Common sedative‑induced disorders

• Substance/medication‑induced anxiety disorder (excessive anxiety temporally related to sedative use or withdrawal).
• Substance/medication‑induced depressive disorder (depressed mood linked to sedative exposure or discontinuation).
• Substance/medication‑induced sleep disorder (persistent insomnia or hypersomnia after medication change).
• Substance/medication‑induced delirium (acute disturbance of attention and cognition often in intoxication/withdrawal).
• Medication‑induced neurocognitive disorder (long‑term cognitive impairment related to chronic sedative exposure).

Diagnostic considerations

1. Temporal relationship: symptoms begin during intoxication, withdrawal or soon after dose change/cessation.
2. Clinical course: onset, peak and resolution within expected timeframe after stopping/switching agent supports a substance‑induced diagnosis.
3. Rule out primary disorders: consider prior history, family history, and symptom persistence beyond expected recovery period (then consider primary diagnosis).
4. Consider medical contributors: infections, metabolic disturbance, or other medications that may cause similar presentations.

Assessment checklist

• Complete medication and substance use history (including OTC, herbal, alcohol, and opioids).
• Timeline mapping: correlate symptom onset with medication changes, reductions or missed doses.
• Mental state exam, cognitive screening (e.g., MoCA or MMSE if cognitive symptoms), and delirium screen (e.g., CAM).
• Basic investigations: electrolytes, LFTs, glucose, thyroid function, and consider toxicology when appropriate.

Management principles

• Whenever possible, remove or reduce the offending agent cautiously — avoid abrupt cessation unless clinically indicated (e.g., life‑threatening situation).
• Treat specific syndromes: delirium requires immediate medical assessment and management of underlying causes; severe depression or suicidal risk needs urgent psychiatric care.
• Provide symptomatic treatments (short‑term) — e.g., low‑dose antipsychotic for severe delirium agitation under monitoring; sedating antidepressant or CBT for insomnia where appropriate.
• Coordinate multi‑disciplinary care — psychiatry, addiction services, primary care, and neurology where cognitive issues are prominent.

Specific disorder management

Medication‑induced anxiety

• Assess if symptoms are due to intoxication (excess drug effect) vs withdrawal (absence of drug). Manage intoxication with monitoring; manage withdrawal with substitution/taper and supportive care.
• Offer CBT for anxiety and, where indicated, consider switching to an evidence‑based long‑term treatment (e.g., SSRI) rather than restarting benzodiazepines.

Medication‑induced depressive disorder

• Evaluate severity and suicidal risk. If mild and temporally linked, treat supportively and plan medication review. If moderate–severe, consider antidepressant initiation and psychiatric referral.

Medication‑induced sleep disturbance

• Prioritise sleep hygiene and CBT‑I. Consider short‑term pharmacological aids only when necessary, and avoid reinstating long‑term sedative therapy.

Medication‑induced delirium

• Delirium is a medical emergency — identify and treat precipitating causes, ensure safety, maintain hydration, and provide low‑stimulus environment. Use antipsychotics for severe agitation if needed (with caution in the elderly).

Medication‑related cognitive impairment

• Consider tapering and discontinuing long‑term sedatives where safe, perform cognitive assessment, and refer to neurology or geriatric psychiatry if cognitive deficits persist after medication withdrawal.

When to refer

• Persistent or severe symptoms despite cessation of the offending agent.
• Delirium, suicidality, psychosis, or complex comorbidity (neurological disease, pregnancy).
• Evidence of progressive cognitive decline after reasonable washout period — refer for specialist cognitive workup.

Key takeaways

• Establish temporal link between symptoms and sedative exposure to diagnose medication‑induced disorders.
• Prioritise cautious medication review and tapering, manage acute syndromes promptly, and arrange timely specialist referral if symptoms persist.
• Non‑pharmacological therapies (CBT, sleep interventions) and multidisciplinary care improve outcomes.