Abrupt cessation of stimulant (amphetamine, cocaine) use is associated with depression, anergia, anhedonia, increased drug craving, increased appetite, hypersomnolence and increased REM sleep (Weiss, Greenfield & Mirin, 1994). This initial period of intense symptoms is commonly termed the 'crash', which is usually selflimiting to a period of days. There have been reports of myocardial ischaemia occurring in the first week of stimulant withdrawal (Nademanee, Gorelick et al, 1989) although this is uncommon, and other medical effects are relatively minor.

The 'dopamine deficiency' hypothesis of stimulant withdrawal has not been supported by clinical practice - controlled clinical trials of dopamine agonists have yielded inconsistent results. Similarly the use of tricyclic antidepressants to limit the effects of withdrawal on the basis that they inhibit presynaptic catecholamine neurotransmitter uptake, have failed to deliver any significant benefit. Antidepressants may however be useful in the treatment of an on-going depressive disorder associated with stimulant drug misuse.

The stimulant withdrawal syndrome is thus best treated supportively and symptomatically by allowing the patient to sleep and eat as much as necessary. A benzodiazepine