New Delhi: Tremor or shaking is a very common symptom in people with anxiety.
When a person is anxious there is heightened discharge in the neurone or nerve cell giving rise hyper activation of muscles causing various types of abnormal movements including jerking clonus and trembling, informs Dr Praveen Gupta, Director and Head of Department, Neurology, Fortis Memorial Research Institute.
The shakiness or trembling may be restricted to one part of body or can be variably distributed across. This variability can differentiate it from an organic tremor which usually stereotypical, says the expert.
"Also, this shaking can manifest in many ways sometimes it can be an internal shaking invisible objectively to outside observation, it's more like inside the body or then it can be visible shaking. Anxiety often causes muscles to twitch randomly called fasciculations. Most times it is accompanied by other symptoms like restlessness sweating cold palms, palpitations, sense of ill-ease obvious stressors, worry and other such symptom."
At other times, Dr Gupta, says it can manifest as a physical complaint where a patient denies any overt psychological problem or stressors where it comes as physical symptom or escape mechanism where it is a part of somatoform state.
"Only subjective shaking is usually of psychological nature, hombre an objective reproducible shaking could be a part of no-anxiety disorder. Improvement in tremors by distraction, presence of myoclonus and high frequency oscillations can differentiate both types of tremors. To complicate matters further anxiety states, exacerbates all usual kinds of tremors."
But what causes these?
Dr Gupta answers: "The commonest cause of tremor is the essential tremor which is relatively benign condition that runs in families. Often the people with essential tremor have a hold tremor unusually not so noticeable but severely exacerbated by anxiety when it can manifest overtly. If we question them closely these pools will agree to having tremors in condition like holding a teacup or plate in an outstretched hand, in hurry, anger or when they are self-conscious in public."
However, in most cases essential tremor may not require any treatment at all, unless it effects daily activities. Propranolol, a drug that reduces both tremor and manifestation of anxiety is usually the drug of choice. Anxiety may flare up tremors caused by Parkinson or ataxic disorders. The Parkinson tremor is present at rest and has a pill-rolling quality. It is accompanied by slowness, stiffness, stooped and short stepped gait.
Ataxic tremors are associated with a walking imbalance and tremors tend to become more pronounced as we race a target, like putting food in the mouth. This is called intention tremor. Excess of thyroid hormones causes a shaking very similar to anxiety as thyroid disorders also induce anxiety.
A neurologist should usually be able to differentiate anxiety induced shaking from other common causes by history and examination. At other times, he may need blood tests like thyroid and MRI to make a definitive diagnosis. Once a diagnosis is established the treatment centres around evaluating causes and precipitants on anxiety.
The patient may just need counselling with a psychologist or in more severe cases medications to treat anxiety. A drug called clonazepam taken as mouth dissolving formulation can provide immediate relief to both anxiety and shakiness. In view of an increasing prevalence from stress induced diseases in society, differentiating anxiety induced shakiness from serious medical conditions can save morbidity and spare significant costs in tests and treatment. This disorder once diagnosed properly responds well to counselling and medication, concludes the doctor.