Clinicians are often indifferent to the phenomenon of lethargy in depressed patients, which is in fact the main manifestation of hyperkinetic symptoms. Listlessness: the “VIPs” of depressive symptoms Psychiatrists are no strangers to the name of hyperkinetic symptoms of depression, as they are included as a core symptom of depression in the World Health Organization’s diagnostic criteria for depression (ICD-10). However, clinicians’ understanding of the clinical manifestations of hypokinetic symptoms varies widely. In fact, the “status” of each symptom is unequal in terms of driving the development of depression: some specific depressive symptoms have a broader intrinsic connection to the rest of the symptoms, have a greater impact on the course of depression, are far more important than other general symptoms, and should therefore be considered as critical to treatment success or failure. Studies have shown that these “higher” symptoms include lack of pleasure, decreased energy, lack of interest, and impaired attention/decision making. Taken together, hyperkinetic symptoms are core symptoms of depression and have a significant impact on the development of depression, but clinicians’ attention to hyperkinetic symptoms falls far short of what is needed. This may involve the inadequacy of the diagnostic classification system itself, and is also related to the lack of in-depth understanding by psychiatrists. If the psychiatric symptoms of depression are understood as independent signs that are not connected to each other, and if the English name is translated directly, it is easy to conclude that hyperkinetic means “not strong enough, easily tired”, so it is not easy to attract attention. ”No essence” and “playing”: this is the same root At this point can not help but recall the vast Chinese culture and commonly used words “no essence”, “no essence “is the lack of energy, “playing color” is the lack of interest. How amazing! Although there is no scientific basis, the ancients have long linked energy and interest through phenomena and experience. A new large-scale quantitative network analysis study of 28 depressive symptoms (including the 15 standard symptoms specified in the Diagnostic and Statistical Manual of Mental Disorders [DSM-5] and 13 non-DSM-5 standard symptoms) showed highlights the association between energy and interest, with a strong positive correlation between the two Decreased energy was ranked first in strength of correlation with other depressive symptoms, while Interest deficit also ranked fourth. The top 5 depressive symptoms node centrality (centrality) were decreased energy, sadness, sympathetic arousal, lack of interest, and lack of pleasure (FriedEIetal. 2015) To this day, a common neurotransmitter base also ties the two together, further confirming ancient observations and experiences. The production of anhedonia is related to the inhibitory effect of 5-hydroxytryptamine (5-HT) on dopamine (DA) and norepinephrine (NE) release: 5-HT2C receptors are distributed on brainstem GABA interneurons, and 5-HT in the synaptic gap binds to 5-HT2C receptors, elevating the activity of GABA neurons and leading to increased GABA release This ultimately inhibits the release of NE and DA from the prefrontal cortex, which in turn leads to hypokinetic symptoms in patients. In clinical work, difficulties in concentration and fatigue are not only quite common in patients in the acute phase of depression, but are also the most common residual symptoms of depression. These symptoms, on the one hand, have an impact on the functional recovery of the patient and, on the other hand, can easily be confused with depressive relapse and interfere with the treatment. To address this situation, foreign researchers have suggested the use of DA- and NEergic pharmacotherapy or as potentiating agents. The 5-HT2C receptor plays a key role in the development of hyperkinetic symptoms; it acts as a “brake”, inhibiting the release of prefrontal NE and DA; conversely, if the receptor is antagonized, 5-HT cannot “apply the brake”, and then Conversely, if this receptor is antagonized, the release of DA and NE can be deregulated, and the hypokinetic symptoms can be resolved. Clinical use of antidepressants with 5-HT2C antagonism and de-inhibition of DA and NE release can help depressed patients to alleviate their hypokinetic symptoms and to regain the sails of an exciting life.