Selective Serotonin Reuptake Inhibitors and Bruxism

         Regarding central nervous system dysfunction may cause bruxism. Dopamine has frequently been cited as being involved as well as other agents that affect dopaminergic neurotransmission such as amphetamines and levodopa
have also been implicated.

        A review of the experience with selective serotonin reuptake inhibitors (SSRIs) has shown that they are associated with several movement disorders including akathisia, dystonia, dyskinesia, tardive dyskinesia, and parkinsonism. Patients taking fluoxetine or sertraline for depression often develop bruxism within the first few weeks of therapy. Some patient had relief when the dose of fluoxetine was reduced from 20 mg/day to 10 mg/day. Other patients responded to the addition of buspirone in doses of 5-15 mg per day. Other patients developed bruxism within the first few weeks of therapy with sertraline however they were successfully treated with buspirone in doses of 10 mg twice daily to three times daily. Thus antidepressant-induced bruxism may be more common than currently thought.

Treatment

        Buspirone appears to be an effective treatment based on a few case reports. Small doses (e.g., 5-10 mg once to three times daily) have been effective for many of them. This drug may have an additional benefit of relieving anxiety if it is present. It is usually well tolerated and carries a low risk of significant side effects. Reducing the dose of SSRI has been helpful for some patients and may be tried first. However, recurrence of depression should be watched for. Finally, switching to antidepressants that have not been associated with bruxism such as mirtazapine or nefazodone may lead to resolution.

References

       
1.        Thompson B, Blount B, Krumholz T. Treatment approaches to bruxism.
Am Fam Physician 1994;49:1617-22.

2.        Brown E, Hong S. Antidepressant-induced bruxism successfully treated
with gabapentin. J Am Dent Assoc 1999;130:1467-69.

3.        Amir I, Hermesh H, Gavish A. Bruxism secondary to antipsychotic drug
exposure: a positive response to propranolol. Clin Neuropharmacol
1997;20:86-89.

4.        Gerber P, Lynd L. Selective serotonin reuptake inhibitor-induced
movement disorders. Ann Pharmacother 1998;32:692-98.

5.        Ellison J, Staziani P. SSRI-associated nocturnal bruxism in four
patients. J Clin Psychiatry 1993;54:432-34.

6.        Fitzgerald K, Healy D. Dystonias and dyskinesias of the jaw
associated with the use of SSRIs. Hum Psychopharmacol 1995;10:215-19.

7.        Romanelli F, Adler D, Bungay K. Possible paroxetine-induced bruxism.
Ann Pharmacother 1996;30:1246-47.

8.        Bostwick J, Jaffee M. Buspirone as an antidote to SSRI-induced
bruxism in 4 cases. J Clin Psychiatry 1999;60:857-60 .

*J Clin Psychiatry 1999;60:857. J Clin Psychiatry 1996;57:449. J ClinPsychiatry 1993;54:432. Clin Neuropharmacol 1993;16(4):315.

 
Source
 
Dr. Mark Donaldson B.Sc.(Pharm), R.Ph., Pharm.D.
Director of Pharmacy Services
Kalispell Regional Medical Center
310 Sunnyview Lane
Kalispell, Montana     59901-3199

(406)  756-4701  (voice)
(406) 756-3528 (facsimile)
mdonaldson@krmc.org