How to manage jaw clenching (bruxism) secondary to Selective Serotonin Reuptake Inhibitor (SSRI) use?

Management of SSRI-Induced Jaw Clenching (Bruxism)

Add buspirone 5-10 mg at bedtime as first-line treatment for SSRI-induced bruxism, which typically resolves symptoms within 3-4 days while allowing continuation of the SSRI. 1, 2, 3

Initial Management Strategy

When a patient develops jaw clenching or bruxism after starting an SSRI, you have three evidence-based options, listed in order of preference:

Option 1: Add Buspirone (Preferred)

• Start buspirone 5 mg at bedtime 2
• Symptoms typically improve within 3-4 days of initiation 2
• This allows continuation of the SSRI without interrupting depression/anxiety treatment 3
• Buspirone's 5-HT1A agonist properties likely counteract the serotonergic mechanism causing bruxism 1
• Can increase to 10 mg if needed based on response 3

Option 2: Reduce SSRI Dose

• Lower the current SSRI dose if clinically feasible 3
• Symptoms may resolve within 3-4 weeks of dose reduction 1
• Caution: This risks undertreating the primary psychiatric condition 1
• Only consider if the patient's depression/anxiety is well-controlled and dose reduction won't compromise efficacy 3

Option 3: Switch Antidepressants

• Discontinue the offending SSRI and switch to an alternative antidepressant 1, 4
• Symptoms typically resolve within 3-4 weeks of discontinuation 1
• Consider alternatives: Bupropion or mirtazapine may be less likely to cause bruxism, though evidence is limited 4
• Avoid: Other SSRIs (fluoxetine, sertraline, paroxetine) and venlafaxine are the most commonly reported offenders 1, 2

Alternative Pharmacologic Option

Low-Dose Quetiapine

• Quetiapine 25-50 mg daily can effectively treat SSRI-induced bruxism 5
• Works through 5-HT2 receptor antagonism 5
• Improvement reported within days of initiation 5
• Consider this if buspirone is ineffective or not tolerated 5

Clinical Pearls and Timing

Onset and Recognition:

• Bruxism typically develops within 3-4 weeks of SSRI initiation or dose increase 1, 3
• More commonly reported in female patients 1
• Can occur with both short-term and long-term SSRI use 1

Dental Manifestations:

• Patients may present with jaw pain, jaw tenderness, tooth damage, or headaches 2
• Dental examination may reveal tooth wear patterns consistent with grinding 2
• Some patients may be unaware of nocturnal bruxism until dental damage occurs 2, 3

Important Caveats

Do not simply discontinue the SSRI without addressing the underlying psychiatric condition. SSRIs are prescribed for depression, anxiety, or OCD—conditions that significantly impact morbidity and quality of life 6. Abrupt discontinuation risks SSRI withdrawal syndrome and psychiatric decompensation 6.

The mechanism remains incompletely understood but likely involves serotonergic-mediated dopamine inhibition or sleep disturbance 2, 3. This explains why dopaminergic agents and buspirone (which modulates serotonin differently) are effective treatments 4, 3.

Monitor for treatment response within 1 week of adding buspirone or quetiapine 5, 2. If no improvement occurs, consider switching to a non-SSRI antidepressant rather than continuing to manage the side effect 4.