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Tremors when nervous


What Causes Your Hands to Shake and When to Worry

You’re nervous about a big presentation. Your heart begins to race, your throat gets dry and your hands start to tremble. Deep breaths can help calm your nerves, but what if you can’t shake off your trembling hands?

Nerves aren’t the only thing that can make your hands tremble. There are a number of reasons hands shake, but interesting fact: Your hands actually shake way more than you realize.

“To be certain, everyone’s hands have a little movement even when we’re trying to keep them very still,” said Ryan Barmore, MD, a movement disorders specialist with Banner Health Clinic in Colorado. “This is broadly known as a physiologic tremor, and while some have subtle movement, others can have a little more.”

According to the National Institute of Neurological Disorders and Stroke, a tremor is a rhythmic or unintentional muscle contraction that can cause shaking in one or more parts of the body. It most often can affect your hands but can also occur in your arms, head, vocal cords, torso and legs.

Our bodies are sure full of surprises, but if your shakiness concerns you, here are eight potential reasons it’s happening and when you should talk to your health care provider.

1. You have a movement disorder.

Essential tremor, also referred to as “action” tremor, is the most common cause of tremor in adults. Although essential tremor is neurological, it is a distinct disorder and different than Parkinson’s disease.

“Noticeable shaking occurs when using your muscles to hold out your limbs up against gravity or moving them from Point A to Point B,” Dr. Barmore said. “Your hand might shake while holding up your hands or trying to do movements like eating, drinking, pouring and writing.”

You may first notice a tremor in one or both hands that then gradually progresses over time. It primarily causes tremors, usually just in the hands (though it can occur elsewhere) and have little to no other neurological symptoms.

Experts don’t know why essential tremor occurs, but there seems to be a strong genetic component and it often runs in families.

2. You have Parkinson’s disease or another brain disease.

Other than essential tremor, there are many diseases that can cause your hands to shake. Parkinson’s disease is what often comes to mind when thinking of tremors. But unlike essential tremors, the shaking with Parkinson’s disease is often worse when you’re at rest and not while using your hands.

“This tremor is most prominent when your hands are completely at rest, such as when watching TV, while walking with your arms loose at your side and so on,” Dr. Barmore said. “This tremor usually stays on one side of the body for a few years, and the other side often begins a little later.”

There are other degenerative brain diseases, such as multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration, that may look like Parkinson’s disease at first but later progress differently. “These are generally much rarer than Parkinson’s disease,” Dr. Barmore said.

Other diseases of the brain, such as multiple sclerosis, stroke, traumatic brain injury and so on, may also cause tremor.

3. Your blood sugar is low (hypoglycemia).

When your blood sugar dips, it can leave you feeling hungry, lightheaded and shaky. When this occurs, it’s called hypoglycemia. It can happen to anyone who’s not eaten in a while but can be life-threatening for diabetics if it gets too low.

4. You’re consuming too much caffeine or alcohol.

If you’ve had a little bit too much coffee or other stimulants, they can leave you feeling jittery. Caffeine can stimulate your body, causing muscles to move out of sequence.

While occasional alcoholic beverages won’t make you develop a tremor, if you’re a heavy drinker, your body can become dependent on the effect of the alcohol. Because your body has adjusted to having it around much of the time, when the alcohol wears off the balance in the brain is thrown off.

“Think of it like having a balance of ‘gas’ and ‘brakes,’” Dr. Barmore said. “When the alcohol wears off there is too much gas and not enough brakes. Tremors can then occur and more dangerous things after, if the alcohol withdrawal is not treated appropriately. ”

5. You might be taking a certain medication.

Many medications may cause your hands to shake as a side effect—from mild to severe.

“Some of the most common medications include those used for various aspects of mental health treatment, such as antidepressants of various types,” Dr. Barmore said. “As well, inhalers used for asthma and other lung diseases can also cause tremors.”

6. Your thyroid could be off.

Your shaky hands may be a sign of hyperthyroidism, an overactive thyroid gland. This means your thyroid is working overtime and kicking your heart rate into high gear. Along with shaky hands, you may also lose weight without trying, be sensitive to light and have trouble sleeping.

7. You have anxiety.

Uncontrollable shaking or trembling of the hands or other parts of the body can be a symptom of anxiety. Tremors caused by anxiety aren’t dangerous, but they can be uncomfortable.

