How SSRIs can Trigger Teeth Grinding and Bruxism

By James Fricton DDS, MS

Research surfaces the surprising link between using antidepressants and teeth grinding. What it means to use muscle relaxers for TMJ.

Bruxism is a common jaw movement disorder characterized by repetitive clenching of the jaw and grinding of the teeth. Sleep bruxism is typically associated with lateral teeth grinding and significant wear on the teeth. Patients often complain of jaw pain, headaches, and tightness of the jaw when awakening, and are unaware that they are grinding and jaw clenching during their sleep. Bruxism can also occur while awake during the day.

Whether day or nighttime clenching, it is often associated with stress. Severe cases of bruxism trigger symptoms of TMD jaw pain, along with tension headaches, facial pain, and sleep disorders.

When you add taking prescribed SSRIs antidepressant medication, it can be like throwing fuel on a flame of bruxism. This is especially true if the pain patient ingests SSRI in combination with another medicine (or substance) that also raises serotonin levels.

First, we’ll cover common questions and answers that provide a background.

Table of Contents

• How SSRIs can Trigger Teeth Grinding and Bruxism
  • What is SSRIs Medication?
  • What does Trismus have to do with Bruxism?
  • How are SSRIs different from SNRIs?
• Can Bruxism develop With the Use of SSRIs?
• How do SSRIs Cause Jaw Clenching Issues?
• Treating Sleep Bruxism with Patient-Centered Care vs Drugs?
• Antidepressant Derivatives used for Temporomandibular Disorders
• What are Commonly Prescribed SSRI Drugs?
  • SSRI drugs approved to treat painful depression
  • Current SSRIs with FDA labeled indications
  • Evidence of efficacy of antidepressants
• How to Stop Teeth Grinding Caused by Antidepressants?
• CONCLUSION: How Pain Specialist Help You Avoid Stress-Related Bruxism

In this article, we will discuss the connection between antidepressants and teeth grinding, and what you can do to prevent it.

What is SSRIs Medication?

SSRIs medication is commonly used to treat depression that may also be related to delayed recovery of a pain condition and chronic pain. SSRIs increase levels of serotonin in the brain. SSRIS stands for Selective Serotonin Reuptake Inhibitors. They are a commonly prescribed class of drugs used as antidepressants in treating major depressive disorders, anxiety disorders, and other mental health conditions like fear, social isolation, and loneliness that impact pain tolerance.

The MN Head & Neck Pain Clinics help patients with chronic pain and associated conditions by providing a whole-person treatment approach. The comprehensive pain program provides patients with both a proper diagnosis of the pain condition and early recognition of the risk factors. When bruxism is the cause of pain, this approach helps most TMJ patients gain satisfactory results without surgery.

What does Trismus have to do with Bruxism?

Trismus is more widely known persistent spasm of the muscles of mastication that can feel like lockjaw. Acommon cause can be sustained bruxism. While initially attributed to the setting of tetanus, it now refers to a bilateral restriction in your mouth opening properly from any cause.

Trismus is associated with multiple conditions and medical issues. However, the most common causes are bruxism, temporomandibular muscle and joint (TMJ) disorders, and injury following dental treatment such as the removal of wisdom teeth. TMJ patients who are also on SSRI medications can experience aggravation of their pain and can often benefit from other avenues of care. This may include physical therapy, self-care support, and mindfulness-based stress reduction to reduce the side effects of antidepressants.

When stress induces trismus lockjaw or TMJ, find a provider who treats both the psychological distress symptoms with antidepressants along with a holistic approach. If you are under high levels of stress, you may be unconsciously clenching your jaw during the day or grinding your teeth while you sleep. These actions can add strain and pressure to your jaw muscles, which can eventually cause tenderness and pain in the jaw, temples, and neck. A TMJ orofacial specialist can help you determine the source of your jaw pain, diagnose TMJ disorders, and treat the root causes of your condition.

How are SSRIs different from SNRIs?

SSRIs are selective serotonin reuptake inhibitors that are intended to only impact the amount of serotonin in your body. SNRIs are serotonin-norepinephrine reuptake inhibitors that are prescribed to impact both serotonin and norepinephrine rather than only serotonin.

Can Bruxism develop With the Use of SSRIs?

Bruxism may be triggered as an adverse reaction to antidepressant therapy and may cause symptoms within weeks of medication introduction or dose titration. This phenomenon may be seen in a variety of serotonergic antidepressants and may be most associated with fluoxetine, sertraline, or venlafaxine.

