I take Zoloft (Sertraline) 100mgs daily. I have been on this medication for many years before the parkinson's diagnosis.
My hand tremors are not stopping after starting 6 weeks ago C/L 25/100 (generic Sinemet) 1 pill, three times a day? My family Doc said that maybe the Zoloft is the reason for the continuity of the tremors.
Diagnosed with PD by DatScan after seeing MDS a few months ago.
Anybody taking these 2 medications and willing to share experiences?
Thanks!
Tremor is a known and common side effect of Zoloft :
drugs.com/sfx/zoloft-side-e....
A relevant quote :
' Common side effects of Zoloft include: diarrhea, dizziness, drowsiness, dyspepsia, fatigue, insomnia, loose stools, nausea, tremor, headache, paresthesia, anorexia, decreased libido, delayed ejaculation, diaphoresis, ejaculation failure, and xerostomia. Other side effects include: abdominal pain, agitation, pain, vomiting, anxiety, hypouricemia, and malaise. Continue reading for a comprehensive list of adverse effects. '
Art
Thanks for the link. I had never had hand tremors while taking Zoloft for many years before the PD diagnosis
It is difficult to know for sure if it is the disease or the medication because both have tremor as a common symptom or side effect. Even harder is the fact that you can not take an instant brake from Zoloft to try and determine if it is the cause or not. Your body won't be happy if you instantly go without Zoloft!
Are you taking high dose vitamin B1? Some forum members have reported that B1 has helped reduce their tremor, but others have reported no tremor benefit.
Art
Yes, you are absolutely right about not stopping the Zoloft cold turkey.
And yes, I am following the protocol of Vit B1 with the sublingual dose 😊
My brother follows the B1 protocal. Takes simnet daily once in the morning. His hand still tremors but it did before he started taking simnet
Did your brother's tremors stop?
No sadly not
This paper seems to suggest a link between SSRIs (e.g. Sertraline) and tremors, Parkinson's and some other movement disorders:
bmcpsychiatry.biomedcentral...
"Conclusions
A potential harmful association was found between movement disorders and use of the antidepressants mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan, fluvoxamine, citalopram, paroxetine, duloxetine, bupropion, clomipramine, escitalopram, fluoxetine, mianserin, sertraline, venlafaxine and vilazodone. Clinicians should beware of these adverse effects and monitor early warning signs carefully. However, this observational study must be interpreted as an exploratory analysis, and these results should be refined by future epidemiological studies."
my husband was on Prozac then Zoloft . Both worked for a while then eventually made him manic, he would speed, buy stuff we didn’t need, use our credit card to gamble, then jittery then suicidal. I could believe it causes tremors.
I weaned him off over a year . The last little bit is the worst. I had to weigh with jewellers scales and dilute with rice flour into capsules decreasing by about 10% of remainder every 2-3 weeks. I finished with 6 weeks placebo before telling him he was off it. I tried to go cold turkey when he was at 3% of the original amount and he relapsed.
At the same time he started on Hardys den. He hasnt been depressed again since then, but suffers in and off with anxiety for which a tiny amount of clonazapam has been the best remedy. 0.5 mg split over then day
Please read this book on Vitamin B3 - Niacin. It will help with anxiety. " Niacin: The Real Story: Learn about the Wonderful Healing Properties of Niacin Learn about the Wonderful Healing Properties of Niacin". It is available on Amazon.
The Hardys has b3 in it. He tried taking extra for a while but it seemed to make it worse if anything so I think he must be getting enough. Thanks.
How much Niacin should you take for anxiety and is there something called the niacin flush it you take too much ?
Such a journey you both had! Is he suffering from Parkinson's?
Yes, diagnosed 2018 but had symptoms a lot longer. Eg depression, fatigue, rosacea, restless sleep, hands that don’t work, rigidity, loss of hand swinging and frozen face, loss of smell, Parkinson’s body odour. Urinary frequency.
He has had quite a few months with most of his symptoms reduced (anxiety, depression, rosacea gone, face and sense of smell , Parkinson’s odour, gone. Still had PD gait and hands that don’t work.)
Recently his anxiety has increased again and face has frozen again. Trying to work out what changed. It is spring here and he had severe pollen allergies as a kid and young adult so i suspect it isn’t helping. Also we have had a few dramas with leak in bathroom causing damage, and rental property needing maintenance so could be the added stressors.
I was diagnosed on March this year but also I had some symptoms for a lot longer like lack of smell, rosacea(I did not know about this previously!), etc
Sorry, "Hardys den" is this a contraction or a spelling error, what's the actual name and spelling of the supplement?
