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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by PhoenixGirl on December 14, 2003, at 23:00:51
My meds make my hands shake....One co-worker said "You're shaking like a crack addict." How can we explain it when people notice our hands shaking? I've thought about saying that I have a thyroid problem. I worry about if people notice, but don't say anything, so I don't even have a chance to tell my little fib.
It would be nice if we lived in a world where people would say they notice our hands are shaking, and we'd say "My antidepressant makes them shake", and they would say "I'm sorry to hear that, I hope you are feeling better soon."
Posted by blondegirl47 on December 15, 2003, at 0:36:04
In reply to Shaky hands - how to explain to people?, posted by PhoenixGirl on December 14, 2003, at 23:00:51
Just give a little laugh and tell them you need to decaf :)
You could also ask them how they know so much about crack heads :)
Blondegirl
Posted by sb417 on December 15, 2003, at 6:25:56
In reply to Shaky hands - how to explain to people?, posted by PhoenixGirl on December 14, 2003, at 23:00:51
It's none of their business. You don't need their permission to take medication -- or anything else, for that matter.
Posted by GreatDaneBoy on December 15, 2003, at 8:58:57
In reply to Shaky hands - how to explain to people?, posted by PhoenixGirl on December 14, 2003, at 23:00:51
I have the same problem (it gets so bad sometimes I can't even write my own name) and people are always making remarks about it. I just tell them that I have that early-onset Parkinson's disease like Michael J Fox and that not only explains the problem and garners sympathy, but it also has the satisfying effect of making them feel like shit for saying anything in the first place!!! =)
BTY, have you tried to add anything to help the tremors? I have tried about fifty-leven different things from benzo's to Parkinsons meds and nothing seems to help. I'd love to hear about any other experiences with this problem!!!
Dane =)
Posted by psychlover on December 15, 2003, at 20:49:51
In reply to Re: Shaky hands - how to explain to people?, posted by GreatDaneBoy on December 15, 2003, at 8:58:57
My friend, who I have known for years and who has told me about all the psychotropic drugs he is on and has taken, told me his hands have always been shaky like that. And I believed him, although now I realize he was full of crap. Poor thing.
So try telling people your hands have always been shaky! It fooled me.
Speaking of which, anyone from California remember Shakey's Pizza? I attended many a birthday party there. Only recently did I realize that is a funny nickname for someone....
Posted by shadows721 on December 15, 2003, at 21:45:13
In reply to Shaky hands - how to explain to people?, posted by PhoenixGirl on December 14, 2003, at 23:00:51
Oh, I know what you are going thru. As a nurse, it is the worst. Other nurses and patients think I am extremely nervous. I have literally had it written on my job performance review. That made me extremely angry. I wrote back that I had a medical condition that no one even asked about to find out the truth. I have literally been thinking about getting out of the profession, because I am judged so harshly. They act like I have the plaque, because I shake. It's funny there are nurses with all sorts of conditions working, but shaking seems so unforgiveable. It is always assumed that I am nervous. The truth of it is that I only get nervous when they point out the darn tremor. The tremor is aggrevating to me enough, let alone having some insensitive person judging me so wrongly.
I started telling people that I have a benign tremor and it is not contagious. It helps keep me slim and gives me energy. When I say that, others say they wish they had it too. I say, "No, you don't wish you had it, because you get questioned by uncaring nosey people." Whew, that really keeps them off my back. What meds are causing yours? I have heard that taking a benzo on an as needed basis helps. Also, beta blockers help some that don't have low blood pressure.
I sure can relate.
Posted by PhoenixGirl on December 15, 2003, at 22:12:49
In reply to Re: Shaky hands - how to explain to people?, posted by psychlover on December 15, 2003, at 20:49:51
I think what causes the shaking is the "upper" type drugs I'm on. I take Provigil and Wellbutrin, which I think are the primary causes. I also take Strattera and Lamictal. At night I take a low dose of Klonopin. The Klonopin does help the "upper" side effects, but not enough to make the shaking un-noticeable.