Teeth grinding, also known as bruxism, is a common condition that affects many people. The causes of teeth grinding can range from stress to misaligned teeth, but recent research has revealed a surprising link between the use of certain antidepressants and these muscle-tensing habits.

How do SSRIs Cause Jaw Clenching Issues?

Recent studies suggest that SSRIs may increase jaw-clenching because of their impact on the level of neurotransmitters such as serotonin in the brain. In turn, neurotransmitters control nerve sensors and emotions, but they also affect movement regulation.

Knowledge about how antidepressants impact jaw clenching is cornerstone to how orofacial pain specialists offer jaw pain relief. Some physicians think SSRIs may induce bruxism symptoms indirectly by lowering dopamine levels. Dopamine inhibits certain movements, including jaw clenching. Treatment with other agents that affect dopaminergic neurotransmissions, such as antipsychotics, amphetamines, and levodopa, are also associated with bruxism.

“Bruxism may develop as an adverse reaction to antidepressant therapy and is most likely to develop within 2–3 weeks of medication introduction or dose titration”, according to the 8 April 2018 SSRI-associated bruxism article. Andrew R. Garrett, DO, MPH, MS, explains how serotonergic antidepressants may be most associated with fluoxetine, sertraline, or venlafaxine.

“Despite the notion of bruxism being a behavioral phenomenon, there are several case reports and series describing a possible relationship between bruxism and serotonergic antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs).” – Andrew R. Garrett

Treating Sleep Bruxism with Patient-Centered Care vs Drugs

Sleep bruxism (SB) is a masticatory muscle activity during sleep that can co-occur with Obstructive sleep apnea (OSA). While a prescription for muscle relaxants can be helpful, there are better approaches to improve sleep bruxism and protect the muscles and joints.

Nighttime use of both intra-oral stabilization splints or sleep apnea oral appliances can both alter bruxism and protect the muscles and joints from excessive strain. Additionally, techniques to help people learn to calm the mind and reframe or reduce negative thoughts and sleep better are a component of cognitive behavioral therapy for insomnia (CBT-I). Types of mindfulness therapy or talk therapy often improve sleep quality while addressing anxiety and stress as well. Improving sleep hygiene and employing mindfulness relaxation techniques offer added benefits for falling asleep more easily.

Medications help some people reduce sleep bruxism by altering brain chemicals to reduce muscle activity involved in teeth grinding. Prescribing muscle relaxants and other pain management drugs require careful attention to addiction risks.

Pain patients often end up on multiple medications by multiple providers. Individual healthcare providers bear the responsibility of assessing each patient’s prescription use both from the perspective of their own specialty and the overall patient. Pain patients trust each provider to link their prescription risks with good clinical judgment and awareness. Pain treatment with a holistic approach avoids some unnecessary SSRIs and related bruxism issues.

If grinding your teeth is stress-induced, you may be able to prevent the problem by learning strategies that promote relaxation, such as mindfulness with integrative telehealth coaching leading patient-centered transformative care.

“When usual care fails, clinicians and patients often escalate care to passive higher-risk interventions, such as opioids, polypharmacy, surgery, or extensive medical and dental treatment, resulting in devastating consequences including a high prevalence of disability, opioid addiction, and intractable pain.

 

Yet, clinical trials have shown the long-term outcomes of these passive interventions are no better, and in many cases worse, than patient-centered approaches that activate and empower patients with self-management strategies such as cognitive behavioral therapy (CBT), therapeutic exercise, and mindfulness-based stress reduction. – James Fricton DDS, MS

Antidepressant Derivatives used for Temporomandibular Disorders

Antidepressants and muscle relaxants can be used safely with oversight. Tryclic anti-depressants and Methocarbamol are considered to have a therapeutic effect in these areas. Therefore, the centrally-acting skeletal muscle relaxant methocarbamol is also considered to be effective for treating TMD-related muscle tensing and anxiety issues.

However, the risk is that muscle relaxers and SSRIs make the patient feel good. They cause a sedative effect by preventing a person’s nerves from sending pain signals to the brain. It’s easy to take them and avoid the self-management that provides real long-term benefits. Therefore, it is up to pain clinic providers to monitor safe use when prescribing them.

“Naproxen should be recommended for initial pharmacotherapy of temporomandibular disorders. The addition of cyclobenzaprine is recommended if there is clinical evidence of muscle spasm.

 

Randomized controlled trials of good-quality Corticosteroid injections into the temporomandibular joint are no better than arthrocentesis with saline and should be avoided due to potential cartilage damage. – Temporomandibular Disorders: Rapid Evidence Review by American Family Physicians

What are Commonly Prescribed SSRI Drugs?

