From the Guidelines
Managing bruxism in patients taking SSRIs requires a comprehensive approach, prioritizing the use of a custom-fitted occlusal splint (night guard) as the first-line treatment to protect teeth from damage, as evidenced by the potential side effects of SSRIs, including bruxism, highlighted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1.
Key Considerations
- The guideline notes that SSRIs, as a group, are generally well tolerated by children and adolescents, but most adverse effects, including bruxism, emerge within the first few weeks of treatment 1.
- Pharmacological management may include low-dose benzodiazepines or muscle relaxants, but their use should be carefully considered due to potential risks and side effects.
- Behavioral interventions, such as stress management techniques and sleep hygiene improvement, are crucial in reducing bruxism symptoms.
Treatment Options
- Custom-fitted occlusal splint (night guard) to protect teeth from damage
- Low-dose benzodiazepines (e.g., clonazepam 0.5-1mg before bedtime) for short-term use
- Muscle relaxants (e.g., cyclobenzaprine 5-10mg at bedtime or tizanidine 2-4mg at bedtime)
- Botulinum toxin injections into the masseter muscles for severe cases
- Behavioral interventions, including stress management and sleep hygiene improvement
SSRI Considerations
- Some SSRIs (e.g., fluoxetine and sertraline) may be more commonly associated with bruxism than others, as suggested by their pharmacodynamic profiles and potential effects on the mesocortical dopaminergic system 1.
- Consulting with the prescribing physician about possibly switching to a different antidepressant may be warranted if bruxism remains severe despite interventions.
From the Research
Management of Bruxism in Patients Taking SSRIs
- Bruxism is a common side effect of Selective Serotonin Reuptake Inhibitors (SSRIs) 2, 3, 4, 5
- The exact mechanism of SSRI-induced bruxism remains unclear, but several theories have been proposed, including sleep disturbance, serotonergic-mediated inhibition of dopamine manifesting as akathisia, and SSRI-induced anxiety 5
- Treatment options for SSRI-induced bruxism include:
- Alternative classes of antidepressants, such as serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, and monoamine oxidase inhibitors, may be considered for patients with bruxism and TMD 3
- Dopamine agonists and buspirone are currently the most effective medications to treat the side effects of SSRI-induced bruxism 3