Hardy’s DEN daily essential nutrients.
hardynutritionals.com/produ...
TY on that one, LAJ, I will look into that supplement, thanks..
Meanwhile, it seems that comments are accumulating rather quickly so that the original poster needs a little space to consider all the responses.
But it seems to me that all the medications that include stimulant activity may need a second look. !!
Maybe the best course in the meantime is a small dose of clonazepam. You know there is no substitute for careful use of clonazepam in small doses. At least that's my clinical experience, that's both as a practitioner, and consumer, and commentator with the neurology and psychiatry people that Mayo Clinic.
A little relief wouldn't be objectionable, would it? I think not.
Duloxetine has its stimulant side. Zoloft has its stimulant side. I think a little bit of rest might be in order and that can be had through small dose anxiolytic of clonazepam.
I don't really hold with using duloxetine as an anxiolytic since it also has its stimulant component through it's mechanism of inhibiting norepinephrine uptake. since blocking norepinephrine uptake does have its stimulant property.
I am not going to spend time trying to convince people. I will provide the clinical data and a little bit of a chemical data, and after that people who have a problem will have to take the responsibility to figure out critically whether I have any sand. It's your life after all, and it is up to you.
I agree. Clonazapam has been the single most useful thing that my husband has been prescribed, but he takes it at a very low dose. 0.5mg cut into 1/4s over the day. If he is feeling particularly anxious he can take an extra 1/4 very rarely.
Interestingly he had his genetics tested and it said his seratonin and dopamine pathways are very poorly functioning so I think it’s why these meds don’t work for him like they do for other people. Really that should be the first test doctors do before prescribing them.
I've tried every SSRI and SNRI antidepressant and they all increased my tremors.
Did you try sertraline after the start of thePD tremors?
Yes it was several years after my tremors started. The meds made it worse.
I actually think the antidepressants probably triggered hubby’s PD. They gave him mirtazapine when the ssri made him suicidal and that made him into a zombie. He looked like a 90 year old dementia patient but he was 58. He would not get out of bed or do anything at all. That’s when he got really bad. I wish I had found the Hardys nutrients before he was put on SSRIs as that might have cured his depression and kept him moving and averted the PD.
That makes sense because every SSRI includes a stimulant property in the sense of chemical mechanism. If you really want control of anxiety, you don't want to stimulant, you want something that will settle down the anxiety, ie, will work through the chemical mechanism of the traditional and anxiolitics of benzodiazepines, the kindest of which is clonazepam. It's not a crime, people. And if, after considerable painful experience, you finally find that I am telling you the truth, it's not my fault, it's yours. 0.25mg or 0.5mg will not kill you. Up to you, suffer if you must for ego or misinformation, but I've given you what you need and the rest is up to you to sell it to your prescriber. It won't kill you so what the f***.
I was on Clonazepam for about 10 years. At that time I had to change doctors, and my new doctor wanted me off if it as she felt I had been on too long. It took me 2 full years to taper off Clonazepam. I also was tapered off Cymbalta. My tremors started at the time I was tapered off Clonazepam. Now I feel it's likely I had tremors further back than I thought and Clonazepam was "blunting" them. I've since tried several antidepressants and some anti-anxiety meds, but every one exacerbates my tremors.
Hi Patitou,
I did have terrible tremors with Zoloft. In my case, I got Parkinson's before we tried Zoloft. I was on Paxil before which worked exactly as a SSRI should but I was taken off it because it contributes to weight gain. Now, I am on Cymbalta (duloxetine) which is okay.
I do have dystonic-dyskinesia (cramping and tremors at the same time) between doses. The solution that works for me is 10 mg propranolol which starts working to diminish tremors within 15 minutes. Unfortunately, it also brings down my blood pressure (after all it's a blood pressure medication). So I have to be careful. Maybe you can ask your doctor about it.
Hi pdpatient,
I've just read your reply to Patitou where you say that 10 mg Propranolol helps you with your tremors within 15 min.
I am on 10 mg Propranolol up to 5 times a day to control my pulse rate. Unfortunately, I've never noticed any improvement in my tremor when I take Propranolol. So I was wondering how your tremor looks/feels. Mine is a whole-body shaking, usually high frequency and amplitude. When I have it I have to lie down and need someone to hold my arms and legs until it disappears.
I think this is different from what Parkinson's tremor looks like - lower frequency and amplitude, usually in a joint e.g. the wrist.