Current SSRIs used in the United States:

• Fluoxetine.
• Sertraline.
• Paroxetine.
• Fluvoxamine.
• Citalopram.
• Escitalopram.
• Vilazodone.

Neurontin (gabapentin) and Lyrica (pregabalin) are examples of anticonvulsant drugs that may help relieve TMJ pain.

SSRI drugs approved to treat painful depression and their common names:

The following SSRI antidepressants ease symptoms of moderate to severe depression, are quite safe, and typically trigger fewer side effects than similar antidepressants.

• Citalopram (Celexa).
• Escitalopram (Lexapro).
• Fluoxetine (Prozac).
• Paroxetine (Paxil and Pexeva).
• Sertraline (Zoloft).

Below is Selective Serotonin Reuptake Inhibitors information provided by the National Institute of Health.

Current SSRIs with FDA labeled indications for treating:

• Major depressive disorder.
• Generalized anxiety disorder.
• Bulimia nervosa.
• Bipolar depression.
• Obsessive-compulsive disorder.
• Panic disorder.
• Premenstrual dysphoric disorder.
• Treatment-resistant depression.
• Post-traumatic stress disorder.
• Social anxiety disorder.

Evidence of efficacy of antidepressants

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews by Giovanni E Ferreira, concludes that a more nuanced approach whill help when prescribing antidepressants for pain conditions.

“Conclusions Evidence of efficacy of antidepressants was found in 11 of the 42 comparisons included in this overview of systematic reviews—seven of the 11 comparisons investigated the efficacy of SNRIs. For the other 31 comparisons, antidepressants were either inefficacious or evidence on efficacy was inconclusive.” – 1 February 2023, British Medical Journal; Reprinted by the National Institutes of Health (NIH)

 

 

Antidepressants are commonly prescriped to treat stress and mental health conditions such as depression, anxiety, and panic disorders. However, caution should be taken. Research proves that changes occur in brain chemicals due to these medications, which can also perpetuate bruxism.

How to Stop Teeth Grinding Caused by Antidepressants?

If you are taking prescribed antidepressants and experience symptoms of teeth grinding, here’s what you can do to prevent it:

1. Talk to your pain specialist.

2. Use a mouthguard or anterior bite splint.

3. Enlist professional stress management.

4. Avoid actions that trigger stress.

1. Talk to your pain specialist: When facing symptoms of bruxism and resultant pain, discuss it as soon as possible with your provider. They may adjust your SSRIs dose or prescribe a different type of antidepressant that is less prone to cause this habit. Or they may suggest alternative, transformative treatment for TMJ.
2. Use a mouthguard or anterior bite splint: Wearing a device that prevents your teeth from touching while you sleep can protect them. Unwanted damage caused by grinding your jaw or teeth is helpful during TMJ and sleep apnea treatment. Custom-fitted splints and mouthguards adjusted to protect the muscles and joints can be effective help.
3. Enlist professional stress management: On-going stress and anxiety can cause or worsen teeth grinding, meaning, it’s important to implement ways to manage stress. After diagnosis, your plan may integrate physical therapy exercise, mindfulness, and deep breathing.
4. Avoid actions that trigger stress: If you are aware of what activities (people, occasions) trigger your teeth grinding, it will be easier to recognize and improve your reaction to the situation.

Come prepared to ask questions during your appointment to treat bruxism pain. To avoid any hidden TMJ issues, be ready to answer questions from your orofacial pain specialist so that you get the most out of your appointment.

CONCLUSION: How Pain Specialist Help You Avoid Stress-Related Bruxism

Our pain specialists strive to provide the highest level of pain management care with our excellent evidence-based wholistic approach for the comprehensive orofacial pain, head, and neck pain, or bruxism treatment you may need. We’re looking forward to working with you!

Schedule your pain diagnosis and consultation

LOCATIONS:

Plymouth(763) 577-2484

St. Paul(651) 332-7474

Burnsville(952) 892-6222

St. Cloud(763) 233-7252

 

About the Author

James Fricton DDS, MS is trained as an Anesthesiology Pain Management specialist from UCLA School of Medicine. He has over 40 years of National Institutes of Health sponsored research, University-based education, and patient care of chronic pain patients at MN Head and Neck Pain Clinics. Dr. Fricton is a pain specialist and clinical research scientist whose clinical and research interests have focused on relieving and preventing chronic pain and addiction.

https://www.painmedicinenews.com/Primary-Care/Article/02-23/Some-Antidepressants-May-Relieve-Pain/69587