Antidepressant-Induced Bruxism

Introduction

• Presenter: Dr. Harvinder Singh, outpatient psychiatrist, Reno, Nevada
• Host: Elena Fellini
• Platform: Psychiatry Education Forums Coffee Club
• Topic: Antidepressant-induced bruxism
• Structured into 5 sections/questions:
  1. What is bruxism and why is its recognition important?
  2. Mechanism behind bruxism with antidepressant use
  3. Antidepressants that increase the risk of bruxism
  4. High-risk groups for developing bruxism with antidepressant use
  5. Management strategies for antidepressant-induced bruxism
• Focus: Unusual but troublesome side effect of antidepressants

1. What is Bruxism?

• Definition: Jaw contraction happening more often than usual
  • Includes jaw clenching and teeth grinding
• *Types:
  • Sleep bruxism: Occurs during sleep
  • Awake bruxism: Occurs during daytime
• Relevance: Important for various medical disciplines as they may prescribe serotonergic medications (psychiatry, internal medicine, family medicine, sleep medicine, dentists)***

2. Mechanism Behind Antidepressant-Induced Bruxism

• Hypothesis: Medications increasing serotonin can cause bruxism
  • Hyperactivity in serotonergic neurons (raphe nucleus to ventral tegmental area)
  • Causes indirect hypoactivity in the mesocortical pathway (ventral tegmental area to prefrontal cortex to masticatory muscles)
  • Results in bruxism
• Relevance of Buspirone: This understanding helps explain why buspirone is effective in managing bruxism

3. Antidepressants Increasing Risk of Bruxism

• SSRIs (Selective Serotonin Reuptake Inhibitors):
  • High incidence with Fluoxetine, Sertraline, Escitalopram
  • List of medications grew as they are the most studied; all SSRIs noted to cause this side effect
• SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):
  • Venlafaxine, Duloxetine with Venlafaxine having more cases
• Bupropion: Unexpected finding; has a case report despite minimal serotonin activity
• Tricyclic Antidepressants and MAOIs: No cases found in literature review
• Personal experience: Some anecdotal effectiveness of tricyclic antidepressants in treating bruxism

Visual Summary

• Visual aids and literature reviews used to rank antidepressants by risk
• New studies: Mirtazapine found effective in a case with cerebral glioblastoma
• Triazadone useful in managing bruxism
• Higher risk with: SSRIs and SNRIs
  • Fluoxetine, Sertraline, Escitalopram, Venlafaxine, Duloxetine
  • Lower risk with: Mirtazapine, Triazadone, Tricyclic Antidepressants, MAOIs

Conclusion

• Next Talk: High-risk groups and management strategies
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