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 on its own and 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 

Adrenaline and Tremors 

Other Symptoms of Anxiety 

Essential Tremor and Anxiety 

Anxiety-Triggering Situations

Coping with Essential Tremor and Anxiety 

Treatment for Essential Tremor and Shaky Hands


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 people nervous in normal social situations like a party or performance. Anxiety might cause shaky hands and trembling, alongside other symptoms that we’ll explore in later sections.

With that said, if you’re experiencing both hand tremor and anxiety, it’s important to see a doctor. Although a tremor might be temporary and related to stress, a persistent tremor or shaking that occurs during certain movements could be a sign of underlying health conditions or essential tremor (ET).

Although most people associate tremor with Parkinson’s disease (PD), shaky hands aren’t always a sign that you have or will get PD. In fact, the most common movement disorder that may present as shaky hands is essential tremor.



Adrenaline and Tremors

When you’re under stress, either chronic or acute, your body can transition into fight-or-flight mode. When you’re stressed, hormones like epinephrine (adrenaline) increase in your body, which can cause an elevated heart rate, high blood pressure, and a rapid respiratory rate. Norepinephrine, another stress hormone, is also released and involved in the manifestation of these physical symptoms of anxiety.

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.

If you have essential tremor, anxiety isn’t the direct cause of it. But, ET patients can experience an uptick in the severity of their tremor due to feelings of 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 you’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.

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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.



Coping with Anxiety and Essential Tremor

If you’re dealing with anxiety and essential tremor, you can take steps to better cope. recommends the following steps:

  • 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.
  • Relax: Meditation, yoga, and visualization techniques can help soothe anxiousness.

In some cases, a doctor might prescribe an anti-anxiety medication to help those with chronic anxiety issues. There are some anti-anxiety medications that also might improve essential tremor symptoms. For example, benzodiazepines and beta-blockers are common anti-anxiety prescriptions that can also improve essential tremor. 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 surgical. 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  a prescription wearable therapy, Cala Trio™ . Cala Trio is an FDA-cleared medical wearable device customized for your unique tremor. In Cala Trio’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.

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 Trio wristband, especially if you’ve had negative side effects from commonly prescribed ET medications or if those medications failed to improve your tremor. Cala Trio 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 Trio.

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.

MKG-1123 Rev B Feb 2021

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