Man, this is bullsh*t...We're OKAY! What makes anyone so special that they are suited to judge us?
Posted by Viridis on December 15, 2003, at 23:12:32
In reply to Re: Shaky hands - how to explain to people?, posted by PhoenixGirl on December 15, 2003, at 22:12:49
I'd guess that it's the WB. I've taken the other meds you mention (except Lamictal), and WB was the only one that caused the shakes (and a bunch of other weird effects, including severe anxiety). But that's just a guess -- we all react differently.
Posted by scott-d-o on December 16, 2003, at 0:12:27
In reply to Re: Shaky hands - how to explain to people?, posted by PhoenixGirl on December 15, 2003, at 22:12:49
> I think what causes the shaking is the "upper" type drugs I'm on. I take Provigil and Wellbutrin, which I think are the primary causes. I also take Strattera and Lamictal. At night I take a low dose of Klonopin. The Klonopin does help the "upper" side effects, but not enough to make the shaking un-noticeable.
> Man, this is bullsh*t...We're OKAY! What makes anyone so special that they are suited to judge us?It sounds like you are taking too many noradrenergic meds simultaneously. Wellbutrin (releases NA, blocks DA/NA reuptake), Provigil (alpha-1 adrenergic agonist), Strattera (selectively blocks NA reuptake) all have this effect. Honestly I'm suprised a pdoc would put you on all those meds concurrently; they should have a synergistic effect when combined.
scott
Posted by jbs on December 16, 2003, at 20:57:06
In reply to Re: Shaky hands - how to explain to people? » PhoenixGirl, posted by scott-d-o on December 16, 2003, at 0:12:27
Yeah, how did you end up on that combination; what are you being treated for?
Posted by PhoenixGirl on December 16, 2003, at 22:58:51
In reply to Re: Shaky hands - how to explain to people? » scott-d-o, posted by jbs on December 16, 2003, at 20:57:06
I've been treated for depression, anxiety, and social phobia since I was about 12. The doctors have tried almost everything to help me, even ECT (at age 23). I'm 25 now. So, my doctor and I have been trying a lot of unconventional approaches to my treatment because all of the "safer" options have been tried. We just keep trying and trying to help me. I think that if I had love and real friendship in my life, I could stop taking a lot of these drugs.
Posted by scott-d-o on December 17, 2003, at 8:00:37
In reply to Re: Shaky hands - how to explain to people?, posted by PhoenixGirl on December 16, 2003, at 22:58:51
> I've been treated for depression, anxiety, and social phobia since I was about 12. The doctors have tried almost everything to help me, even ECT (at age 23). I'm 25 now. So, my doctor and I have been trying a lot of unconventional approaches to my treatment because all of the "safer" options have been tried. We just keep trying and trying to help me. I think that if I had love and real friendship in my life, I could stop taking a lot of these drugs.
I still don't see the use in combining these three drugs together when they all do almost the exact same thing. You could probably just use a higher dose of the one that helps you the most and achieve the same effect without complicating things. Is this drug cocktail providing relief for you? Have you tried any dopaminergic drugs or a low-dose of an anti-psychotic? Many consider Wellbutrin a dopaminergic med but it's effect on dopamine is really very weak.
Posted by PhoenixGirl on December 17, 2003, at 20:00:34
In reply to Re: Shaky hands - how to explain to people?, posted by scott-d-o on December 17, 2003, at 8:00:37
I haven't tried any dopaminergic drugs, unless you include Ritalin. I developed a tolerance to it after about 3 months, though.
Selegiline is a drug I'm considering. My doctor is hesitant to try it because it's technically an MAOI. But I would like to try it because it works differently than anything I've tried before, and it might help my barely-existent libido.
Do you have any suggestions about dopaminergic meds?
Posted by scott-d-o on December 17, 2003, at 21:58:30
In reply to Re: Shaky hands - how to explain to people?, posted by PhoenixGirl on December 17, 2003, at 20:00:34
>
> I haven't tried any dopaminergic drugs, unless you include Ritalin. I developed a tolerance to it after about 3 months, though.
