Go back to Tremor Resources home

Anxiety Tremors and Shaky Hands

Medical Reviewer: Dhira Khosla D.O.

Millions of Americans suffer from anxiety, which can cause nervousness, difficulty concentrating, shaking, and muscle tension. Anxiety can cause shakiness, especially shaky hands, on its own, but it can also make an existing tremor more pronounced.

It’s important to note that if you have an existing movement disorder like essential tremor, or ET, feelings of anxiety can exacerbate symptoms – but anxiety isn’t the root cause of ET. Furthermore, some patients with ET might experience increased anxiety in situations where their tremor is more apparent, for example, eating in a social setting or holding a paper while giving a presentation.

Understanding how anxiety can influence essential tremor and avoiding anxiety-triggering situations can help you better manage your ET symptoms. Keep reading to learn more about how tremors and anxiety interact and how to manage feelings of unease in healthy ways.

How the Body Responds to Anxiety

Anxiety is your body’s natural response to stress and triggers a fight-or-flight response. In dangerous situations, it helps protect you from being injured or worse. But anxiety can also be triggered in situations that aren’t dangerous. For example, many people suffer from social anxiety disorder (SAD) that makes normal situations like a party or performance extremely nerve wracking.

Here’s how your body responds to anxiety:

Adrenaline

Adrenaline, also known as epinephrine, is a stress hormone secreted by your adrenal glands in the face of a perceived threat or exciting situation. When you are feeling anxious, adrenaline floods your body, causing elevated blood pressure, an increased heart rate, sweating, dilated pupils, heightened senses, and more. It is why you may be feeling nervous and shaky in certain circumstances.

Tremors

When you’re feeling anxious, your muscles may become tenser, since anxiety primes your body to react to an environmental “danger.” Your muscles may also twitch, shake, or tremble. Tremors that are caused by anxiety are known as psychogenic tremors.

While anxiety-induced shaking is relatively harmless, it can be very uncomfortable. It is important to know how to guide your body back to a relaxed state and learn how to cope with anxiety for your overall well-being.

Shaky Hands

When you are experiencing anxiety, you may be wondering, “why are my hands shaking?” While it may be concerning, this is a very normal reaction. As your body produces more adrenaline and your muscles tense up, your hands may shake uncontrollably.

Unlike other hand tremors caused by chronic disorders such as essential tremor, however, shaky hands as a result of anxiety attacks are temporary. It is important to know how to differentiate between these types of tremors and when to seek medical help.

If you suddenly start to notice a progressively worsening tremor in your hands that is affecting your ability to complete daily tasks, contact a healthcare professional as soon as possible. Getting an accurate diagnosis and ruling out any other underlying conditions is a key first step to managing your shaky hands and other symptoms.

If you are already diagnosed with essential tremor, keep in mind that while anxiety is not a direct cause of this disorder, it can impact its severity. ET patients can experience an uptick in the severity of their tremor anxiousness and stress.

Other Symptoms of Anxiety

Symptoms of anxiety might not always manifest in shaky hands or tremor. You might also experience the following symptoms:

  • Sense of doom
  • Fatigue
  • Frequent urination
  • Restlessness
  • Grumpiness
  • Sweating
  • Upset stomach
  • Racing heart
  • Feeling tense

People with essential tremor can experience these symptoms of anxiety in addition to the worsening of their tremor. ET can also be a great source of anxiety, since managing a chronic health condition can take a mental and emotional toll over time.

Essential Tremor and Anxiety

Anxiety can affect individuals with ET in different ways. Common types of anxiety disorders seen in conjunction with essential tremor include:

  • Panic disorder: One of the most extreme anxiety disorders is panic disorder. Someone with a panic disorder may suddenly feel intense anxiety or fear that reaches a peak. Heart palpitations, chest pain, shortness of breath, and feelings of impending doom are all associated with panic disorder. Panic attacks can happen without a trigger.
  • Social anxiety disorder: People with social anxiety have high levels of fear and nervousness in social situations. They tend to avoid social situations due to self-consciousness and the fear of judgment.
  • Agoraphobia: Those with agoraphobia suffer from the fear or avoidance of places or situations where they’re not in control.
  • Generalized anxiety disorder: Generalized anxiety is persistent worry about activities or events, even ones that are normal. Usually, anxious feelings are out of proportion with the situation itself. GAD often appears with another disorder or depression.

For some, essential tremor causes both anxiety and stress – which can make the shaking from essential tremor worse. Interactions between essential tremor and stress can be hard to avoid and just as troublesome.

Anxiety-Triggering Situations

A stressor that triggers anxiety can be short-lived and situational, like being stuck in traffic when you’re trying to get to work on time. Or, it can be long-term stress over time, like worrying about paying your bills after a period of extended unemployment.

Those with essential tremor may develop anxiety as they worry about issues related to their health condition. Essential tremor can be a source of both long-term and short-term situational stress. For example, those with ET may be concerned about the effectiveness of their treatment and whether their tremor symptoms will worsen over time. ET patients might also worry about how their tremors are judged or perceived by others in public. Specific actions and tasks that are particularly difficult to accomplish with essential tremor like drinking water, holding a spoon, and other activities might also be anxiety triggers.

