Medication tremor:why your hands shake
A medication tremor is a shaking you can see or feel, most often in the hands, that some antipsychotic and antidepressant medications can cause. It is often most noticeable when holding a cup or phone, or when your hands are resting in your lap. Many things can cause a tremor, so it is worth describing to your doctor.
Last updated Published by MANOAI Pty LtdDeveloped by clinicians working in psychiatry
Definition
- Tremor
- An involuntary, rhythmic shaking of part of the body, most often the hands.
- In plain words
- Shaky hands or trembling that you do not mean to make.
On this page
- What does a medication tremor look and feel like?
- Why do my hands shake on my medication?
- Is my medication causing my tremor?
- What kinds of tremor might my doctor ask about?
- How do I describe a tremor to my doctor?
- Should I stop my medication if I notice a tremor?
- How to keep track of a tremor with EPSpeak
What does a medication tremor look and feel like?
A tremor can be obvious or so slight that only you notice it. People commonly describe:
- Hands that shake when holding a cup, a phone or a spoon
- Handwriting that has become shakier or harder to read
- Trembling when the arms are held out in front
- Shaking in a hand resting in the lap, which can ease when you reach for something
- Shaking in the jaw, lips or legs
- A feeling of trembling inside, even when little is visible
Some people say their hands will not stop shaking, or that they feel like they are vibrating. A tremor is often worse when you are tired, anxious, cold or have had caffeine.
Why do my hands shake on my medication?
Antipsychotic medications that block dopamine can cause a tremor as part of a wider pattern of movement side effects called drug-induced parkinsonism. This tremor is often most visible when the hand is at rest.
Some antidepressants can cause a fine, fast tremor that is more noticeable when the hands are held out or in use. Some other medicines used in mental health care can also cause tremor. How likely it is depends on the individual medicine, the dose and the person.
Is my medication causing my tremor?
It might be, but many other things cause shaking too. Caffeine, anxiety, tiredness, low blood sugar, an overactive thyroid, alcohol or alcohol withdrawal, other medicines and conditions such as essential tremor or Parkinson's disease can all cause a tremor.
Only a doctor can say what is behind yours. Timing is one of the most useful clues you can give them: when the shaking started, and whether it began or changed around the time a medicine was started, stopped or changed.
What kinds of tremor might my doctor ask about?
Doctors often describe a tremor by when it happens. You do not need to know these terms, but noticing which situations make your shaking worse helps:
- At rest (resting tremor): shaking when the hand is relaxed, such as lying in your lap.
- Holding a position (postural tremor): shaking when you hold your arms out or hold something still.
- Moving (action tremor): shaking when you reach for, write or pour something.
How do I describe a tremor to my doctor?
A tremor can come and go, and it may not show up during a short appointment. These details help your doctor understand it:
- When it started, and any medication or dose change around then
- Which parts of your body shake, and whether one side is worse
- When it happens: at rest, holding a position or while moving
- What makes it better or worse, such as caffeine, stress or tiredness
- What it gets in the way of, such as writing, eating, drinking or using your phone
A short video of your hands on your phone, taken when the shaking is noticeable, can be very helpful to show your doctor.
Should I stop my medication if I notice a tremor?
No. Do not stop or change a medication on your own, even if you think it is causing a tremor. Stopping suddenly can bring back the symptoms the medicine was prescribed for, or cause other effects. Contact your doctor or care team, tell them what you have noticed, and decide on next steps together. Movement side effects are well recognised, and there are usually options to talk through.
How to keep track of a tremor with EPSpeak
EPSpeak lets you log your medications and doses, complete a short daily check-in, and note shakiness in your own words on the days you notice it. Over time you build a record of when it happens and how it changes, which is much easier to share than trying to remember weeks of detail.
EPSpeak does not diagnose a tremor and cannot tell you what is causing it. You can choose to share your record with a clinician using a QR code.
When to get help straight away
Call 000 or go to an emergency department if a tremor comes with:
- Sudden, severe muscle stiffness together with a high temperature, heavy sweating, confusion or a racing heartbeat. This can be a rare but serious reaction to some medicines and needs urgent care.
- Sudden weakness, numbness, drooping of the face or trouble speaking.
Other movement side effects
- Can't sit still, restless inside (Akathisia)A restlessness that feels like it comes from the inside, and an urge to keep moving. Some people describe it as being unable to settle, even when they are tired.
- Stiff, tight muscles (Muscle rigidity)Muscles that feel tight or hard to move freely. Everyday movements, like turning your head or getting out of a chair, can start to feel effortful.
- Slowed down, moving heavily (Bradykinesia)Movements that feel slower or heavier than usual. Things you normally do without thinking, like buttoning a shirt or walking to the door, may take longer.
Common questions
Yes. Some antidepressants can cause a fine tremor, usually most noticeable when the hands are held out or in use, such as when holding a cup. It often appears after starting the medicine or changing the dose. Many other things cause shaky hands too, so note when it started and describe it to your doctor.
Often it eases, sometimes once a doctor adjusts the medicine, the dose or the plan around it, but this differs between people and medicines. Never stop or change a medicine on your own to see whether the tremor stops. Instead, keep a record of when it happens and discuss it with your doctor or care team.
No. A tremor caused by a medicine can look similar to the tremor in Parkinson's disease, which is why doctors call the pattern drug-induced parkinsonism, but the cause is different. Parkinson's disease is a condition of the brain, while drug-induced parkinsonism is a side effect. Only a doctor can tell them apart.
Keep a clear record with EPSpeak
Log your medications, check in each day in under a minute, and share your record with your clinician when you choose. Free on Android and iPhone, with no account needed.
Sources
Side effect information on this site draws on published comparative research. Medicines are described by class only.
- Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. The Lancet. 2019.
- Leucht S, Cipriani A, Spineli L, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet. 2013.
- Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th edition. Wiley Blackwell. 2021.