> Selegiline is a drug I'm considering. My doctor is hesitant to try it because it's technically an MAOI. But I would like to try it because it works differently than anything I've tried before, and it might help my barely-existent libido.
> Do you have any suggestions about dopaminergic meds?Hi PhoenixGirl,
I would recommend dropping at least one of the three NAergic meds (I would probably keep the Provigil and drop the other two), and add a *low-dose* of an antipsychotic such as amisulpride. This should have the effect of both reducing depression, anxiety and fatigue and increasing motivation and confidence. Amisulpride and sulpiride are the only two antipsychotics I know of that work *only* at dopamine receptors. However, if you are in the USA, neither of these meds are FDA approved so you will have to order it from a pharmacy overseas once you get your prescription.
If this is too much of a hassle, there are many others that are available that might work just as well, ask your pdoc about it. You probably developed tolerance to the Ritalin because your dopamine autoreceptors became supersensitive thus causing hardly any dopamine to be released, which eventually renders the reuptake inhibition from the Ritalin almost useless. A *low-dose* of an antipsychotic will antagonise these receptors which forces dopamine to be released into the synapse.
I believe that I have a dopamine dysfunction as well and I had the same thing happen to me with stimulants. At first it would give a great antidepressant effect with no anxiety but after continued use I would get nothing but an increase in anxiety due to this dopamine autoreceptor supersensitivity. However, 100mg/d of sulpiride has been wonderful for me. I believe you could benefit from this as well.
Best of luck to you.
scott
Posted by Viridis on December 18, 2003, at 0:15:43
In reply to Shaky hands - how to explain to people?, posted by PhoenixGirl on December 14, 2003, at 23:00:51
Have you tried Adderall + Klonopin? It's a great combo for me, for the kind of situation you're describing. Some Provigil in the mix (to which you're already accustomed) could also be helpful, based on my experience.
Wellbutrin is a hit-or-miss med with many potential side effects. Strattera can be good but can also be weird and unpredictable, in my experience.
Posted by stjames on December 18, 2003, at 13:15:38
In reply to Shaky hands - how to explain to people?, posted by PhoenixGirl on December 14, 2003, at 23:00:51
My hands have always been shakey, all my life.
I go with the truth, "My hands have allways been shakey, even as a child. It does not bother me
but it seems to bother others. Thanks for asking"
Posted by PoohBear on December 19, 2003, at 13:49:45
In reply to Re: Shaky hands - how to explain to people?, posted by stjames on December 18, 2003, at 13:15:38
This has happened all of my adult life. I just explain that it's always been so because I'm high-strung (I am...). They usually let it go at that...
TR
Posted by Laree on December 22, 2003, at 21:20:36
In reply to Re: Shaky hands - how to explain to people? » PhoenixGirl, posted by scott-d-o on December 16, 2003, at 0:12:27
Scott, I am on Wellbutrin SR 200 mg./day & Adderall 50 mg./day. Do you think these are a bad combination? Thanks!
>
> It sounds like you are taking too many noradrenergic meds simultaneously. Wellbutrin (releases NA, blocks DA/NA reuptake), Provigil (alpha-1 adrenergic agonist), Strattera (selectively blocks NA reuptake) all have this effect. Honestly I'm suprised a pdoc would put you on all those meds concurrently; they should have a synergistic effect when combined.
>
> scott
Posted by KimberlyDi on December 23, 2003, at 11:39:18
In reply to Re: Shaky hands - how to explain to people?, posted by PoohBear on December 19, 2003, at 13:49:45
I always joke that it takes too much caffeine to get me going in the morning. Blame it on too much coffee!
:)
> This has happened all of my adult life. I just explain that it's always been so because I'm high-strung (I am...). They usually let it go at that...
>
> TR
Posted by scott-d-o on December 23, 2003, at 15:30:37
In reply to Re: Shaky hands - how to explain to people?, posted by Laree on December 22, 2003, at 21:20:36
> Scott, I am on Wellbutrin SR 200 mg./day & Adderall 50 mg./day. Do you think these are a bad combination? Thanks!
