Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Mysoline and Depressive Side Effects

Forum: Neurology Forum
Topic: Movement


I have been recently diagnosed with essential tremor and my neurologist prescribed mysoline. I also suffer from anxiety which is largely attributable to the tremor and attempting to cope with it at work. I have been taking effexor and clonazapan for the anxiety which definitely helps. My problem is that even a dose of mysoline as small as 50 mg taken at night before bed causes me to feel depressed and tired the next day. This is unfortunate because even this small dose of mysoline reduces the tremor substantially. I spoke to my neurologist and he said "what is more significant the tremor or depression brought on by the mysoline"? Am I faced with having to choose between the two? What about going to a beta-blocker instead? Also could the effexor be aggrevating the tremor as my previous experience with the SSRI paxil certainly did? I have been so fustrated with the medication approach to solving my issues that I have even explored acupuncture? I just find it hard to believe that a neurologist could look you straight in the face and say "pick between the tremor and depression? Can't help but think that doctors should take some of these medications as part of their training and perhaps they would think a little more clearly. Sorry, don't mean to ramble. Finally, are there any new drugs on the horizon for treating essential tremor? THANKS!!!!!!

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There are several other options used in the treatment of essential tremor
including strategies these include the new anticonvulsant
gabapentin (Neurontin) which has worked in a small number of cases.
Beta blockers like propanolol which can be very effective, and could
possibly be a good option in your case provided there is no
contraindication.
It is possible that the Effexor could be exacerbating the tremor so this
is an area which should be checked out, this is well described as you
experienced, with other SSRIs.
Other options include nicardipine, clozaopine , botulinum toxin
injection if the tremor is very localized.
There are therefore, several options available to you, and you do not have to face this
choice, I suggest that the next choice you make should be that of
chosing a neurologist for a second opinion !




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