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Don't Be Embarrassed by Essential Tremors

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"This study highlights the importance of physical illness as a cause for social phobia," R. Bruce Lydiard, PhD, MD, a professor of psychiatry at the Medical University of South Carolina in Charleston, tells WebMD after reviewing the findings.

Unlike patients with social phobia unrelated to essential tremor who develop their fear in their teens, those with tremor developed fear of social situations much later, around age 50 -- when they already had problems with shaking getting worse over many years.

In these patients, activities that brought on the tremor, like writing, eating, and drinking in public, were most likely to trigger anxiety. These activities rarely provoke anxiety in patients with social phobia unrelated to essential tremor.

While Schneier's group recommends further research to determine whether treating social phobia in these patients is effective, there are simple strategies that can help people with essential tremor cope with potentially embarrassing situations.

"People with essential tremor should remember that stimulants like caffeine or nicotine may temporarily worsen tremor," Schneier says. "Fortunately there are ways to treat the tremor directly and to help minimize the embarrassment."

"Alcohol is a great drug to decrease tremor," William C. Koller, MD, a professor of clinical neurology at the University of Miami School of Medicine, tells WebMD. Koller was not involved in the study. "We tell some patients to have a drink before social engagements -- the effect lasts for about an hour."

But drink in moderation. Too much alcohol makes coordination worse and may trigger alcoholism or medical problems related to its use.

Another strategy both Koller and Lydiard recommend for some is a small dose of a drug called Inderal or other beta-blockers, used only before social outings.

"Beta-blockers tend to reduce the tremor and also can help control the increased heart rate, which accompanies exposure to the feared situation," Lydiard says. "They can relieve performance anxiety in musicians and other performers, as well as in individuals with public speaking fears."

Other treatments for tremor are also available. Doctors of severely affected patients might consider injections of Botox, surgery, or deep brain stimulation.

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