Jitteriness syndrome

Pohl, R., Yeragani, V.K., Balon, R., and Lycaki, H. (1988) The jitteriness syndrome in panic disorder patients treated with antidepressants. J Clin Psychiatry 49 100-104. 

Alprazolam has been shown to be effective in alleviating the jitteriness syndrome ( 94). A patient s inability to tolerate these adverse effects may be the most important treatment-limiting factor with these drugs. Alternatively, short-term combination with another BZD may be helpful until the full impact of the antidepressant is realized. 

Behavioral activation. Adverse effects while on the SSRIs may include anxiety, restlessness, agitation, ak-athisia, jitteriness, disinhibition, and/or activation. The development of anxiety, restlessness, and agitation while on an antidepressant has been described as part of the complex and poorly self-described syndrome of akathisia (Kalda, 1993). Behavioral activation is variously reported as akathisia, jitteriness, disinhibition, activation, or agitation, and may represent overlapping or different phenomena. It is important for clinicians to discuss these potential symptoms with children and their parents, as the symptoms certainly can occur in the pediatric age group, and it is not known if there is an additional age-related risk. 

SSRIs sometimes cause an initial jitteriness similar to that noted with initial imipramine therapy for PD. This may be more common with SSRIs than with other currently available non-TCA antidepressant therapies for PD. Just as low initial imipramine doses avert this reaction, initiating SSRI therapies with one fourth to one half the usual starting antidepressant dose followed by gradual increments with low doses can avert this reaction. This syndrome can also be blocked by add-on, low-dose, as-needed BZD therapy (e.g., alprazolam or lorazepam). 

Patients with phobias or panic disorders are extremely sensitive to the adverse effects of tricyclic drugs early in treatment. They often have a syndrome of fine tremor, insomnia, and anxiety, which can be characterized as jitteriness and which is sometimes attributed to adrenergic hypersensitivity (SEDA-13, 9). Serum iron concentrations were significantly lower in jittery patients than in those who were not affected (SEDA-17, 19) (60). The authors suggested that this may be related to the role of iron as a co-factor for tyrosine hydroxylase. 

A neonatal withdrawal syndrome has been described, with verification by the detection of pentazocine and its metabolites in the urine of both mother and baby. Within 4 hours of birth the child was irritable, jittery, and hypertonic, with a high-pitched cry, a voracious appetite, and frequent bowel movements. The symptoms improved over 3 days. The mother had abused parenteral pentazocine (23-46 mg) for the previous 10 years and injected the last dose of 46 mg some 10 hours before dehvery (10). 

Ethyl alcohol is found in alcoholic beverages and is a known teratogenic material, which is the reason doctors tell pregnant women not to drink alcohol. When a mother drinks, the unborn child drinks as well. Ethyl alcohol causes growth failure and impaired brain development. Unborn children exposed to alcohol may suffer the effects of Eetal Alcohol Syndrome when they are bom. Symptoms of Fetal Alcohol Syndrome include sleep disturbance, jitteriness, a higher incidence of impaired vision and hearing, lack of motor coordination, balance problems, abnormal thyroid function, and a decrease in immune system effectiveness. Additional teratogens include heavy metals, methyl mercury, mercury salts, lead, thallium, selenium, penicillin, tetracyclines, excess Vitamin A, and carbon dioxide. 

The clinical presentation of patients with endocrine pancreatic tumors will vary according to the type of hormone released. Hyperinsulinism manifested with diarrhea, abdominal pain, and low levels of glucose will be found in the majority of patients. Nesidioblastosis is a primitive pancreatic B cells hyperplasia. Approximately 5% of patients with hyperinsulinism may have this type of tumor. Hunger, jitteriness, lethargy, apnea, and seizures are common manifestations in newborns with nesidioblastosis, while older children may show diaphoresis, confusion, or unusual behavior. Zollinger-Elli-son syndrome will present with intractable peptic ulcers. Patients with vipomas will have watery diarrhea, hypokalemia, and achlorhydria, while multiple endocrine neoplasias have been reported with multiple endocrine neoplasia type 1 (MEN 1). 

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