Tremor: A Potential Side Effect of Antidepressants

Understanding Tremors

• Tremors are involuntary shaking of body parts like the head, limbs, and eyelids.
• Common symptoms include:
  • Rapid oscillations, usually between four and 12 movements per second
  • Intermittent or continuous occurrence, lasting briefly or for extended periods
  • May subside during sleep and worsen with stress
  • May manifest as head nodding or a shaky voice

Antidepressants Linked to Tremors

• Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Examples include Zoloft, Prozac, and Paxil.

• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs):

• Tricyclic Antidepressants:

  • Examples include Ascendin, Anafranil, Elavil, Norpramin, Pamelor, Sinequan, Surmontil, Tofranil, and Vivactil.

Other Medications Causing Tremors

• Lithium

• Depakote (sodium valproate)

• Anticonvulsants

• Anti-emetics

• Bronchodilators

• Epinephrine

• Certain antibiotics and antiviral drugs

• Chemotherapy and immunosuppressant medications

• Heart and blood pressure medications

• Stimulants like caffeine and amphetamines

Tremor-Inducing Conditions

• Neurological Disorders:

  • Parkinson's disease

• Anxiety or Panic Attacks

• Alcohol Withdrawal

• Thyroid Disorders:

  • Hyperthyroidism

• Pheochromocytoma

• Wilson's Disease

• Liver Failure

• Stroke

• Multiple Sclerosis

Determining the Cause of Tremors

• Physical Examination: Evaluation of physical signs and symptoms.

• Medical History Review: Exploration of past medical conditions and treatments.

• Medication Review: Assessment of current medications and their potential side effects.

Managing Tremors Caused by Antidepressants

• Medication Adjustment:
  • Discontinuation of the causative antidepressant.
  • Switch to an alternative antidepressant with a lower risk of tremors.
  • Addition of other medications to alleviate tremor symptoms.

Medications for Tremor Control

• Beta-blockers: Regulate heart rhythm and lower blood pressure.

• Benzodiazepines: Provide sedation, reduce anxiety, and suppress seizures.

• Mysoline (primidone): Calms overactive nerves.

• Neurontin (gabapentin): Effective in treating seizures and alleviating nerve pain.

• Topamax (topiramate): Used for seizure treatment and nerve pain relief.