Bruxism (clenching of the jaw or teeth) is a known side effect of the class of medications known as selective serotonin reuptake inhibitors. Zoloft (sertraline) is a population drug within this class of medications.
Bruxism can cause a variety of problems including strained muscles, headaches, jaw pain, cracked teeth/fillings and other dental problems. Many times patients don't know the origin of their symptoms resulting from bruxism as bruxism typically manifests overnight, while sleeping. In most cases, bruxism will come about quickly, within a few weeks of initiation of therapy. The mechanism behind SSRIs causing bruxism isn't well understood, but it is thought that the cause is actually a decrease in the neurotransmitter dopamine.
SSRIs increase serotonin in a part of the brain which is also a major dopamine pathway. It has been theorized that this increase in serotonin somehow decreases dopamine levels. One function of dopamine in this pathway is to inhibit motor activity in certain areas, which includes the jaw muscles. Overall, a reduction of dopamine, in turn, reduces the inhibitory effect it is supposed to have. The result is the development of bruxism.
You have a few options in regards to fixing the problem:
- Lower Your Dose: Lowering the dose of the offending SSRI drug has shown to improve or even eliminate symptoms. While this may be an option for some, it isn't ideal for those who are already on a low dose or on a dose that is working well for them.
- Switch antidepressants: There are many other antidepressant drugs that do not affect serotonin as much. An alternative drug may be an option. Possible alternatives include mirtazapine and Wellbutrin (buproprion).
- Protective Equipment: If dental problems are the main issue, a mouth guard could be beneficial. If you are experiencing muscle tightness, headaches or tightness, a mouthguard may not be appropriate to relieve all symptoms
- Add Buspar (buspirone): Buspar is a popular prescription drug used to relieve anxiety. It has a large body of evidence regarding its use to treat bruxism and appears to be an effective treatment. Small doses (5 to 10 mg one to three times daily) have been very effective and is generally well tolerated.
Please let your doctor know about the side effects you are having. As mentioned, it is not uncommon to experience this and the side effect is fairly well known. There are a lot of options for you in terms of relieving these side effects!