Lexapro and Shaking/Tremor
Yes, Lexapro (escitalopram) can cause shaking and tremor as a recognized side effect, occurring in approximately 2% or more of patients treated with this medication. 1
Evidence from FDA Drug Label
The official FDA prescribing information for Lexapro explicitly lists "shaking (tremors)" as a potential sign of serotonin syndrome, a serious adverse reaction that can occur with this medication. 2 Additionally, the drug label warns that tremors can manifest as part of serotonin syndrome when Lexapro is combined with other serotonergic medications. 2
Clinical Evidence on Tremor Incidence
Tremor is documented as a commonly reported adverse effect in patients receiving second-generation antidepressants including SSRIs like Lexapro, with an incidence of 2% or greater in clinical trials. 1 The American Family Physician guidelines specifically identify tremor among the common side effects experienced by approximately 63% of patients who develop at least one adverse effect during SSRI treatment. 1
Mechanism and Clinical Presentation
SSRIs including escitalopram are well-recognized tremorogenic drugs that can cause or exacerbate tremors through serotonergically mediated inhibition of the dopaminergic system. 3, 4 The tremor typically:
- Resembles essential tremor in character 3
- Can affect various body parts, including limbs and jaw 5
- May present as part of drug-induced parkinsonism with rigidity, bradykinesia, and mask-like facies 6
- Can occur as hypnic jerks (involuntary muscle contractions during sleep transition) 7
Risk Factors
Certain patient characteristics increase the risk of developing tremor:
- Male gender 3
- Older age 3
- Higher doses of medication 3
- Polypharmacy, especially with other serotonergic agents 2, 3
Clinical Management Approach
If tremor develops on Lexapro, the following algorithmic approach should be followed:
Assess for serotonin syndrome immediately - Look for associated symptoms including agitation, confusion, tachycardia, hypertension, hyperthermia, hyperreflexia, inducible clonus, diaphoresis, diarrhea, or rigidity. 2 If present, this is a medical emergency requiring immediate discontinuation and emergency care.
Review all medications - Identify any concomitant serotonergic drugs (triptans, other SSRIs/SNRIs, tramadol, fentanyl, tryptophan, St. John's Wort, lithium) that may be contributing. 2
Consider dose reduction - If tremor is isolated and bothersome but not part of serotonin syndrome, reducing the Lexapro dose may alleviate symptoms while maintaining therapeutic benefit. 6, 7
Add symptomatic treatment - Benzodiazepines like clonazepam can be added to manage tremor without discontinuing the SSRI if the antidepressant effect is beneficial. 7
Switch antidepressants if necessary - If tremor persists or is intolerable, switching to a different antidepressant class (such as bupropion, which has lower rates of tremor) may be warranted. 7
Important Caveats
Drug-induced tremor typically resolves after discontinuation of the offending medication, though some cases may show persistent tremor (tardive tremor). 3 However, symptoms may not resolve immediately and can take weeks to fully improve even after stopping escitalopram. 6
Do not abruptly discontinue Lexapro without medical supervision, as this can cause discontinuation syndrome with symptoms including tremor, dizziness, paresthesias, and other neurological symptoms. 2 Gradual dose tapering is recommended.
The tremor associated with escitalopram in overdose situations has been documented alongside QT prolongation and serotonin toxicity, emphasizing the importance of recognizing this side effect in various clinical contexts. 8