When your body is under stress, it goes into fight-or-flight mode, causing stress hormones to flood your body and speed up your heart, blood pressure and breathing. This can cause your muscles to tense which can lead to a trembling sensation or shaking.

8. You’re not getting enough sleep

Your body needs sleep to reset and repair cells, so if you’re not getting your recommended hours of sleep, you’re forcing your body to function in a stressful situation. As a result, sleep deprivation can leave you feeling foggy-headed and shaky.

Bottom line: If you have a tremor that worries you, talk to your health care provider.

If you can tie your tremor to something you can tackle on your own, like over-caffeination, hunger or lack of sleep, most likely some minor lifestyle changes can rectify it.

“But it’s always appropriate to discuss a new tremor with your health care provider, even if it seems to come and go,” Dr. Barmore said.

Before your appointment, pay attention and jot down when during the day your tremor tends to happen, what you’re doing with your hands when the tremor seems to be the worst and the best. Take note of any medication changes in the time before your tremor began and pay attention to see if the tremor gets better or worse after taking medication doses during the day.

This information can help guide your health care provider in identifying the cause of your shaky hands and direct any further evaluation and treatment. To find a health care provider near you, visit bannerhealth.com.

For related articles, check out:

  • Tardive Dyskinesia: A Common Culprit for Face and Body Tics
  • Nerve Transfer Surgery: When and Why You Might Need It
  • 6 Neurological Conditions and What You Should Look Out For

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Anxiety Shaking: Causes and Treatments

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Anxiety and worry are emotions everyone feels at some point. Approximately 40 million American adults have anxiety disorders.

Feelings of anxiety can trigger other symptoms, such as:

  • muscle tension
  • difficulty concentrating
  • increased heart rate
  • uncontrollable shaking or trembling

Tremors caused by anxiety aren’t dangerous, but they can be uncomfortable. Sometimes losing control of your body when you’re having anxiety can quickly escalate into other symptoms.

This article will explore the connection between shaking and anxiety, and leave you with some ideas for how to treat this symptom.

Panic disorder and anxiety that leads to attacks have some things in common, but they’re not the same condition. Both conditions can lead to physical symptoms that feel out of your control, including trembling and “the shakes.”

If you have generalized anxiety disorder, ordinary situations may make you feel intensely fearful or overwhelmed. You may find it hard to concentrate. You may also experience your mind going “blank” as the fear and worry from your thoughts take over.

In addition, headaches, muscle aches, and other pains you can’t explain may accompany your anxious thoughts.

Panic attacks don’t always have a clear cause. When you have panic attacks due to a certain trigger, it’s called an expected panic attack. That means they’re somewhat predictable.

The symptoms of a panic attack can be seen and identified by someone else, while the symptoms of anxiety take place mostly in your mind and may be harder to spot.

When you’re having severe anxiety, it can cause physical symptoms. Perceived stress, danger, and high levels of emotion usually set off anxiety. Anxiety can lead to a panic attack, but it doesn’t always.

Similarly, having a panic attack doesn’t mean that you have an anxiety condition.

When your body is subjected to stress, it goes into fight, flight, or freeze mode. Stress hormones flood your body and speed up your heart rate, blood pressure, and breathing.

Your body prepares to deal with the stressor, interpreting the anxiousness as a signal that you’ll need to stand your ground or escape from danger. Your muscles become primed to act, leading to a trembling sensation, twitching, or shaking.

Other symptoms of anxiety and panic disorder include:

  • difficulty concentrating on anything besides anxious thoughts
  • fatigue and muscle ache
  • headache or migraine
  • nausea, vomiting, or loss of appetite
  • rapid breathing
  • excessive sweating
  • feeling tense, irritable, and “on edge”

Once you’ve determined that you’re having a panic or anxiety attack, fighting against your symptoms might make them last longer.

The most effective strategy to stop trembling from panic or anxiety is to guide your body back to a relaxed state. Certain techniques can help you calm down:

  • Progressive muscle relaxation. This technique focuses on contracting and then releasing different muscle groups. It can be done in tandem with deep breathing. The goal in practicing this technique is to get your body to relax. This can stop you from trembling.
  • Yoga poses. The child’s pose and sun salutations can help you regulate your breathing and bring calm back to your body. Regular yoga practice has been shown to reduce anxiety symptoms.
  • Mindfulness exercises. Exercises that incorporate meditation can also help stop you from shaking. Mindfulness meditations to guide you through 5 to 10 minutes of awareness and relaxation. These can be found on apps, such as Headspace, and online.

