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Early worsening of anxiety, agitation and irritability are thought to be
common among people commencing antidepressants, especially for anxiety
disorders. This phenomenon, which may be termed jitteriness/anxiety
syndrome, is cited as an explanation for early treatment failure and
caution in using selective serotonin reuptake inhibitors (SSRIs).
However, we believe that it is inconsistently defined and that robust
evidence to support the phenomenon is lacking.
To review systematically all evidence relating to jitteriness/ anxiety
syndrome to identify: constituent symptoms; medications implicated;
disorders in which it was reported; incidence; time course; management
strategies; relationship of this syndrome to therapeutic response;
distinction between syndrome and akathisia; relationship between syndrome
and suicide; and genetic predispositions.
A systematic search identified articles and these were included in the
review if they addressed one of the above aspects of jitteriness/anxiety
Of 245 articles identified, 107 articles were included for review. No
validated rating scales for jitteriness/anxiety syndrome were identified.
There was no robust evidence that the incidence differed between SSRIs
and tricyclic antidepressants, or that there was a higher incidence in
anxiety disorders. Published incidence rates varied widely from 4 to 65%
of people commencing antidepressant treatment. Common treatment
strategies for this syndrome included a slower titration of
antidepressant and the addition of benzodiazepines. Conclusive evidence
for the efficacy of these strategies is lacking. There was conflicting
and inconclusive evidence as to whether the emergence of this syndrome
had a predictive value on the response to treatment. It appears to be a
separate syndrome from akathisia, but evidence for this assertion was
limited. The effect of jitteriness/anxiety syndrome on suicide rates has
not been evaluated. Three studies examined genetic variations and
side-effects from treatment, but none was specifically designed to assess
Jitteriness/anxiety syndrome remains poorly characterised. Despite this,
clinicians' perception of this syndrome influences prescribing and it is
cited to support postulated mechanisms of drug action. We recommend
systematised evaluation of side-effects at earlier time points in
antidepressant trials to further elucidate this clinically important
This report describes the excavation of two pits which had been dug into the natural rock, apparently in connection with the storage and perhaps original manufacture of plaster, in the space named after them the ‘Room of the Plaster Pits’. The pits were filled and covered in LM II, and the evidence for their date helps to bring the history of this part of the palace into clearer focus. The Room of the Plaster Pits may be the same as the elusive Lapidary's Workshop described by Evans in his Knossos report for 1901. It is suggested that the lack of observed floors or blocking walls in doorways separating deposits in this area makes it difficult to divide the vases assigned to LM III B here from tablets and seal impressions involved in the final destruction of the palace.
This shell applique in the Ashmolean Museum at Oxford was acquired by Evans in Crete in 1894. He was told that it came from the Mesara, but there is no evidence to link it with the Ayios Onoufrios deposit. The material is Aegean Spondylus gaederopus L., not Tridacna from the Red Sea. The plaque is probably Cretan work of the period of the Early Palaces (Middle Minoan I–II), not Early Minoan or Archaic Greek as Evans at different times believed. It seems to represent, not a negro or ‘negroid’ as often claimed, but a physical type attested by other representations of Bronze Age date in Crete and elsewhere in the Aegean area.
Four letters written in 1879, 1880, and 1884, by Thomas B. Sandwith, the British Consul in Crete, to the British Museum throw light on the early history of the site of the Bronze Age palace at Knossos. The first of these letters (1879) contains a brief eyewitness account of the excavations of Minos Kalokairinos there in the winter of 1878–9 and urges the British Museum to continue his work. The two later letters (1884) deal with his gift of a pithos from the palace excavations to the Museum. The letters also refer to clandestine excavations in the Sanctuary of Demeter at Knossos.