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Dr. Vikas
Dr. Vikas, Doctor
Category: Medical
Satisfied Customers: 2207
Experience:  MBBS; MD
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I would like to know what i can do about the tremor that i

Customer Question

I would like to know what i can do about the tremor that i am getting. I have had a tremor for 15 years at the higher doses of zoloft 250mg +. Since it is not working for me anymore I have switched to pristiq. I am in the process of titrating now. I am on 150mg zoloft and 50mg pristiq. I am very upset because the pristiq has been wonderful for depression/ocd but has caused an increase in tremor. I am not able to do my job because my tremor is too significant I am off work. I am 100% sure that I cannot stop taking an antidepressant as I would for sure be suicidal. I am someone who is a lifer unfortunately. I am very scared as my job as a paramedic requires fine motor skill. As someone with OCD I know that we typically need higher than normal doses of antidepressants therefore I am very scared that there is nothing that can be done. I will lose my job or not be able to do my job i should say . I know that the effects of ssri /snri's are pretty similar. So can i find one that will not cause tremor? or will the pristiq get better with time? zoloft never did get better with time which makes me leary.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Have you listed all of the antidepressants that you have tried?
I notice that you have not provided a positive rating for the recent questions for which I have applied answers. Can you explain what is lacking in these answers so that I can provide what information you are seeking?

Customer: replied 1 year ago.

yes i believe so

Expert:  Dr. D. Love replied 1 year ago.
I notice that you have not provided a positive rating for the recent questions for which I have applied answers. Can you explain what is lacking in these answers so that I can provide what information you are seeking?

Customer: replied 1 year ago.

i would actually like my question re posted to someone else please. i just didnt find your answer in line woth other doctors on JA and my own drs

Expert:  Dr. D. Love replied 1 year ago.
I have opted out.

Expert:  Dr. Vikas replied 1 year ago.

Hello,

SSRI antidepressants like Zoloft can cause tremors as a side effect and this is a typical example of drug induced tremors. Many patients report tremor specially when taking high doses of Sertraline (Zoloft) like the one you are taking.

Drug-induced tremors are treated by decreasing the dose or stopping the offending drug which probably in your case is Zoloft. After stopping Zoloft, tremor may not resolve immediately but should usually subside in about 3-4 months, in some cases it may take more than a year.

Tremor are not that much commonly reported by patients taking Desvenlafaxine (Pristiq) and most likely your tremors are because of Zoloft which should subside once you taper down and stop it under your doctor supervision.

Once you are able to stop Zoloft, your doctor can further increase the dose of Pristiq to 100 mg per day depending on the clinical response to control OCD and Depression symptoms.

In the mean while, you can discuss with your doctor about trying benzodiazepine like Clonazepam or Beta blocker like Propranolol which can be useful in controlling drug induced tremors.

I hope this helps. Please feel free to discuss further if you have any doubt / query regarding my suggestions.

Kind regards

Vikas

Customer: replied 1 year ago.

interesting thanks for your answer. i wonder why the tremor got much worse after starting pristiq than when i just was taking zoloft, even zoloft at higher doses? is it the combination? it should subside after zoloft is gone?

Expert:  Dr. Vikas replied 1 year ago.
You are most welcome.

150 mg of Zoloft is comparatively a high dose as the usual dose range is from 50-150 mg per day. It may be a coincidence also that your tremor got worse after starting Prisitq as you were already on a very high dose of Zoloft at that time.


I have never seen any patient reporting tremor after starting Pristiq and tremors are also not a commonly reported side effect due to Pristiq so most likely your tremor are because of Zoloft which should subside once you stop it completely.

As I mentioned earlier, you can also discuss with your doctor about trying benzodiazepine like Clonazepam or Beta blocker like Propranolol which can be useful in controlling drug induced tremors.
Expert:  Dr. Vikas replied 1 year ago.
Have your doctor ever tried Clonazepam or Propranolol for controlling tremors?
Expert:  Dr. Vikas replied 1 year ago.
My goal is to provide you with excellent service and I hope I’ve provided the information you were seeking, if not, please let me know so that l can continue to help you. If you need more help, please use the reply tab to continue our conversation.

If you do not require further assistance,please rate one of the positive ratings (3,4,5 / smiley faces) as this is the only way how we are compensated for our time and expertise.


Please take a moment to rate the answer.


Kind regards


Vikas
Dr. Vikas, Doctor
Category: Medical
Satisfied Customers: 2207
Experience: MBBS; MD
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Customer: replied 1 year ago.

hello i will rateyour answer. yes i did try clonazepam but it was too addictive. i thought propanalol could excaxerbate drpression? do you know other antidepressants that are the least likely to cause tremors besides pristiq?

Expert:  Dr. Vikas replied 1 year ago.
Many thanks for accepting the answer and giving a positive feedback.

Clonazepam can be prescribed by your doctor for short duration (4-6 weeks) in low dose of .25 or .5 mg twice daily and the chances of developing dependence are very low when used for short term in such a low dose.

Prorpanolol may exacerbate depression in some patients but I personally have noticed that this is not very common. This medicine is routinely used by many Physicians and Cardiologist without much problem. And since,you are already taking an antidepressant so should not worry about propranolol induced depression as a side effect in my view.

You can discuss with your doctor about trying Mirtazapine and Duloxetine as an alternative antidepressant to Pristiq.

Kind regards

Vikas

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