Tremor and Antidepressants

Tremor and Antidepressants
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Question:  I've been on an antidepressant for a couple of months now and I've been having shaky hands.  Is it normal to have tremor with antidepressants?

Answer:  First, let's talk about what tremor is.  Tremor is an involuntary shaking that occurs in the head, limbs or eyelids.  This shaking can occur either when you are moving or when you are attempting to hold your body still.  It is usually fast (about 4 to 12 movements per second).

  It may come and go or occur in bursts.  It may subside during sleep and get worse when a person is under stress.  A person might also experience head nodding or have a shaky sounding voice.

Certain types of antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs) and tricyclics, can indeed cause tremor as a side effect.   Some studies estimate that 20 percent of patients treated with an SSRI or tricyclic antidepressant will develop a tremor.  This may occur some time after the medication was initiated.

Other psychiatric medications, such as lithium and Depakote, may also commonly cause tremor.  In addition, there are a wide variety of other prescription drugs which may cause this side effect.  Antipsychotic medications, particularly the older agents, may cause a tremor similar to Parkinson's disease.  Finally, there are certain medical conditions which can cause tremor, such as Parkinson's disease, alcohol withdrawal, hyperthyroidism, pheochromocytoma, Wilson's disease and liver failure.

In order to determine whether your tremor is indeed related to your antidepressant, your doctor will do a physical exam and ask you questions about your medical history, including what medications you are taking.  Generally this is enough to determine if your antidepressant is causing your tremor, although your doctor may order additional testing if he needs to rule out any other potential causes.

Perhaps the best solution for tremor caused by antidepressants is to stop taking the drug causing it and switch to a different medication.  Tremor will generally resolve over time after the offending medication has been ceased.

Sometimes, however, you may be doing so well on your medication that you don't want to change it for fear of returning depression.  In these cases, your doctor may opt to add an additional medication to control your tremor, such as a beta-blocker, a benzodiazepine, primidone (Mysoline), topiramate (Topamax) or gabapentin (Neurontin).

Sources:

Barton, Brandon, Elizabeth Zauber and Christopher G. Geotz.  "Movement Disorders Caused by Medical Disease."  Seminars in Neurology.  29.2 (2009):  97-110.

"Drug-Induced Tremor."  Medline Plus.  U.S. National Library of Medicine. Last updated:  By Joseph V. Campellone, MD on July 27, 2014.  Reviewed by: David Zieve, MD, MHA, Isla Ogilive, PhD and the A.D.A.M. Editorial Team and VeriMed Healthcare Network.  Accessed:  September 21, 2015. 

National Cancer Institute.  "Tremor - Topic Overview."  WebMD.  WebMD, LLC.  Last updated: March 12, 2014.  Accessed:  September 21, 2015.

The Carlat Psychiatry Report.  "Evaluating and Treating Tremor."  Psych Central.  Psych Central.  Last reviewed: By John M. Grohol, Psy.D. on September 17, 2013.  Accessed:  September 21, 2015.

Wint, Carmella.  "Drug-Induced Tremor."  Healthline.  Healthline Networks, Inc.  Published:  July 20, 2012.  Last reviewed:  By George Crucik, MD on July 20, 2012.  Accessed:  September 21, 2015.

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