Tremor as a Side Effect From Taking Antidepressants
Medically reviewed by Daniel B. Block, MD
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.
Some studies estimate that 20% of people treated with an SSRI or tricyclic antidepressant will develop a tremor. This may occur at any time after the medication was initiated.
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)
Tremors can also be a symptom of antidepressant withdrawal. You should never stop taking your antidepressant or change your dose without talking to your doctor first. Your doctor may recommend gradually tapering your dose in order to minimize symptoms of discontinuation syndrome.
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)
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
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
Frequently Asked Questions
Do Zoloft tremors go away?
Usually, a tremor caused by Zoloft (sertraline) goes away once you stop taking the medication. If the tremor persists, your prescribing doctor may recommend treatment options to stop the tremor such as a beta-blocker, anti-seizure medication, and/or physical therapy.
Does Prozac shaking go away?
Usually, shaking or a tremor caused by Prozac (fluoxetine) goes away after you stop taking the medication. If it persists, your doctor may prescribe another medication and/or physical therapy to reduce or stop the tremor.
Do Lexapro tremors go away?
Usually, a tremor caused by Lexapro (escitalopram) goes away after you stop taking the medication. If your tremor persists after you stop taking Lexapro, your doctor can advise you on other methods to stop the tremor such as medication and/or physical therapy.
Does Celexa cause tremors?
Sometimes, but not always. Certain studies estimate that 20% of people taking an SSRI like Celexa will develop a tremor. Talk to your doctor if you're taking Celexa and develop a tremor. They may recommend discontinuing the medication (which usually stops the tremor) or taking another medication to stop the tremor.
