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.
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.
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
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
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)
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