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Buspirone for SSRI induced Bruxism

Vol 10 #6

 

 

Alan Eppel MB, FRCPC

 

Introduction

Bruxism although originally identified as a mechanical dental problem has more recently been recognized as a form of abnormal muscle movements. Bruxism is described as a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible [1,2]. Sleep bruxism is no longer considered a parasomnia nor is its etiology believed to be based on purely mechanical factors or psychological Issues. It is now considered to be primarily a sleep-related movement disorder [2,3].

Symptoms

Bruxism produces significant morbidity. It consists of grinding of the teeth, jaw pain, headache, damage to teeth including fracture. Dental repair can be costly and often the use of a mouth guard is recommended.

 

Medications and Substances that Can Cause Bruxism

Medications with serotonergic actions are associated with bruxism which includes SSRIs and SNRIs. Bruxism is a common side effect in psychiatric patients treated with these medications.

Other medications and drugs that can induce bruxism include:

  • methamphetamine,
  • methylenedioxymethamphetamine,
  • nicotine
  • amphetamines,
  • anticonvulsants,
  • aripiprazole,
  • atomoxetine,
  • duloxetine,
  • flecainide,
  • ketotifen
  • alcohol,
  • heroin,
  • piperazines (synthetic psychostimulants such as “Ecstasy”).

 

Medications That Have Been Used To Treat Bruxism

 

  • botulinum toxin A,
  • bromocriptine,
  • buspirone,
  • clonazepam,
  • clonidine,
  • gabapentin

Buspirone

Buspirone, was synthesized in 1968 and marketed in 1986. It is an azapirone drug. It has been used for treating generalized anxiety, depression, alone or as augmentation with an antidepressant, and for treating adverse sexual side effects. It has been trialed in a number of other conditions including alcoholism and cannabis abuse but its effectiveness is most clearly demonstrated for the treatment of generalized anxiety disorder.

Buspirone is generally a safe medication with minimal side effects. It is not habit-forming.

Bostwick and Jaffee have proposed that bruxism is a disorder of the masticatory muscles somewhat analogous to akathisia. Increase levels of serotonin acting on mesocortical neurons arising from the ventral tegmental area suppress dopamine actions. Buspirone is a partial agonist at 5-HT1A  receptors and can raise dopamine levels.

Buspirone acts as an agonist at the presynaptic 5-HT1A somatodendritic receptors located on the cell bodies of raphe serotonergic neurons that project to the ventral tegmental area (VTA) of the midbrain[4,5]

 

Numerous case reports have demonstrated the association of antidepressants with bruxism and the effectiveness of buspirone for its treatment [6-15].

 

Conclusion.

Buspirone is a safe and effective medication to counteract antidepressant induced bruxism.

 

References

 

  1. de Baat C, Verhoeff MC, Zweers PGMA, Vissink A, Lobbezoo F. [Medicaments and oral healthcare. Medicaments and addictive substances, potentially inducing or ameliorating bruxism. Article in Dutch]. Ned Tijdschr Tandheelkd. 2019 May;126(5):247-253.

doi: 10.5177/ntvt.2019.05.19006.

  1. Sleep related bruxism. In: International classification of sleep disorders. 3rd ed. Darien, IL.: American Academy of Sleep Medicine; 2014.
  2. Klasser GD, Rei N, Lavigne GJ. Sleep bruxism etiology: the evolution of a changing paradigm. J Can Dent Assoc. 2015;81:f2. PMID: 25633110.
  3. Jaffee MS, Bostwick JM. Buspirone as an antidote to venlafaxine-induced

bruxism. Psychosomatics. 2000 Nov-Dec;41(6):535-6. doi:

10.1176/appi.psy.41.6.535. PMID: 11110119.

  1. Bostwick JM, Jaffee MS. Buspirone as an antidote to SSRI-induced bruxism in 4

cases. J Clin Psychiatry. 1999 Dec;60(12):857-60. doi: 10.4088/jcp.v60n1209.

PMID: 10665633.

  1. Çolak Sivri R, Akça ÖF. Buspirone in the Treatment of Fluoxetine-Induced

Sleep Bruxism. J Child Adolesc Psychopharmacol. 2016 Oct;26(8):762-763. doi:

10.1089/cap.2016.0075. Epub 2016 Jun 17. PMID: 27315110.

7 Akbaş B, Bilgiç A. Fluoxetine-Induced Sleep Bruxism Rapidly Treated With

Once-Nightly Dosing of Buspirone in a 6-Year-Old Girl. Clin Neuropharmacol. 2018 her Sep/Oct;41(5):197-198. doi: 10.1097/WNF.0000000000000293.

  1. Sabuncuoglu O, Ekinci O, Berkem M. Fluoxetine-induced sleep bruxism in an

adolescent treated with buspirone: a case report. Spec Care Dentist. 2009 Sep-

Oct;29(5):215-7. doi: 10.1111/j.1754-4505.2009.00091.x.

  1. Raja M, Raja S. Two cases of sleep bruxism associated with escitalopram

treatment. J Clin Psychopharmacol. 2014 Jun;34(3):403-5.

doi:10.1097/JCP.0000000000000122

  1. Milanlioglu A. Paroxetine-induced severe sleep bruxism successfully treated

with buspirone. Clinics (Sao Paulo). 2012;67(2):191-2. doi:

10.6061/clinics/2012(02)17. PMID: 22358247; PMCID: PMC3275112.

  1. Wise M. Citalopram-induced bruxism. Br J Psychiatry. 2001 Feb;178:182. doi:10.1192/bjp.178.2.182. PMID: 11157444.

12.Romanelli F, Adler DA, Bungay KM. Possible paroxetine-induced bruxism. Ann Pharmacother. 1996 Nov;30(11):1246-8. doi: 10.1177/106002809603001107.

  1. Albayrak Y, Ekinci O. Duloxetine-induced nocturnal bruxism resolved by

buspirone: case report. Clin Neuropharmacol. 2011 Jul-Aug;34(4):137-8. doi:

10.1097/WNF.0b013e3182227736.

  1. Kuloglu M, Ekinci O, Caykoylu A. Venlafaxine-associated nocturnal bruxism in a depressive patient successfully treated with buspirone. J Psychopharmacol.

2010 Apr;24(4):627-8. doi: 10.1177/0269881109102612. Epub 2009 Mar 5.

15.Ellison JM, Stanziani P. SSRI-associated nocturnal bruxism in four patients.

J Clin Psychiatry. 1993 Nov;54(11):432-4

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