Tricyclic antidepressants like amitriptyline can cause tremor progression or an increase in tremor amplitude or drug induced tremors tremor severity, i.e., it can make a tremor more noticeable. Selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa) and fluoxetine (Prozac) and serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) can cause twitching and hand tremor. Stopping these medications abruptly can cause tremors due to withdrawal effects. A double-blind placebo-controlled crossover study conducted by Hellriegel et al. 11, investigated the efficacy of levetiracetam in comparison to placebo in twelve patients. At the beginning, the patients received 500 mg levetiracetam twice a day, with the dosage subsequently escalated to a maximum of 3000 mg per day for those whose renal function could tolerate such high doses.
In addition to the elevated creatine kinase, laboratory investigations usually find leucocytosis, abnormal electrolytes, renal impairment, abnormal liver function tests, and altered coagulation studies. Drinking caffeinated beverages, like coffee and certain teas or sodas, can make your tremors worse. Tremors aren’t life-threatening, but they may be embarrassing for you if they happen in public. You might want to go to a support group while you wait for your symptoms to subside. The tremor can occur episodically after taking the medication, intermittently in bursts, or occasionally without correlation to medication intake.
Action tremor, in contrast, occurs with voluntary movement and can be divided into postural tremor and kinetic tremor. Postural tremor occurs classically when maintaining the arms in an outstretched position against gravity. Kinetic tremor includes tremor that is task specific or with goal-directed movements.
Improving Medication-Induced Movement Disorders and Seeking Medical Help
Early recognition of a drug-induced movement disorder is essential to allow for prompt intervention. This includes stopping the offending drug, supportive care, and sometimes other pharmacological treatment. Management consists of altering the dose of, or if possible stopping, the offending drug, or switching to an alternative drug. Should the offending drug need to be continued, discuss the risks of the adverse effects versus the benefits of continuing to ensure the patient is informed. If the drug is continued, drugs typically used for essential tremor (for example, propranolol) can occasionally be beneficial. The tremors may not happen all of the time, but they’re likely to occur within the first hour of taking medication.
Common Medications That Can Cause Tremors
Myoclonus, or sudden, brief muscle jerks, occurs in about 5-10% of patients with medication-induced movement disorders. This symptom can be triggered by medications that affect the central nervous system, such as antidepressants or anticonvulsants. Myoclonus can affect any muscle group and may occur spontaneously or in response to stimuli such as light or sound. While myoclonus is usually not painful, it can be disruptive and may interfere with activities such as writing or eating. Resting tremor (as typically occurs in DIP or PD) is commonly 4–6 Hz in frequency and occurs when the affected body part is fully supported without ongoing voluntary muscle contraction.
- You may find it challenging to perform easy tasks, which may, in turn, affect your social functioning and interpersonal communication.
- Therefore, there is limited scientific literature on parasomnias and SRMD induced by medications, although this is a common and challenging clinical scenario (Kierlin & Littner, 2011).
- Resuming the offending drug or changing to an atypical antipsychotic is sometimes required.16 In patients with a chronic psychotic disorder clozapine is preferred.
- Additionally, Drug-Induced Movement Disorders will interfere with your quality of life.
She described hearing neighbors accuse her of poisoning their pets; moreover, she believed that they were “bugging” her apartment and watching her through her TV. Her medical history was notable for having systemic lupus erythematosus and chronic kidney disease. Although she had an episode of depression during college, she had not received psychiatric treatment for the past 2 years. There is a paucity of literature that deals with the mechanisms of MIT, with most manuscripts only describing the frequency and clinical settings where MIT is observed. That being said, MIT emanates from multiple mechanisms depending on the drug and it often takes an individualized approach to manage MIT in a given patient.
