The Stimulant Syndrome

Beneath the black box, a headline reads warnings—Clinical Worsening and Suicide Risk. Without identifying it as such, this section contains a warning about the stimulant or activation syndrome that I first described in Toxic Psychiatry in 1991  

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. 

The new label addresses information that should be given to patients and their caregivers who take the newer antidepressants  

Most of the symptoms described in my previous publications and by the FDA in its new label are the result of activation or stimulation, a syndrome similar to that caused by stimulants such as amphetamine, methamphetamine, and methylphenidate, especially in high doses. Compared to antidepressant-induced suicidality, activation is bolstered by a much larger scientific literature and poses a far more common, and often disastrous, level of risk (see subsequent discussion). 

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Our whole task from a clinical perspective includes (1) delineation of the patterns of behavioral pathology induced both during the active stimulant abuse phase and the phases of withdrawal (2) description of the sequential profile of underlying structural and functional pathology at each of the clinical phases and (3) an attempt to elucidate the relationship between (1) and (2). In addition, an understanding of the pharmacological and other parameters sufficient and necessary for inducing components of the stimulant syndrome is clearly needed and can be obtained only from basic laboratory studies. 

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