Dear Dr. K: My mother’s hands are shaking more than usual lately. She has made an appointment with her doctor, but in the meantime, can you tell me if shaking is always a sign of something serious like Parkinson’s disease?

Dear Reader: The shaking in your mother’s hands is called a tremor. Tremors can affect the hands, limbs, head or voice. The actress Katherine Hepburn developed tremors of her head and voice in her later years. A person can’t control a tremor.

Most of us can get temporary tremors as a normal reaction to fear, anger, or when we are simply too tired or worn out. Too much caffeine or nicotine (in heavy smokers) can cause a tremor. So can withdrawal from an addictive substance (powerful painkillers or alcohol). Many commonly prescribed drugs also can cause a tremor. Examples include drugs used to treat depression such as selective serotonin reuptake inhibitors (SSRIs), tricyclics and lithium; the asthma drugs terbutaline and theophylline; and potent anti-inflammatory drugs such as prednisone. Lowering the dose of these medicines may reduce the tremor.

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