This outcome could be linked with the ability of nervous system drugs to modulate the release of neurotransmitters that are involved in the regulation of sleep–wake cycle (Franco‐Pérez et al., 2012). Noradrenaline, serotonin (5‐hydroxytryptamine 5‐HT), acetylcholine, gamma‐aminobutyric acid (GABA), histamine, orexin, and adenosine play a major role in sleep–wake cycle (Franco‐Pérez et al., 2012). Agonists and antagonists that interact with these neurotransmitter receptors can increase or decrease the duration of the sleep stages. Sleep‐related movement disorders (SRMD) are characterised by simple, often stereotyped movements during sleep (Merlino & Gigli, 2012; Sateia, 2014). However, a high frequency and severity of SRMD can impair sleep quality and cause insomnia, poor sleep quality, fatigue and excessive daytime sleepiness (Merlino & Gigli, 2012). Restless legs syndrome (RLS) is the most common SRMD, which affects between 3.9% and 24% of adults in Western countries (Hadjigeorgiou et al., 2007; Nichols et al., 2003).
Frontal Lobe Syndrome Unveils an Unexpected Diagnosis
In all four cases, the response to levodopa treatment was striking, leading to the complete resolution of the standing tremor. However, this study did not investigate primary orthostatic tremor and only described four cases and therefore did not meet our inclusion criteria 16. According to the study by Bertram et al. 7, botulinum toxin was ineffective in treating orthostatic tremor, as demonstrated by the lack of improvement following the administration of 200mU of abobotulinumtoxin A into the anterior tibial muscles.
Associated co-morbidities in a retrospective cohort of orthostatic tremor
However, this effect diminished and was not observed at the three-month follow-up. Of the 11 patients that had reported an improvement in symptoms at the follow-up at one month, only one patient continued to report such improvement at the three-month follow-up. Eight patients decided to continue treatment with perampanel following the completion of the study 13. Medication-induced movement disorders can significantly impact daily life, but early diagnosis and appropriate treatment can provide symptom relief. A combination of medications, lifestyle changes, and regular medical follow-ups can effectively manage these disorders. If you or a loved one is experiencing symptoms of a movement disorder, seek medical advice.
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A medication-induced tremor can be an action tremor that occurs with movement or a resting tremor that occurs at rest. Emotional stress and voluntary movements can make drug-induced tremors worse. One limitation in the comparison of these studies lies in the inconsistent diagnostic criteria employed. For instance, in the study by Gironell and Marín-Lahoz, it is merely stated that the diagnosis was established by external neurologists 13.
Essential tremor is a neurological disorder in which involuntary and rhythmic shaking affects a part of the body, typically in the hands and forearms. It can be an action tremor that occurs when you try to do simple tasks like picking up something or drinking from a glass. While it is not life-threatening, many patients find an essential tremor affects their quality of life. The study conducted by Bertram et al. 7 was a double-blind, placebo-controlled, randomized cross-over study compared the effects of injecting 200 mU of botulinum toxin A with an equal volume 0.9% aline solution into the anterior tibial muscle. Eight female patients with electrophysiologically proven primary orthostatic tremor were randomly assigned to either the experimental or control group, with a drop-out of one patient during the entire course of the study.
Additionally, there is a poor response to typical antiparkinsonian drugs, including levodopa, dopamine agonists and anticholinergic drugs. Cessation of the offending drug usually results in complete resolution of the disorder. Diagnosis of your drug-induced tremors will start with your doctor asking you about your symptoms and medical history.
The lifetime prevalence of sleepwalking is 3.5% in adults (Hublin et al., 1997). Nightmare disorder is characterised by recurrent, highly dysphoric dreams during REM sleep. It is estimated to affect 2–8% of the general population (Akkaoui et al., 2020). Episodic nightmares are very common in the general population with a prevalence of about 35–45% (one nightmare per month) (Akkaoui et al., 2020). Sleep‐related hallucinations are very common unreal experiences that occur at the onset of sleep or upon awakening from sleep.
While the movement disorder usually occurs following drug ingestion, it can also occur during the withdrawal phase. Typically, it subsides on cessation of the drug, but can last for months. No specific treatment exists for movement disorders caused by illicit drug use. In contrast to idiopathic Parkinson’s disease, drug-induced parkinsonism usually presents as a symmetrical akinetic rigid syndrome which develops over days to weeks to months following ingestion of the offending drug.