Could you please give me an idea of how your tremor looks like? I just wonder if I there is a way of making Propranolol work for me too.
Five years after diagnosis and I still don't understand my symptoms. More worryingly, my Neurologist doesn't understand them either and regularly tells me that!
Thank you in advance.
Hi Daisies. I understand your concerns and I want to help you. Let's see if I can help you with the problem.
What does the tremors look like for me? Whole body just as you described. It is definitely dyskinesia for me, and from a layman's perspective, I suspect that you probably have the same as well. Interestingly, my Parkinson tremor is confined to the right hand thumb where it originated. For perspective, I was diagnosed 11 years ago at age 48. Young onset indeed.
I suspect that Young Onset Parkinson patients have a fundamentally different journey than patients who are diagnosed later on in life as is typical.
I have terrible dyskinesia along with dystonia which is cramping and curling of toes and my body goes into a strange writhing mode as a result of the combination. It's a sorry sight to see and I feel that my self respect and dignity has gone down the toilet.
Sometimes my family holds me down and sometimes I just curl up into a fetal position and it helps. I find that doing this helps more along with the propranolol. Also, deep breathing helps sometimes with calming me down when done with the other stuff.
Possible solutions :
1. Use a combination of medications. I use Sinemet, Nourianz, and Amantadine.
2. I also take Cymbalta as well to help control my anxiety. A lot of my problems are attributed to anxiety. Maybe talk to your doctor about it?
3. I also do meditation using apps. UCLA has a great one.
4. I wait till I act start shaking before taking the propranolol. I don't take it with the Sinemet. Maybe try changing the timing and sequence of your medicine.
I hope you find it solution to your problems. Keep me and the community posted.
Thank you so much for taking the time to reply! I do appreciate it.I'm sorry that you are going through all this suffering, and I dare say, trust me I know the feeling.
I can see quite a few similarities - YOPD for me too, five years ago at the age of 49 (a day before my birthday! My Neurologist is devoid of any human emotions)
I am on Madopar and a tiny dose of Rotigotine (originally 10 mg but now 0.88 mg per 24h transdermal patch). The Rotigotine made my life a living hell and I'm still struggling with it.
Recently I realised that Madopar also contributes to my suffering which was absolutely unexpected. After some time spent looking at its concentration of levodopa versus time curve I realised that I feel worst where the rate of change of the levodopa concentration is very fast, doesn't matter in which direction up or down. So perhaps a solution for me would be replacing madopar with Sinemet as its curve is less steep in both ends. I don't know why how fast the changes of levodopa concentration are should affect my hearth rhythm and physically incapacitate me but it does. Of course, I might be wrong but I would like my Neurologist to show me some evidence and analysis rather than to give me his opinion. (Apologies for the rant)
Thank you for s your experience with Propranolol. I was taking it roughly at the times when I take madopar, will change that with my next dose.
Will let you know how it goes especially if I get a prescription for Sinemet and things improve.
Thank you so much again.
(Forgot to mention that I liked the bbc link in your bio about the little bird that had too many 'treats')
Enjoy the rest of your day.
D.
I like your response even though I don't quite understand it but the clinical reality is yours, not anyone else, and so I will trust it.
Thank you for your comment.I wish I understood my paradoxical reaction to anti-Parkinson's medication. Like I said before, I've been on every dose starting from 500mg levodopa per day, up to 1100 mg, and now down to 850 mg per day. So far I have not identified an interval of levodopa concentration where I feel even some marginal improvement in my symptoms. It's been five years already. I only got an email from my PD nurse which says that they don't know why this medication is affecting me the way it does. This was three years ago. My case has been shelved for another year. My next telephone appointment with my Neurologist is in a year's time.
Hello Patitou, I have been using 50 mg per day of Zoloft for about 12 years. I began using it about two years before being diagnosed with PD. I've never changed the dosage in all of these years, mainly because I'm afraid of the withdrawal symptoms. I have never noticed any increase in tremors or any other problems. My complaint is that because Zoloft interacts with so many other drugs, I am limited on what drugs I can take for other ailments.
Thank you Grannyfan for your words! So you have been diagnosed with PD 10 years ago, right? I also think that the Zoloft does not contribute to my tremors but my Family Dr keeps telling me about that possibility and the Psychiatrist tells me the contrary. I will remind my MDS next week. He never said anything about the Zoloft contributing to my tremors.
Hi. I've had a recent Parkinsons assessment and the result was I don't have Parkinsons and my continuous rabid tremor is Essential Tremor. I've found that the only thing which reduces it is alcohol!
