Posted by med_empowered on November 19, 2005, at 16:12:44
In reply to Anyone Else on Symbyax, posted by Graceneeded on November 19, 2005, at 9:47:04
hey! Antidepressants can sometimes cause tremors. So can antipsychotics. These side-effects are known as EPS (extra-pyramidal symptoms) and are pretty common with antipsychotics (more common with the old ones, like Thorazine, but they still happen a good bit with the newer ones, such as Zyprexa). Sometimes the tremors go away after a couple weeks. Other times, they remain or get worse, and sometimes can lead to TD (tardive dyskinesia, a usually permanent movement disorder...it involves involuntary movements, usually in the facial area). TD is pretty common with the old drugs; about 3% of patients will get them annually, rising to about 20% after 5 years, with the numbers rising to 50% or so after "long-term" treatment. You could add something to your mix like Cogentin, which has long been used to treat EPS with antipsychotics. It can cause sedation, cognitive impairment, but usually isn't necessary long-term (at least with the newer drugs)...if you take it for a month or so, your doc will probably be able to taper it w/o any problems. There are other medications that can do this, as well; some people find relief with Propranolol (Inderal, Inderal XR), a beta-blocker usually used for high blood pressure and stage fright.
Have you tried any other augmentation strategies? Some people with unipolar depression do pretty well adding mood-stabilizers, which are more commonly used in Bipolar and Schizoaffective disorders. Lithium is the classic option. Other options include Depakote, Tegretol, Trileptal, Lamictal, and Keppra (Keppra is a very new option, so the data on it is kind of sparse). Lithium, Depakote, and Tegretol will require blood tests periodically to monitor blood levels of the medication and ensure that there aren't any problems (liver problems, for example). Trileptal is chemically *very* similar to Tegretol, but doesn't require blood tests; you may, however, want to monitor your blood sodium levels, since Trileptal can cause a significant drop in blood sodium. Lamictal is more commonly used for depression in BP I and BP II disorders, but may be useful for more "treatment-resistant" cases of unipolar depression; there aren't any required blood tests, but you will have to increase the dose very slowly to prevent developing a severe rash (its a rare side effect, but has proven fatal in some people). You will also need to monitor for the development of a rash. Lamictal has some unique antidepressant properties; however, some people find that it can induce hypomanic states (I believe there are case reports of Lamictal inducing full-blown mania as well). If you have bipolar disorder, this will need to be taken into cosideration; if you have unipolar disorder this will be less of a problem, but still something to watch out for.
There are also a number of other augmentation strategies. Klonopin seems to help some people with depression, although it can induce/worsen depression in other people. Stimulants (ritalin, dexedrine,desoxyn, adderall, provigil) help some people with depression as well.
Good luck!
poster:med_empowered
thread:580372
URL: http://www.dr-bob.org/babble/20051119/msgs/580452.html