How to Stop Anxiety Tremors

Whether you’re dealing with both anxiety and essential tremor or just need help with shaky hands during anxiety attacks, there are steps you can take to better cope. From mindfulness exercises to medication and therapy, you don’t have to let anxiety take control of your life.

Here are some ways to deal with feeling nervous and shaky:

  • Deep breathing: Take deep breaths and regulate your breathing to calm your nerves. Hyperventilation can worsen feelings of anxiety.
  • Therapy: Cognitive behavioral therapy (CBT) can help you identify anxiety triggers and practice grounding techniques to stay calm. Therapy provides you with support while you deal with the uncertainties around essential tremor.
  • Exercise: Not only can exercise improve your mood, but it can also reduce your stress.
  • Avoid alcohol: Alcohol is a depressant and can worsen anxiety.
  • Avoid smoking and coffee: Nicotine and caffeine are both stimulants that tend to make anxiety worse.
  • Sleep: Getting enough sleep is another important step that can help you manage your anxiety. Sleep is critical for helping your body and brain function at optimal levels.
  • Meditation: Meditation can help you still your mind. By focusing your attention, you can expel any thoughts that are causing you stress.
  • Yoga: Yoga connects the body and mind, enhancing your mood and overall well-being. By soothing the overactive nervous system, yoga can reduce symptoms of anxiety, including shaky hands.
  • Medications: If you experience frequent, intense bouts of anxiety, your doctor may prescribe medication to help you soothe your mind. Benzodiazepines like diazepam and alprazolam enhance the function of the neurotransmitter GABA to induce feelings of calmness. SSRIs and beta blockers like propranolol can also be prescribed for anxiety.

Benzodiazepines and beta blockers can also improve essential tremor. Propranolol, in particular, shows improvement in about 50 to 60 percent of essential tremor patients, especially for those with hand tremors. However, it’s not the only treatment option for dealing with essential tremor symptoms.

Treatment for Essential Tremor and Shaky Hands

Treating essential tremor may begin with pharmaceuticals like propranolol and primidone. These are considered the first line of defense against tremors. Unfortunately, these medications can have undesirable and unpleasant side effects. Patients with essential tremor may also develop a tolerance to these medications over time or find them ineffective in the first place.

Another option to treat essential tremor is surgery. Deep brain stimulation is one surgical procedure approved to treat essential tremor. The procedure involves implanting electrodes into the brain that targets the nerves thought to control tremor. The drawback is that this is an invasive option that isn’t guaranteed to work for all patients with ET.

If you don’t want the side effects of medication and don’t want invasive surgical procedures, you may consider alternative essential tremor treatment such as Cala TAPS therapy. Therapy is delivered on an FDA-cleared, wearable medical device customized to each patient’s unique brain signal pattern. With 40-minute sessions, it targets the tremor network in the brain with electrical stimulation through the peripheral nerve. Cala TAPS therapy is a safe and effective way to provide temporary relief to shaky hands.

In Cala TAPS therapy’s clinical study, 64% of patients experienced on-demand tremor relief for an average of 94 minutes. (Isaacson SH, , et al. Tremor and Other Hyperkinetic Movements. 2020;10:29. http://doi.org/10.5334/tohm.59)

Consult your doctor and ask about your options for treatment. Only you and your physician can decide the right course of action.

Takeaways: Dealing with Anxiety and Essential Tremor

If you’re concerned about essential tremor and anxiety, it’s crucial to talk to your doctor to address these issues. Essential tremor can trigger anxiety as patients grapple with their new diagnosis and face uncertainty regarding its future progression. Anxiety can also be present with depression, which may affect patients with ET who can’t perform activities as easily or as well as they had before ET.

Essential tremor can be managed by careful observation and a treatment plan made with a physician. You may want to ask your doctor about non-invasive options like the Cala device, especially if you’ve had negative side effects from commonly prescribed ET medications or if those medications failed to improve your tremor. Cala TAPS therapy can provide temporary relief from your symptoms and peace-of-mind. Although there is no cure for ET, you can deal with essential tremor and anxiety with supportive care from your medical team, lifestyle changes, and Cala TAPS therapy.

Curious about how to get started? Read more about this revolutionary, targeted therapy that can help give you peace-of-mind and a better quality of life.

Mental Health Resources:

The first step to managing anxiety is getting a better understanding of how it affects the brain and your overall well-being. For patients with essential tremor, evaluating how anxiety exacerbates your symptoms and working through your feelings of nervousness can help alleviate anxiety tremors and improve your mood. Here are some resources to guide you on your mental health journey:

  • National Alliance on Mental Illness (NAMI): NAMI is a non-profit organization that provides support and education to those affected by mental illness. With support groups throughout the U.S. and a helpline that runs from Monday to Friday, NAMI is here if you have any questions or need someone to talk to.
  • Mental Health America (MHA): Learn more about the state of mental health in the U.S. and find help with MHA. You can get screened, read up about different treatments, and find a therapist in your area through MHA’s website.
  • Substance Abuse and Mental Health Services Administration (SAMHSA): The U.S. Department of Health & Human Services’ SAMHSA has special resources for older adults affected by mental health issues.