Practicing these techniques when you’re not in a state of panic or anxiety will make them more effective when you need to use them.

Long-term solutions for people with anxiety or panic disorder can include medication and help from a licensed therapist or psychiatrist. Several methods of therapy can help you identify the triggers of your anxious thoughts and feelings. These include:

  • cognitive behavioral therapy (CBT)
  • talk therapy
  • eye movement desensitization and reprocessing therapy (EDMR)

If you frequently experience anxiety or panic attacks, you should speak to your doctor about medication treatment options. Those include:

  • Benzodiazepines. These are drugs that help relax your mind and calm your body. Alprazolam (Xanax), chlordiazepoxide (Librium), and clonazepam (Klonopin) are examples of this class of drug used for short-term anxiety and panic relief. Both prescribers and patients should be aware that benzodiazepines are associated with a risk for tolerance, dependence, and addiction. The Food and Drug Administration requires that they carry a boxed warning.
  • Selective serotonin reuptake inhibitors (SSRIs). This is one class of drug that might be prescribed for long-term treatment. Escitalopram (Lexapro), fluoxetine (Prozac), and paroxetine (Paxil) are examples of this type of drug usually prescribed to treat depression and anxiety.
  • Monamine oxidase inhibitors (MAOIs). MAOIs are used to treat panic disorder, but can work for anxiety, too. Dicarboxamide (Marplan) and tranylcypromine (Parnate) are examples of this type of medication.

Integrative treatments, like herbal teas and supplements, can cut down on anxiety and panic attacks for some people. More research needs to be done on herbal treatments to determine whether they’re effective.

Remember that herbal remedies aren’t necessarily better for your body than traditional medication. Herbals have properties that cause side effects and interactions just like medication does.

Online therapy options

Read our review of the best online therapy options to find the right fit for you.

Physical symptoms that feel out of your control can be frightening and make your anxiety feel even worse. The good news is that anxiety and panic can be helped with medication, therapy, and a proper diagnosis.

Make an appointment with your doctor if you’re experiencing anxiety-induced trembling or shaking.

Drug tremor - Neurology - LiveJournal

... according to the WHO definition, the side effects of drugs include any reaction to a drug that is harmful and undesirable for the body that occurs when it is prescribed for the treatment, diagnosis and prevention of diseases.

Drugs that cause tremors (involuntary, stereotypical rhythmic oscillatory movements of the whole body or parts of it): epinephrine, norepinephrine, isoprenaline hydrochloride, salbutamol, terbutaline, fenoterol, mexiletine, encainide, amiodarone, tricyclic antidepressants, MAO inhibitors, psychostimulants, methylxanthines (caffeine , eufillin, theophylline), corticosteroids, antihistamines, levodopa, lithium salts, phenytoin, novocainamide, pindolol (whisken), cimetidine, calcium antagonists, (nifedipine, flunarizine), insulin preparations, antipsychotics, valproic acid, quinolone derivatives and fluoroquinolones, acyclovir (intravenously). nine0004

Physiological postural tremor (positional, while maintaining a certain posture), which is normal, increases in amplitude with anxiety, fatigue, thyrotoxicosis and after intramuscular administration of adrenaline or isoproterenol, etc., including selective β2-adrenergic agonists. Some drugs, especially bronchodilators, tricyclic antidepressants, and lithium (lithium causes tremors more often than other complications, even at therapeutic doses), can cause a dose-dependent increase in normal physiological tremor. which quickly disappears when the drug is discontinued. β-Adrenergic agonists, as drugs that stimulate the sympathetic nervous system, stimulating presynaptic β-adrenergic receptors on the cholinergic endings of skeletal muscles. often cause tremor, trembling fingers. a state of anxiety, increased irritability, anxiety. The occurrence of tremor. as a rule, coincides in time with the development of a bronchodilating effect. nine0004

Among β-agonists, are partially selective (β1- and β2-agonists) and purely selective (β2-agonists). Side effects are much more likely to develop when taking partially selective β-agonists (orciprenaline sulfate - alupent, asthmapent, methopril, metoproterinol; isadrin - isoproterinol, isoetarin, euspiran). Therefore, purely selective β2-agonists are considered as more promising and safe drugs of this class: salbutamol (ventolin, salomol), terbutaline (briconil), hexoprenaline (ipradol), acting 4-6 hours and long-acting (within 12 hours) - salmeterol ( salmeter, servent, azrol), fenoterol, formoterol (foradil), clenbuterol (contraspasmin, spirolente). nine0004

