title: Depressive symptoms can amplify embarrassment in essential tremor.
abstract: BACKGROUND
  Embarrassment can be a considerable problem for patients with essential tremor (ET) and is a major motivator for treatment. Depression is also a common feature of ET; as many as 35 % of patients report moderate to severe depressive symptoms. Our goal was to assess the associations between these motor and psychosocial factors (tremor, depression, embarrassment) in ET, with a particular interest in more fully assessing the possible association between depression and embarrassment.
  
  
  METHODS
  Ninety one ET cases (age 70.4 ± 12.8 years) enrolled in a prospective, clinical-epidemiological study. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale (CESD-10, 0-30 [maximum]), embarrassment, with the Essential Tremor Embarrassment Assessment (ETEA, 0-70 [maximum]), and action tremor, with a detailed in-person neurological examination.
  
  
  RESULTS
  Higher CESD-10 score was significantly associated with higher ETEA score (p = 0.005), but not with increasing tremor severity (p = 0.94). In stratified analyses, cases with no or minimal depressive symptoms had the lowest ETEA scores, cases with moderate depressive symptoms had intermediate ETEA scores, and cases with severe depressive symptoms had the highest ETEA scores (p = 0.01). Furthermore, at each level of tremor severity, cases with more depressive symptoms had more embarrassment.
  
  
  CONCLUSIONS
  Depressive symptoms seem to be more than a secondary response to the tremor in ET; they seem to amplify the level of embarrassment and, in addition to their own importance, seem to be a driver of other important clinical outcomes. Earlier treatment of depressive symptoms in ET patients could lessen the burden of secondary embarrassment.
authors.affiliation: Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, LCI 710, 15 York Street, PO Box 208018, New Haven, CT 06520-8018 USA ; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT USA ; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT USA.
authors.forename: Elan D
authors.initials: ED
authors.lastname: Louis
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Division of Geriatric Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cosentino
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Division of Geriatric Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY USA ; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY USA.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Huey
keywords: Clinical; Depression; Embarrassment; Essential tremor; Non-motor; Treatment