I wouldn't say any combination of meds is intrinsicly a bad combination because they all work differently for everyone. I'm sure you know what works best for you. I was merely trying to make a suggestion as to why the original poster might be having problems with shaking.
In my experience, this shaking is caused by low dopamine, or too high serotonin, norepinephrine, and acetylcholine. Dopamine inhibits involuntary movements such as these and acetylcholine excites them. People with Parkinson's disease have a compromised dopamine system, therefore acetylcholine overpowers it, causing them to shake. Fortunetly in this case it is a temporary condition that can be overcome whereas Parkinson's is caused by irrepairable damage to dopamine neurons.
Another solution besides increasing dopamine transmission is to take a small amount of the over-the-counter antihistamine diphenhydramine. It is an acetylcholine muscarinic antagonist and is used in many sleep aids available over the counter. Antihistamines are also used for Parkinson's on occasion for this anticholinergic action.
Posted by Laree on December 23, 2003, at 18:28:07
In reply to Re: Shaky hands - how to explain to people? » Laree, posted by scott-d-o on December 23, 2003, at 15:30:37
Scott,
I have another question for you. Doesn't Adderall release dopamine & Wellbutrin prevent reuptake of it?? I am really confused there. Could the Wellbutrin (which supposedly works with norepinephrine and dopamine) be blocking the Adderall's dopamine release??? Or does the Wellbutrin release even more dopamine? Again, really confused, and you seem to have a plethora of technical information on how meds work with brain chemicals. Thanks!Scott, I am on Wellbutrin SR 200 mg./day & Adderall 50 mg./day. Do you think these are a bad combination? Thanks!
>
> I wouldn't say any combination of meds is intrinsicly a bad combination because they all work differently for everyone. I'm sure you know what works best for you. I was merely trying to make a suggestion as to why the original poster might be having problems with shaking.
>
> In my experience, this shaking is caused by low dopamine, or too high serotonin, norepinephrine, and acetylcholine. Dopamine inhibits involuntary movements such as these and acetylcholine excites them. People with Parkinson's disease have a compromised dopamine system, therefore acetylcholine overpowers it, causing them to shake. Fortunetly in this case it is a temporary condition that can be overcome whereas Parkinson's is caused by irrepairable damage to dopamine neurons.
>
> Another solution besides increasing dopamine transmission is to take a small amount of the over-the-counter antihistamine diphenhydramine. It is an acetylcholine muscarinic antagonist and is used in many sleep aids available over the counter. Antihistamines are also used for Parkinson's on occasion for this anticholinergic action.
Posted by scott-d-o on December 23, 2003, at 22:23:20
In reply to Re: Shaky hands - how to explain to people? » scott-d-o, posted by Laree on December 23, 2003, at 18:28:07
> Scott,
> I have another question for you. Doesn't Adderall release dopamine & Wellbutrin prevent reuptake of it?? I am really confused there. Could the Wellbutrin (which supposedly works with norepinephrine and dopamine) be blocking the Adderall's dopamine release??? Or does the Wellbutrin release even more dopamine? Again, really confused, and you seem to have a plethora of technical information on how meds work with brain chemicals. Thanks!Reuptake is when a neurotransmitter that is already in the synapse (i.e. it has been released) is transported back up into the cell. Therefore, blocking dopamine reuptake actually allows the dopamine to sit in the synapse longer. Releasing dopamine and blocking its reuptake should have a synergistic (additive) effect since you are not only releasing the transmitter, but also preventing it from being "recycled" by the cell.
Wellbutrin very weakly blocks the reuptake of both dopamine and norepinephrine, and releases norepinephrine. As a stimulant it pales in comparison to the Adderall which is a strong DA/NE reuptake inhibtor and also causes massive release of these transmitters. Really I don't see any problem with what you are taking except the Wellbutrin seems unnecessary because it has almost the same action as the Adderall, but is not nearly as powerful.
scott
This is the end of the thread.
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