Stimulant Withdrawal

Primer

Stimulant Withdrawal is a withdrawal syndrome that develops within a few hours to several days after the cessation of (or marked reduction in) stimulant use (generally high dose) that has been prolonged.

DSM-5 Diagnostic Criteria

Criterion A

Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use.

Criterion B

Dysphoric mood and at least 2 of the following physiological changes, developing within a few hours to several days after Criterion A:

  1. Fatigue
  2. Vivid, unpleasant dreams
  3. Insomnia or hypersomnia
  4. Increased appetite
  5. Psychomotor retardation or agitation
Criterion C

The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion D

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Specifiers

Specifier

Specify the specific substance that causes the withdrawal syndrome (i.e. - amphetamine-type substance, cocaine, or other stimulant).

Signs and Symptoms

  • Acute withdrawal symptoms (post-use “crash”) can be seen after repeated high-dose use (“binges”).
    • These periods are characterized by intense and unpleasant feelings of depression and increased appetite, and requires several days of recuperation and rest.[1]
    • Depressive symptoms with or without suicidal ideation or behaviour can occur during the “crash.”[2]
  • Bradycardia is often present and is a reliable indicator of stimulant withdrawal.[3]
  • Anhedonia and drug craving can also be present but is not part of the diagnostic criteria.[4]

Differential Diagnosis

  • Stimulant use disorder and other stimulant-induced disorders
    • Stimulant withdrawal is different from stimulant use disorder and from the other stimulant-induced disorders (e.g. - stimulant-induced intoxication delirium, depressive disorder, bipolar disorder, psychotic disorder) because the symptoms of withdrawal predominate the clinical presentation and are severe enough to warrant independent clinical attention.

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References

1) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
2) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
3) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
4) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.