What is the relationship between sertraline (selective serotonin reuptake inhibitor) and tremor?

From the Guidelines

Sertraline can cause tremors as a side effect in some patients, and if you're experiencing tremors while taking sertraline, don't stop the medication abruptly, but consult your healthcare provider. According to the most recent evidence 1, tremors are a common side effect of sertraline, and they can be managed by reducing the dose or adding propranolol to the treatment regimen. The study published in 2020 1 suggests that most adverse effects of sertraline, including tremors, emerge within the first few weeks of treatment.

Management of Sertraline-Induced Tremors

• For mild tremors, reducing the dose may help, typically by 25-50mg decrements, as suggested by the guidelines for managing Alzheimer's disease 1.
• Alternatively, your doctor might add propranolol (10-40mg two to three times daily) to manage the tremor while continuing sertraline.
• Tremors often improve with time as your body adjusts to the medication, usually within 2-4 weeks.
• These tremors occur because sertraline increases serotonin levels, which can affect neural pathways controlling fine motor movements.
• Staying hydrated, limiting caffeine, getting adequate sleep, and avoiding alcohol may help reduce tremor severity.

Warning Signs

• If tremors are severe, interfere with daily activities, or are accompanied by other concerning symptoms like muscle rigidity or fever, seek immediate medical attention as this could indicate serotonin syndrome, a rare but serious condition 1.
• Serotonin syndrome can be triggered when serotonergic medications are combined, and symptoms can arise within 24 to 48 hours after combining medications 1.

From the FDA Drug Label

The most common signs and symptoms associated with non-fatal sertraline hydrochloride overdosage were somnolence, vomiting, tachycardia, nausea, dizziness, agitation and tremor.

• Tremor is a possible symptom associated with sertraline hydrochloride overdosage, as reported in the drug label 2.
• This suggests that tremor can occur in patients who have taken an overdose of sertraline.
• However, the label does not provide information on the incidence of tremor in patients taking sertraline at therapeutic doses.

From the Research

Sertraline Tremor

• Sertraline is a selective serotonin reuptake inhibitor (SSRI) that can cause tremor as a side effect, as reported in several studies 3, 4, 5.
• A study published in the Journal of the neurological sciences found that SSRIs, including sertraline, are among the most common drugs associated with tremor 3.
• Another study published in the European journal of neurology found that treatment with sertraline resulted in improvement in all UPDRS domains, but worsening of tremor was observed in some patients 4.
• A systematic review and guide to selection of SSRIs published in the journal Drugs found that the most common adverse reactions to SSRIs, including sertraline, were gastrointestinal and neuropsychiatric, particularly headache and tremor 5.

Risk Factors and Management

• Risk factors for drug-induced tremor, including sertraline, include polypharmacy, male gender, older age, high doses, and immediate-release preparations or reaching toxic levels of the offending drugs 3.
• Drug-induced tremor usually resolves once the offending medication is discontinued, but persistent tremor may be observed in some cases (tardive tremor) 3.
• Active management of depression with sertraline appears to have a positive impact on parkinsonism, despite the potential for worsening tremor in some patients 4.

Comparative Effectiveness

• A systematic review published in the journal Depression and anxiety found that the comparative effectiveness of sertraline and other SSRIs for accompanying anxiety, insomnia, and pain in depressed patients is limited, with moderate evidence suggesting that SSRIs do not differ in their effectiveness for these symptoms 6.
• Another review published in the International clinical psychopharmacology found that sertraline and other SSRIs are effective in the treatment of panic disorder and agoraphobia, but direct comparisons with other antidepressants and therapies are scarce 7.