Tremor as a Side Effect From Taking Antidepressants

Like other medications, antidepressants can have a number of side effects. Tremors are one potential side effect of antidepressants such as Zoloft, Prozac, and Paxil.

This article discusses what a tremor is, the different types of tremors, and what medications as well as medical conditions may contribute to a tremor. It also covers treatments that can help if you experience tremors after taking an antidepressant.

What Is a Tremor?

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. Tremors:

• Are usually fast (about four to 12 movements per second)
• May come and go or occur in bursts
• May subside during sleep and get worse when a person is under stress
• May include head nodding or a shaky-sounding voice

There are some tremors that occur when you're resting and others that only occur when you're moving. A tremor that occurs when you're moving may happen when you're performing any type of motion, or, it may happen consistently during a specific motion.

Antidepressants That Cause Tremors

Certain types of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants can cause tremors as a side effect.

SSRI antidepressants include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Luvox (fluvoxamine)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Tricyclic antidepressants include:

• Ascendin (amoxapine)
• Anafranil (clomipramine)
• Elavil (amitryptyline)
• Norpramin (desipramine)
• Pamelor (nortryptyline)
• Sinequan (doxepin)
• Surmontil (trimipramine)
  
• Tofranil (imipramine)
• Vivactil (protriptyline)
  

Other Medications That Cause Tremors

Other psychiatric medications such as lithium and Depakote (sodium valproate), which are mood stabilizers used in bipolar disorder, may also commonly cause tremors. Antipsychotic medications, particularly typical antipsychotics, may cause a tremor similar to Parkinson's disease.

Extrapyramidal side effects of these drugs may also include dystonia (involuntary contractions of muscles), tardive dyskinesia (abnormal facial movements such as grimacing and chewing), and akathisia, a feeling of restlessness that may sometimes mimic a tremor.

In addition, there are a wide variety of other prescription drugs which may cause tremors. These include:

• Anticonvulsants (anti-epilepsy drugs)
• Anti-emetics (anti-nausea drugs)
• Bronchodilators used for asthma and chronic obstructive pulmonary disease (COPD)
• Epinephrine
• Some antibiotics
• Some anti-viral drugs
• Some chemotherapy drugs
• Some immunosuppressant medications
• Some heart and blood pressure medications
• Stimulants such as caffeine and amphetamines

Conditions That Cause Tremors 

There are certain medical and mental health conditions that can cause tremors. Some non-medication causes of tremors include:

• Parkinson's disease
• Anxiety or panic attack
• Alcohol withdrawal
• Hyperthyroidism
• Pheochromocytoma
• Wilson's disease
• Liver failure
• Stroke
• Multiple sclerosis

How to Determine the Cause?

A careful description of your tremor may help your doctor determine whether your antidepressant is causing your tremor of if it could be related to another condition. In order to determine whether your tremor is indeed related to your antidepressant, your doctor will:

• Perform a physical exam
• Ask you questions about your medical history
• Ask what medications you are taking

Generally, this is enough to determine if your antidepressant is causing your tremor, though other tests may be needed to confirm that the tremor isn't a result of another unrelated condition. Your doctor may order lab tests and other tests such as an MRI or CT scan to rule out other conditions.

Treatment for Tremors Caused by Antidepressants

Typically, the best solution for tremors caused by antidepressants is to stop taking the drug causing it and switch to a different medication. Tremors will generally resolve over time after the medication has been ceased, but occasionally a tremor caused by SSRIs may persist.

Sometimes, however, you may be doing so well on your medication that you don't want to change it for fear of depression relapse. If this is the case, your doctor may opt to add an additional medication to control your tremors. Some medications that may be used to manage antidepressant-induced tremors include:

• Beta-blockers: A class of drugs that are primarily prescribed to treat cardiac conditions by controlling heart rhythm and lowering blood pressure
• Benzodiazepines: Depressant medications that can produce sedation, lower anxiety, and reduce seizures
• Mysoline (primidone): Typically used to treat symptoms of epilepsy, this medication helps to calm overactive nerves in the body
• Neurontin (gabapentin): An anticonvulsant medication that is used to treat seizures and relieve nerve pain
• Topamax (topiramate): An anticonvulsant medication that is typically used to treat seizures and nerve pain