Yes, I heard that alcohol does help. Many doctors use the response to alcohol as a consideration when making a differential diagnosis.
I do not drink as I have a very fatty liver
Have you tried cutting out sugar and processed carbs?
Ask your doctor about amantadine. It helped my tremors some slowness and muscle tightness.
I weaned my mother off this because of falling. It was listed on Bayer list to avoid in the elderly. I was surprised how much less she fell off this medication. It was causing probably 3 falls a week. She still falls but no longer weekly. She did not have tremors so I can not attest to the this symptom’s relationship
Zoloft?
today.uconn.edu/2019/06/com...
She might have been on celexa at the time, but took zoloft also before that. I could not find a safe SSRI, so we do without it now. I was shocked at how many falls could be avoided be stopping it, but I guess it was because she was so frail and fell so often.
Hi Astrojupiter. Did you also try Cymbalta?
She did not try it but t is specifically noted to also cause falls.
“One class of drugs in particular stood out as causing more adverse events than the placebo: the selective norepinephrine reuptake inhibitors or SNRIs, Among these, duloxetine, which is commonly known as Cymbalta, was the most notable. Duloxetine “most likely increases the risk of falls over longer treatment,” says Baker.
As a depressive I did not respond well to zoloft, in fact it agitated me. As a patient, I did much better with duloxetine. As a practitioner, I was never impressed with either discussing with my psychiatrist, or as a psychological consultant to the psychiatrist, (you see I was both patient and practitioner, since no one is immune of disease), I never really liked the mechanism of Zoloft. Duloxetine did a bit better with a chaser, when necessary, of a small dose of clonazepam. There is really nothing wrong with clonazepam, it merely stimulates a little bit of your chemical brake system. I think it is been given a bad rap by government, which really has more to do with politics and business, not chemistry.
I think it can be addictive and it has a street value and they are scared patients will sell it for use to someone who hasn’t been prescribed it.
HI LAJ That's outrageous. Doctors are not supposed to be gatekeepers I am surprised that it depends on region. When I was in New York, Columbia University had no issues with it but now UCSF does in California
Hi Marion. I am not able to convince my doctor to up the dosage of clonazepam due to the perception. I am allowed a tiny dose of.25 mg once or twice a week. My voice is amazingly clear after.5mg. Interesting that you mention the fact that politics is involved. Can you please elaborate?
I found this a while back about stiff persons syndrome
ncbi.nlm.nih.gov/pmc/articl...
It seems to have some of the same symptoms as PD and they treat that with clonazapam or other benzos.
I take one and a half sinemet 4 times a day and taking that dose stopped my tremors.
Did you start with a different dose?
Can I ask how long have you been diagnosed?
Good for you, well worth taking note of.
Just curious, why do they have you on Zoloft for so long? Thats no way to live. Im sorry you are going through this.
I feel fine. I take it for generalized anxiety.
ncbi.nlm.nih.gov/pmc/articl....
“Serotonin specific reuptake inhibitors (SSRI) are widely used antidepressants for variety of clinical conditions and have found popularity. They are sometimes associated with extrapyramidal side effects including Parkinsonism. We report a case of generalized anxiety disorder on treatment with SSRI (fluoxetine / sertraline) who developed irreversible Parkinsonism. SSRI are known to cause reversible or irreversible motor disturbances through pathophysiological changes in basal ganglion motor system by altering the dopamine receptors postsynaptically. Clinician should keep risk benefit ratio in mind and change of antidepressant of different class may be considered. Case is reported to alert physicians to possibility of motor system damage while treating with SSRI.”
Interesting article! I wonder when they mention parkisonism if they refer to drug induced parkisonism. I had a Dat Scan which reported that I have regular PD and never had problems with tremors during the long time I took Zoloft
I was going to mention this, then I did and changed my mind, then I decided to say it anyway, and then I changed my mind, and now I'm changing it back again.
There's actually quite a bit of question about whether ssris do anything for depression, and when such as the case going to ask to also question whether it does anything for anxiety, or at least anxiety associated with depression (and I would suspect same about serotonin and anxiety of any kind).
No saying something like this is perhaps a little similar to Martin Luther nailing up his 95 theses in Wittenburg. So before anybody starts throwing rocks, let me just mention this article and then anybody can fight with the authors before they get down to little old me.
Beds for Parkinson's 
Methylphenidate for \"Parkinson's\"
Impact of Parkinson's
Drop Foot and Parkinson's - is there a link?
