What are the Symptoms of a Mood Disorder?

“I recently attended my first DBSA support group.  I noticed that some of the people there trembled.  Their hands and feet shook and it was very hard for them to hold a cup of coffee or sit still without shaking their legs.   I am very worried that I will develop this uncontrollable shaking.  Are these tremors symptoms of depression or bipolar disorder?  Am I destined to have these tremors, too?”

I can only imagine how frightening this experience must have been for you.  You were able to get up the courage to attend your first support group meeting and then you see people there with the “shakes.”   How depressing and anxiety provoking!

There are a number of physical symptoms of mood disorders, which might include unintended weight gain or weight loss, developing a sleep disorder and/or experiencing discomfort or pain, such as migraine headaches or unaccounted for muscle aches.  I can, however, report to you that the shaking you describe is not thought of as directly caused by a mood disorder. People with certain physical diseases, particularly Parkinson’s do develop what is known as tardive dyskinesia (involuntary shaking, usually of hands or feet or legs).

Among persons with mood disorders, the tremors are most often caused by prescribed medication and/or use of stimulants or depressants.  For instance, too much caffeine, too much nicotine or alcohol use or abuse can all influence the development of tremors.  Of major importance, a number of medications that are routinely prescribed for mood disorders, can and do induce these tremors.  Extended, high dose and/or long term use of anticonvulsants (like depakote) and mood stabilizers (like lithium) are well known agents that contribute to the development of tremors.  Unfortunately, these medications are often the first line of defense in the treatment of bipolar disorders.

Sometimes MAO inhibitors, a relatively last line of antidepressant treatment is prescribed.  Tremors are included among a number of side effects of MAO inhibitors. Beta blockers are also sometimes prescribed. They lower the heart rate and often limit tremors. So, what can we do to better control the development of tardive dyskenisia? Maintaining a healthy lifestyle will help.  Regular sleep habits are most important, as being tired, especially exhausted, can and will exacerbate the tremors.  A good sleep pattern is to go to bed and get up at the same time (within an hour) each day.  While this might seem difficult, it will definitely help.

The best case scenario is to eliminate alcohol, caffeine and tobacco.  If you can’t, at least don’t drink or smoke too much, limit your caffeine intake, exercise regularly and be careful what and how much you eat.  Routine medication management with a qualified psychiatrist is most important in monitoring any medications that may contribute to, or alleviate the tremors.  Individual or group cognitive –behavioral psychotherapy will also be helpful to address symptoms and develop ways to minimize their negative effects.

Finally, I would strongly encourage you to continue attending the DBSA support group.  I am sure that seeing others with obvious life-limiting symptoms can be depressing to you.  However, the recognition that you are not alone and that there are others for you to support in their struggles as well as their lending support to you in your own struggles cannot be overemphasized.  Continued group attendance will be an important facet in your own recovery process.

~ Dr. Manuel S. Silverman, PhD