A MEDLINE search of English-language medical journals dated from 1992 to 1995 found no case report of bruxism involving SSRIs. However, upon communication with the local psychiatric hospital, four case reports were found. Ellison and Stanziani described four female patients who developed nocturnal bruxism within two to four weeks after sertraline or fluoxetine was started. Two patients received fluoxetine 20 mg/day, one patient was on fluoxetine 15 mg/ day and the fourth patient took sertraline 25 mg/day. All patients complained of anxiety and one was known to have occlusal disharmony. None of these patients had previous awareness of teeth clenching or grinding during sleep. One patient’s brux-ism ceased upon decreasing the fluoxetine dose from 20 mg to 10 mg. The other patients’ bruxism resolved after addition of buspirone, ranging from 5 mg/day to 30 mg/ day in divided doses. buy ampicillin
The mechanism by which SSRIs induce bruxism is not well defined. Ellison and Stanziani postulated that the reduced depth of sleep incurred by the SSRIs allowed the patients to become aware of their preexisting bruxism. The efficacy of buspirone could not be explained solely by its anxiolytic effect because all four patients had a previous history of anxiety without accompanying bruxism. The authors suggested that buspirone’s dopaminergic activity may counteract the SSRI-induced inhibition of the extrapyramidal dopaminergic pathway. Thus, another possible mechanism by which SSRIs induce bruxism is that bruxism associated with SSRIs may be a manifestation of extrapyramidal side effects due to the imbalance of dopaminergic and serotonergic neurotransmitters secondary to increased concentration of SSRIs.