Substance-induced mood and anxiety — structured clinical viva

Assessment spine. Medical exclusion first for stimulant toxicity, timeline of last use and binge pattern, collateral, MSE, explicit suicide risk (crash window), capacity/legal status, dual diagnosis of stimulant use disorder if criteria met. McKetin work supports dose-sensitive neuropsychiatric effects of methamphetamine — take severity seriously.^[3]

"Is this depression forever?" Use provisional pathway language: working diagnosis may be substance-induced depressive symptoms/crash dysphoria if the temporal link is clear; diagnosis evolves if symptoms persist after abstinence. Avoid fatalism and avoid dismissiveness. Schuckit-style induced versus independent logic applies across substances, not only alcohol.^[1][2]

"Why not an antidepressant tonight?" If pure crash picture with contained risk after observation, short supervised watchful waiting can be reasonable while cessation proceeds; start sertraline 50 mg oral daily (or equivalent SSRI) earlier if independent MDD cues, severity, or uncontained suicide risk. Name monitoring: early review for activation/suicidality, GI effects, interactions. Do not use open-ended benzodiazepines as the depression plan.^[1][2][4]

Panic while high. Cannabis and stimulant intoxication can produce severe anxiety/panic without proving lifelong primary anxiety disorder; reassess after abstinence. Alcohol withdrawal anxiety is a separate medical issue.^[3]

"Addiction first, psychiatry later?" No — integrated concurrent care. Sequential exclusion worsens outcomes; shared formulation, MI/psychosocial SUD work plus mood/anxiety treatment together (Drake). For alcohol dual depression, Pettinati-style dual pharmacotherapy thinking (treat both axes) is examinable.^[4][5]