Depression treatment was initiated with sertraline 50 mg at bedtime. Three days later the patient began to complain of a sudden onset of jaw clenching and teeth grinding. He denied any similar experience before receiving sertraline. Because these symptoms were not debilitating sertraline therapy was continued. Over the next seven days his jaw pain increased in intensity and duration. While awake he was able to control the jaw clenching and teeth grinding voluntarily. However, at night the symptoms would recur. The symptoms made chewing and yawning very difficult and became so intense that he broke two left lower premolars, necessitating a dental visit. Sertraline was discontinued after 14 days of treatment. buy asthma inhalers
Ten days after sertraline was discontinued the signs and symptoms of depression returned. The jaw clenching and teeth grinding were still present, albeit with less frequency and intensity. Fluoxetine 20 mg every morning and ibuprofen 200 mg tid with meals were prescribed. After three weeks of ibuprofen therapy the jaw pain resolved and ibuprofen was discontinued. Jaw clenching and teeth grinding were still present but did not intensify while the patient was on fluoxetine. There were no further complaints of jaw pain. The patient responded very well to fluoxetine and did not experience any other adverse effects.