with individuals
with major depressive disorder who did not have a substance use disorder, individuals
with substance-induced depressive disorder were more likely to be male, to be black, to
have at most a high school diploma, to lack  insurance, and to have  lower family income.
They were also more likely to report higher  family history of substance use disorders and
antisocial behavior, higher 12-month history of stressful life events, and a greater number
of DSM-IV major depressive diso rder criteria. They were more  likely to report feelings of
worthlessness, insomnia/hypersomnia, and thoughts of deat h and suicide attempts, but
less likely to report depressed mood and parental loss by death before age 18 years.
Diagnostic Markers
Determination of the substance of use can so metimes be made through laboratory assays
of the suspected substance in the blood or urine to corroborate the diagnosis.
Suicide Risk
Drug-induced or treatment-emergent suicidality represents a marked change in thoughts
and behavior from the person’s baseline, is us ually temporally associated with initiation of