You should not stop taking any medication without talking to your healthcare provider first. Your doctor will diagnose the cause of your tremor based on your medical history, physical exam, and blood tests. Tricyclic antidepressants like amitriptyline can cause tremor progression or an increase in tremor amplitude or 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.
Drug-induced movement disorders
The most common types drug induced tremors of MIMDs include tardive dyskinesia, drug-induced parkinsonism, and akathisia. Tardive dyskinesia, for example, is characterized by repetitive, jerky movements, often in the face or limbs. Drug-induced parkinsonism mimics Parkinson’s disease symptoms, such as stiffness and slow movements. DIMDs remain a significant burden among certain patient populations, such as those receiving treatment with dopamine receptorÒblocking agents (DRBAs; e.g., various psychotropic agents and antiemetics) (TABLE 2). DIMDs are often underrecognized, and knowledge of DIMDs will allow clinicians, pharmacists, and other health care professionals to better identify and manage patients with these conditions. The majority of MIT are posture holding or kinetic, but some medications (especially lithium, DBAs, valproic acid) can cause resting tremors.
Thyrotoxic Psychosis in Graves’ Disease
Since there is cognitive impairment in both Parkinson’s disease and pseudoparkinsonism, it is difficult to distinguish between the two based on cognitive performance alone. Over the next 30 minutes, her tremor, rigidity, eye movement deviation, and torticollis gradually resolved. All laboratory testing, including a comprehensive metabolic panel, liver function tests, thyroid function tests, and serum and urine toxicology screens, were within normal limits.
Living with Medication-Induced Movement Disorders: Tips for Better Quality of Life
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. 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. If you cannot discontinue the medicine that is causing your tremor, your healthcare provider may change your medication dose or switch you to another medicine to treat your health condition.
If you begin to develop new symptoms as you wean yourself off the medication, talk to your doctor. While pseudoparkinsonism, parkinsonism, and Parkinson’s disease share many of the same symptoms, their causes are different. We performed a PubMed literature search for published articles dealing with MIT and attempted to identify articles that especially dealt with the medication’s mechanism of inducing tremor. Taking too much levothyroxine (Levoxyl, Synthroid), a medication used to treat hypothyroidism (underactive thyroid gland), can cause tremors, a symptom of hyperthyroidism.
Additionally, patients with mental health disorders, such as schizophrenia or bipolar disorder, who are prescribed antipsychotic medications, are at higher risk of developing tardive dyskinesia and other movement-related side effects. Long-term use of certain medications, such as antipsychotics, antidepressants, and anti-nausea drugs, also increases the likelihood of developing MIMDs. Medication-induced movement disorders occur when certain medications interfere with the brain’s ability to regulate movement. These disorders can manifest as involuntary muscle contractions, tremors, or difficulty with coordination.
- Have you ever wondered how often abnormal involuntary movements (AIMs) develop following use of medications?
- Hopefully this further knowledge will lead to better therapeutics for pathological tremors and allow us to develop less tremorogenic drugs.
- We will attempt to discuss what is known and unknown about the pathophysiology of the most common MITs.
- Additionally, alcohol consumption can interact with medications, making it harder for the body to process them properly, which may lead to an increased risk of MIMDs.
- Your doctor will take a detailed history and then perform a neurological exam to determine the right diagnosis.
Neuroleptic malignant syndrome
Anticonvulsants are used for a variety of medical conditions, including epilepsy and bipolar disorder. Bronchodilators, which are commonly used in the treatment of conditions such as asthma, can also cause tremors. Tremor is the shaky movements of your hands, limbs, head, or voice that you can’t control. Sometimes tremor is a normal reaction to a situation such as fear, fatigue, or anger. It also can be a side effect of too much caffeine, a medication, or withdrawal from a drug or medicine.
It occurs due to the relationship between dopaminergic loss and the resultant response to levodopa, rather than being due to excess levodopa ingestion only. Diagnosis of your drug-induced tremors will start with your doctor asking you about your symptoms and medical history. A complete list of the medications you’re taking will be extremely helpful during diagnosis. Telling your doctor how often you’re having tremors can help aid in your diagnosis. The speed of your tremors can also help your doctor determine their cause.
Exposure to toxic levels of certain drugs (e.g., ethanol, lithium, etc.) for longer periods of time can lead to permanent tremors, especially if they affect the cerebellum. Medication-induced tremor (MIT) is common in clinical practice and there are many medications/drugs that can cause or exacerbate tremors. MIT typically occurs by enhancement of physiological tremor (EPT), but not all drugs cause tremor in this way. In this manuscript, we review how some common examples of MIT have informed us about the pathophysiology of tremor. No good evidence exists regarding the management of tardive drug-induced movement disorders.15 Treatment usually consists of withdrawing the offending drug, and a trial of a combination of drugs.
Tremors may be more common in patients taking antipsychotic medications or certain antidepressants. These drugs can interfere with dopamine regulation in the brain, leading to abnormal signaling that results in tremors. Tremors can be present at rest or during movement and may worsen over time if the medication is not adjusted. Patients with certain medical conditions are more likely to develop medication-induced movement disorders. For instance, individuals with a history of neurological conditions, such as Parkinson’s disease, may be more susceptible to drug-induced parkinsonism.
When this occurs, the brain is still producing an adequate supply of dopamine, but cells cannot utilize it properly. Without enough available dopamine, the body is unable to make smooth, purposeful movements. Larger randomized controlled studies investigating the long-term efficacy and safety of deep brain stimulation are underway. Telemedicine offers a convenient way to manage medication-induced movement disorders.
This symptom is often a late-onset side effect of long-term antipsychotic use and may be irreversible if not detected early. Two major categories of tremor are resting tremor and action tremor. 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. Action tremor, in contrast, occurs with voluntary movement and can be divided into postural tremor and kinetic tremor.
Theophylline
Schedule a consultation today to take the first step toward better health. It is interesting to note that Raethjen et al.10 published the first work that demonstrated a definitive effect on the central component of physiological tremor by any drug (amitriptyline) in 2001. The exact mechanism of theophylline-induced tremors is largely unknown, but is likely a result of enhancement of physiological tremor. In contrast, the exact underlying cause of essential tremor is unknown. Essential tremor is a neurological disorder in which involuntary and rhythmic shaking affects a part of the body, typically in the hands and forearms.
Alcohol abuse may also cause bilateral flapping tremors, characterized by arrhythmic interruptions of sustained voluntary muscle contraction. Opioid abuse may also cause quick, involuntary muscle jerks, also known as myoclonus. Again, it would be best to seek medical attention if you experience these symptoms. Cocaine abuse may also cause subtle parkinsonian symptoms like tremors at rest. Crack dancing is characterized by involuntary limb movements that last for several days at a time. If you are an addict, the spontaneous movements may not seem apparent to you.
You may find it challenging to perform easy tasks, which may, in turn, affect your social functioning and interpersonal communication. You may also lose your independence as you’d need help performing easy tasks. Tremors may also result in other symptoms like depression and anxiety, which may have severe consequences. Consequently, it prevents the reuptake of dopamine, increasing extracellular dopamine levels. Common illegal drugs that cause Drug-Induced Movement Disorders (DIMD) are cocaine, opioids, amphetamine, and heroin. During the history portion of the exam, your doctor will ask about your symptoms.
It is crucial to seek professional help to settle for a treatment plan that best suits your needs. Common medications used to treat alcohol tremors are Thiamine, Benzodiazepines, and Propranolol. When you abstain from alcohol, you may experience a tremor similar to an essential tremor.