Buspirone for SSRI induced Bruxism
- Posted by Alan Eppel
- Posted in Brief Review, Clinical Pearls
Vol 10 #6
Alan Eppel MB, FRCPC
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].
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:
- piperazines (synthetic psychostimulants such as “Ecstasy”).
Medications That Have Been Used To Treat Bruxism
- botulinum toxin A,
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].
Buspirone is a safe and effective medication to counteract antidepressant induced bruxism.
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