SSRI OR serotonin reuptake inhibitor OR tricyclic antidepressant; drug-induced akathisia; SSRI AND early onset OR psychomotor agitation OR aggression OR hostility OR impulsivity; and TCA/ tricyclic OR SSRI

in anxiety, agitation and irritability. Medical literature and guidelines cite this phenomenon, advising caution when prescribing selective serotonin reuptake inhibitors (SSRIs), especially for anxiety disorders. This phenomena is also used to support theoretical hypotheses of antidepressant action. However, we believe it remains inconsistently and poorly defined. For consistency in this systematic review we use the term jitteriness/anxiety syndrome to encompass the range of symptoms reported as part of the early antidepressant activation phenomena. To clarify the evidence base for jitteriness/anxiety syndrome we systematically reviewed all existing evidence relating to it, addressing the following questions: what symptoms constitute jitteriness/anxiety syndrome; which medications are implicated; in which disorders has it been reported; what is the incidence; what is the time course; what management strategies are effective; what is the relationship to therapeutic response; what is the relationship between this syndrome and akathisia; what is the relationship between this syndrome and suicide; is there a genetic predisposition? Method