Substance/Medication-Induced Depressive Disorder 175
may be due to the use of hormones rather th an to the underlying condition of premen-
strual dysphoric disorder. If the woman stops hormones and the symptoms disappear,
this is consistent with substance/medi cation-induced depressive disorder.
Comorbidity
A major depressive episode is the most frequent ly reported previous disorder in individuals
presenting with premenstrual dysphoric disorder. A wide range of medical (e.g., migraine,
asthma, allergies, seizure disorders) or other mental disorders (e.g., depressive and bipolar
disorders, anxiety disorders, bulimia nervosa, substance use disorders) may worsen in the
premenstrual phase; however, the absence of  a symptom-free period during the postmen-
strual interval obviates a diagnosis of premenstrual dysphoric disorder. These conditions
are better considered premenstrual  exacerbation of a current mental or medical disorder. Al-
though the diagnosis of premenstrual dysphoric disorder should not be assigned in situa-
tions in which an individual only experien ces a premenstrual exacerbation of another
mental or physical disorder, it can be considered in addition to the diagnosis of another men-
tal or physical disorder if the individual experiences symptoms and changes in level of func-
tioning that are characteristic of premenstrual dysphoric disorder and markedly different
from the symptoms experienced as part of the ongoing disorder. 
Substance/Medication-Induced
Depressive Disorder
Diagnostic Criteria  
A. A prominent and persistent disturbance in mood that predominates in the clinical pic-
ture and is characterized by depressed mood or markedly diminished interest or plea-
sure in all, or almost all, activities.