However, when prescribing β2-adrenergic agonists, there may be side effects from the central nervous system. As a rule, the development of side effects is noted with an increase in doses (since selectivity disappears), an increase in the frequency of administration (there is an accumulation of the drug, which in turn leads to the disappearance of selectivity and the appearance of side effects) or with individual hypersensitivity to drugs. Therefore, it makes no sense to take drugs more often and in larger doses than prescribed by the doctor, repeated doses are contraindicated earlier than after 3 hours. nine0004

With the development of addiction to β-agonists it is not advisable to greatly overestimate the dose, but it is necessary to temporarily stop the drug to restore the sensitivity of β-adrenergic receptors to β-adrenergic agonists, it is possible to recommend taking drugs that restore the sensitivity of adrenoreceptors to stimulation by adrenomimetics, for example, cell membrane stabilizers : sodium chromoglycate (intal, cromolyn), nedocromil sodium (tayled), etc. When taking terbutaline (bricanil, bretin) in tablet form, side effects from the central nervous system often develop: nervousness, excitability increase, anxiety, tremor appear. To prevent them, you can recommend the first 2 weeks to take the drug in half the dose. nine0004

Cholinolytics are currently considered as reserve drugs for the treatment of patients with diseases of the bronchopulmonary system. Classic anticholinergics are atropine, platifillin, scopolamine, metacin. The drugs do not selectively inhibit cholinergic receptors, often causing irritability, anxiety, tremor. More promising are atropine derivative - ipratropium bromide (Atrovent) and our domestic drug Troventol. These drugs have a very low lipophilicity, and therefore they penetrate poorly through biological membranes, have low bioavailability, and are used in aerosols; when taking these drugs, the likelihood of developing side effects (including those from the central nervous system) is much less. nine0004

The first signs of the toxic effect of mexiletin (a fat-soluble drug that easily penetrates the central nervous system) is a small intense tremor that progresses with an increase in the concentration of the drug in the blood, sometimes it occurs at concentrations from 1 to 1.5 μg / ml.

Amiodarone can also provoke tremor due to its electrophysiological action in the form of prolongation of repolarization, blockade of potassium, sodium, calcium channels. nine0004

Intentional tremor (tremor that occurs when moving, when a limb approaches a target) is a manifestation of the toxic effect of alcohol or drugs such as phenytoin. Cancellation or dose reduction leads to relief of the condition.

Tremor at rest usually associated with parkinsonism. However, reserpine, neuroleptics, lithium preparations, calcium antagonists (flunarizine, cinnarizine), amiodarone can cause resting tremor or severe postural-kinetic tremor (Shtok V.N., Levin O.S., 2001). There is no satisfactory pharmacological treatment for severe tremor. However, the tremor caused by sympathomimetics, lithium preparations, in some cases is well suppressed by propranolol. nine0004

Literature : a guide for physicians "Complications of pharmacotherapy" A.B. Zborovsky, I.N. Tyurenkov; Moscow, "Medicina", 2003.


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Hand tremor - what is it, causes and symptoms and why hands are shaking

Shaking hands (tremor) is a common symptom. This disease can be divided into two large groups: physiological and pathological. Many faced with this problem are wondering about the causes of tremor. nine0004

Types of tremor

Neurologists, divide shaking hands into types of occurrence:

  • Physiological tremor. It is not uncommon for hands to begin to shake due to nervous strain, stress or muscle load.
  • Anxiety disorders. With a neurological cause of tremor, other problems come with it: insomnia, nausea, nervousness, and increased fatigue. As you might have guessed, a lot of stress can be the cause.
    • nine0066 Violation of the thyroid gland. Tremor can serve as one of the symptoms of thyrotoxicosis. Other signs indicating this disease are weakness, causeless anxiety, heart palpitations, shortness of breath, sleep disturbances.
  • Essential tremor. In this case, the hands are shaking at a certain position. Most often, this tremor is inherited and does not have serious consequences.
  • Parkinson's disease. This is a very serious disease that is common in older people. With it, the patient's hands tremble during calm. With Parkinson's, there are a number of accompanying symptoms: loss of balance, deterioration in coordination, development of memory loss, amnesia, and others. nine0067

How to get rid of hand tremors

Depending on the type of tremor, there are different methods of treatment, the following are general tips to get rid of this ailment: