Why am I shaking?

The temporary shakes

Anxiety, fear, feeling generally unwell and fever can all make your feel trembly – the expression ‘shaking in his boots’ is one we all recognise. Of course, feeling shaky without knowing what’s causing it can make you feel anxious – which can lead to a vicious cycle of shakiness.

Tremor – what could be the cause?

If you feel shaky as a one-off, it’s likely that a temporary cause like fever, fear or stress is to blame. But if you have repeated or persistent episodes, there’s a long list of possible causes. It’s important to remember that essential tremor, or other causes not related to a serious underlying medical problem, are by far the most likely explanation for tremor if you feel otherwise well.

Among the most common and important causes of tremor are:
  • Anxiety – as well as the obvious feeling anxious, anxiety-related tremor is often accompanied by palpitations, shortness of breath, dry mouth and sometimes chest pain
  • Low blood sugar – most common if you have diabetes treated with insulin, or type 2 diabetes treatment with sulphonylurea (SU) tablets. SU tablets stimulate your pancreas to produce more insulin, which can drop your blood sugar too low. Other symptoms include sweating, feeling very hungry, irritability, poor concentration, feeling sick, blurred vision and palpitations (rapid heartbeat)
  • Caffeine – while it can be useful for keeping you alert, large quantities of caffeine in a short period can lead to tremor and palpitations
  • Medications – culprits include too much salbutamol (used to relieve asthma symptoms); lithium carbonate (usually used in bipolar disorder; some epilepsy medicines; and some cancer treatments. Some antidepressants can also make you feel trembly, especially when you first start them
  • Recreational drugs – a variety of recreational drugs including MDMA and amphetamines can lead to tremor and other movement disorders, which may persist after you stop using them
  • Alcohol withdrawal – if you’re dependent on alcohol, withdrawal can lead to severe symptoms including shaking, anxiety, confusion, sweating, palpitations and even seizures
  • Parkinson’s disease – tremor is one of the three ‘key features’ of Parkinson’s disease, although it doesn’t always happen. When it does, it tends to affect your hands and arms and it tends to be worse when you’re not moving
  • Overactive thyroid – along with feeling shaky, overactive thyroid can often cause weight loss despite eating more, anxiety, palpitations, sweating, intolerance to heat, diarrhoea and shortness of breath
  • Multiple sclerosis – tremor can be a symptom of MS, but it’s highly unlikely to be the only symptom you get, and other causes are much more likely
Essential tremor used to be called ‘benign essential tremor’, on the basis that it wouldn’t do you any harm, wouldn’t lead to any other condition and didn’t affect your life expectancy. But for many of my patients, uncontrollable shaking is anything but harmless. It can make the simplest daily activities a challenge, and has a huge effect on their self esteem.

Essential tremor affects men and women equally, and often runs in families. It tends to start in one arm, gradually spreading to the other a year or two later. It often stops there, but can affect your head and occasionally your legs. Stress, tiredness, heat and hunger can all make it worse.

If your symptoms are mild, you may not need treatment for essential tremor – keeping anxiety to a minimum and avoiding tiredness, extremes of temperature and excess caffeine may be enough.

If you do need treatment, the mainstays for essential tremor are:
Many people with essential tremor find their symptoms get better with alcohol. But given all the problems you can store up for yourself by regularly drinking over the recommended upper limits of alcohol my recommendation is – just don’t!

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.