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Q: What Can Help with
Weakness and Also Shaking Hands?
I am currently on 1200mg of Lithium and 375mg of Effexor and 150mg of
Trazadone. I am 6' 230 lbs and 35 yrs old. I have been battling depression my
whole life. Recently I have have been feeling so tired and in a brain fog. My
hands shake all the time and it frustrates me because I am an artist and Arch.
I took Buspar and it does not stop the shaking. I am not depressed and I have
been sleeping but the weakness and the shaking of the hands are effecting me.
What can help with the shaking and weakness.
Thank you,
Wade
Dear Wade --
First, 2
basic steps:
1. Get
your lithium level checked, if that has not been done recently.
2. While
you're at it, make sure that your thyroid is checked. Make sure that it is not
just "normal", but well over toward the "hyperthyroid" end of the normal range
-- not near the "hypothyroid" end of the normal range (here is more about
thyroid and bipolar if you need it to understand that recommendation or make
the case to your psychiatrist).
If your
lithium level is too high, that could cause shaking and weakness. That's an
easy one to fix. Tremor is a very common side effect that higher doses.
However, make sure you don't just turn the dose down on your own. You may have
struck a delicate balance between Effexor and lithium, and shifting that balance
without being prepared for dealing with the consequences would be a bad idea.
If your
thyroid is too low, that too is easily detected and easy to fix. This is less
likely to be causing the tremor (I'm afraid that is pretty likely to be lithium)
but it could be causing the brain fog and tiredness.
After that,
it gets much trickier. Those are standard potential explanations. If neither
of them is a satisfactory explanation, then something rather weird is going on.
As a friend of mine says, "medications are guilty until proven innocent, so if
it's not lithium that is the problem, the spotlight rather necessarily turns on
Effexor. In my experience, antidepressants can be useful initially and then
cause problems later, at the same dose and the same person. So I would not
exempt it, even though these are not typical side effects of Effexor. (They
might be atypical effects of having any antidepressant on board in
the treatment of bipolar disorder, but that is another rather long story, and
very controversial, and I have a particular point of view on it which is not
standard amongst my colleagues. For more on that point of view, see my lengthy
story about
Antidepressant Controversies.
I hope one
of those ideas proves to be useful. Good luck getting this figured out.
Dr. Phelps
Published June, 2009
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