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Q. I am having head tremors on making eye contact with people despite taking antidepressants. Why?

Answered by
Dr. Hitesh Kumar
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Aug 25, 2021

Hi doctor,

I am a 22-year-old female. I have head tremors that are caused by anxiety. It happens when I make eye contact with people and in anxiety-inducing situations, which are usually social situations. It has been ongoing for about five years now. I have tried Propranolol, Quetiapine, and Sertraline, and they do not have much benefit. Is there any medication you would recommend that is the best? Would Botox injections help? Should I get a brain scan? This is really destroying my life as it has to lead me to rely on alcohol as it is the only thing that completely makes the tremors go away. Is there a reason for that? What chemicals or parts of the brain is the alcohol affecting? Is there anything I can use that is better for me that has the same effect? Please help me.

#

Hello,

Welcome to icliniq.com.

I would like to know some further details about your symptoms:

1) In which body parts do you get tremors?

2) Are these tremors happen at rest or happen while trying to do some activity by hands, for example, writing, holding a cup, glass, spoon, some object in hands, laying in bed, or sitting comfortably in a chair with hands rested on chair arm or in some particular positions?

3) As you mentioned that it happens when you make eye contact with people and in anxiety situations, does it subside completely if you are relaxed and happy?

4) Since when and in what doses and frequency are you taking Propranolol, Sertraline and Queitiapine daily?

5) Have you undergone any investigations till now? If yes, please send the reports in the attachment.

6) Have you met a psychiatrist? It will be better if you can share the psychiatrist assessment sheet too.

7) Since when you started consuming alcohol? And approximately how much quantity are you taking daily?

8) Do you started to have cravings for alcohol?

9) Is there a history of having similar kinds of tremors to any close blood relative?

10) Do you have intermittent suicidal thoughts also?

11) Do you have any walking difficulty also?

12) Are these tremors increasing or decreasing with time or going on at the same pace in these five years' duration?

Other information:

1) How is your sleep routine? Do you get sleepy soon after lying in bed, or it takes a long time? Once got sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning?

2) How is your usual mood in day-to-day activities? Happy or toward the sad side (thinking about past events) or toward the worried side (thinking about future things, irritable or something else)?

3) How is your appetite?

I suggest you get the following tests done:

1) T3, T4, and TSH (thyroid-stimulating hormone).

2) Serum Vitamin B12.

3) Serum Vitamin D3.

4) ECG (electrocardiogram).

5) CBC (complete blood count).

6) LFT (liver function test).

7) KFT (kidney function test).

Alcohol is obviously not the treatment option for it. Instead, it can increase the symptoms of tremor and anxiety or associated other psychiatric symptoms. I would suggest you quit alcohol completely.

Please get back with the above reports and details and, if possible, send a video of the tremors.


Hi doctor,

Thank you.

The tremors are head tremors. They happen at rest. If I move around and start doing things, they stop. Yes, if I am not feeling anxious, then the tremor stops. I am currently taking 100 mg of Sertraline once a day, 25 mg of Quetiapine twice a day, and 10 mg of Propranolol once a day. I have not done any investigations as the psychiatrist just told me I have anxiety and gave me medication for the tremors, but it is not helping. I have been using alcohol for the past two years and have around seven drinks in a week, as I do not drink daily. I do not have a craving for alcohol, I just have the craving to make the tremor stop, and for me, alcohol is the only way so far. My grandmother did have Parkinson’s disease for around 20 years. I do have suicidal thoughts. I do not have any problem with walking. The tremors have stayed mostly the same the past five years.

I can fall asleep easily, and when I get into bed, I tend to feel sleepy pretty soon after, and I do not wake up much during the night. My mood is usually up and down. Unless I do not eat for hours, then I do not get hungry that much.

Kindly help me.

#

Hello,

Welcome back to icliniq.com.

You have not attached any video showing the tremors. As per your description, there is the possibility that these tremors can be anxiety-induced. With up and down mood and history of suicidal thoughts, it may be associated with depression too. Still, I would suggest doing the above-mentioned investigations to rule out few things which can mimic such symptoms or can be associated with such symptoms. Your current medications are antidepressant Sertraline, antipsychotic - Quetiapine and Propranolol.

It will be erroneous to prescribe psychiatry medication or modify medication simply by chat information.

But one suggestion can be to try antianxiety Benzodiazepine group medications like Etizolam or Clonazepam and can also try increasing the dose of Propranolol along with your current medications. For these suggestions, you need to discuss them with your treating psychiatrist or neurologist.

Along with medications, I would suggest for:

1) Daily jogging 30 minutes in the morning.

2) Meditation or yoga daily.

3) Psychotherapy sessions can also be helpful.

4) Quit alcohol completely.

I hope this was helpful.



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