“The anxiety induced by a diagnosis of essential tremor, along with the stresses caused by the life-altering effects of tremors, can be difficult to manage. It’s crucial to have tools to cope with essential tremor, as tremors worsen in times of stress.”
(from International Essential Tremor Foundation)

Anxiety is a normal response in times of stress. Depression is a normal response to loss or grief. Since life is almost never a state of continuous carefree happiness, each day presents small obstacles or minor but stressful circumstances. During those moments, our minds and bodies may temporarily spike anxiety or plummet into depression and discouragement. Usually, it’s not a big deal; circumstances change and we return to a more upbeat state.

For people with essential tremor (ET), however, every single day can be immensely taxing. For those whose hands are most affected, simple manual tasks that other people take for granted become constant sources of frustration and failure. Being out in public brings a string of embarrassing moments accompanied by a loss of confidence and self-esteem. In other words, making it through the day is constantly accompanied by stress and discouragement bordering on depression.

Anxiety and depression: a fact of ET life?

The November, 2019 issue of the journal Neurology carried a Chines study of 245 Han Chinese patients with ET.ⁱ The authors wanted to determine how prevalent the mental symptoms of anxiety and depression were among those with ET, and hopefully identify potential risk factors that create greater vulnerability for these emotional states.

Anxiety and depression were measured using standardized rating scales, and certain characteristics were compared between patients with or without depression or anxiety. The researchers found that “63.3% of patients had at least mild anxiety and 54.3% had at least mild depression.”

Association with other factors

The team found a correlation between the severity of anxiety/depression and how patients rated their functional disability (the worse they perceived their ability to function with ET, the more likely they were to experience anxiety or depression. In addition, the lower their score on a “Mini-Mental State Exam,” the higher their anxiety/depression scores. Finally, the presence of tremor in the head/neck, face, or voice also put patients at greater risk for anxiety or depression. Overall, the authors reported that the greatest risk factors for anxiety were female gender, head/neck/voice tremor, and high functional disability scores; the last two factors were linked with depression. Interestingly, there was no consistent correlation between how severe doctors perceived a person’s arm/hand or leg tremors to be. In other words, anxiety and depression have to do with an individual’s own experience of how difficult ET made their lives and ability to function.

Screening for psychological symptoms

The authors recommend that when people are diagnosed with ET, they should be screened for anxiety and depression, “especially women and those with cranial tremor and self-reported functional disability.” We might go further and suggest annual screening for emotional struggles, something it might not occur to a busy neurologist or primary care physician to ask about.

ET is no fun, and comes with everyday challenges that stimulate anxiety, worry, frustration, fear, depression and discouragement—to name a few. As the opening quote from the International Essential Tremor Foundation acknowledges, in times of stress tremors get worse, leading to stronger anxiety and deeper depression. Intervening in this vicious circle requires early recognition of the inner distress that might be eased by affirmation, support, and empathy. Now that we know at least 50% of people with ET (according to the Chinese study) suffer anxiety and depression on top of disability, it makes sense to begin screening early and at regular intervals.

ⁱ Huang H, Yang X, Zhao Q, Chen Y et al. Prevalence and Risk Factors of Depression and Anxiety in Essential Tremor Patients: A Cross-Sectional Study in Southwest China. Front Neurol. 2019 Nov 15;10:1194.