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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by animalib on August 13, 2007, at 14:09:48
i have tried lexapro, zoloft, buspar, and cymbalta for anxiety/panic disorder and noticed that anything with serotonin (increasing or decresing) leads to bruxism. They have always paired these drugs with a benzo, first lorazepam with lexapro, then serax with zoloft, and cymbalta with klonopin. Well, even the cymbalta which is an SNRI gave me jaw pain so I decreased from 40mg daily to 20mg, everything was fine for two months, then jaw pain again...I had quit all the others for jaw pain (except for Buspar which didn't help anything, it was like taking placebo). So now I can't take anything that has serotonin and the only thing left is Wellbutrin which has not been approved or shown to help anxiety and panic (just depression). My biggest problem is chest pain and panic attacks, so that would be useless. I just got back from the psychiatrist. He doesn't know what to do with me. He told me to increase the klonopin and take more twice a day to control the anxiety while he reads the articles on the buspar relation to blocking those receptors that seem to trigger the TMJ. Meanwhile, I have purchased a nightguard (today) and take Advil for the jaw pain. I can't stop crying and still have anxiety. So, I don't know what will happen next but you all understand that this is not a good quality of life and that I don't plan on having to live with this my whole life, and go to school (law), and take care of my family, and do everything I have to do to pay off my mortgage and school loans. I am overwhelmed and disappointed at the medications.
I have also tried CBT and meditation...nothing has worked. I have lost all hope.
Posted by Justherself54 on August 13, 2007, at 15:00:26
In reply to ssri/snri induced bruxism: what didn't help, posted by animalib on August 13, 2007, at 14:09:48
I have ground my teeth ever since I can remember..my dentist made me a mouth guard which helped..it seems every SSRI makes me grind more, and I found that the heavy duty mouth guard make specifically to fit my teeth stopped the jaw pain..might be worth a try to have one professionally made.
Posted by Phillipa on August 13, 2007, at 16:47:53
In reply to Re: ssri/snri induced bruxism: what didn't help, posted by Justherself54 on August 13, 2007, at 15:00:26
There are a lot of meds left what about remeron? Just one, even serzone in generic form will help anxiety and depression at the same time. Different classes of meds. Good luck. Maybe call you pdoc and suggest? Love Phillipa
Posted by linkadge on August 13, 2007, at 22:27:52
In reply to Re: ssri/snri induced bruxism: what didn't help, posted by Phillipa on August 13, 2007, at 16:47:53
>My biggest problem is chest pain and panic >attacks, so that would be useless.
Have you considered a beta blocker with a benzodiazapine? Beta blockers have some effect in GAD, and can be especially usefull if you have tremor or cardiac issues.
You could, like phillipa mentioned, try Remeron. There are some studies suggesting potential anti-panic effects. It does affect serotonin but in a less forcefull way than the SSRI's. It also blocks certain serotonin receptors which can reduce akathesia.
I have a jaw joint disorder that may require surgical intervention. The SSRI's absolutely caused nasty jaw clenching, although this side effect significantly lessened over the course of a few months. It may be possable to take lower doses to start untill this side effect diminshes.
The jaw clenching is probably due to the initial serotonergically mediated inhibition on dopamine release. The brain does adapt somewhat to this effect. It did for me. Just something to consider.
>Meanwhile, I have purchased a nightguard (today) >and take Advil for the jaw pain. I can't stop >crying and still have anxiety. So, I don't know >what will happen next but you all understand >that this is not a good quality of life and that >I don't plan on having to live with this my >whole life, and go to school (law), and take >care of my family, and do everything I have to >do to pay off my mortgage and school loans.
Sounds like you've got a lot on your plate. Medications can help but they do have limitations.
I hope you can find the ballance in your life that you need.
The MAOI's are usefull for panic and GAD, but have side effects of their own. They may also cause jaw clenching.
The TCA's might be worth looking into, at least in low doses. They are effective for panic attacks. They are probably less likely to cause jaw clenching as the anticholinergic effects, and antiserotonin effects (at 5-ht2a/c) can lesson the effect on dopamine.
Doxapin, for instance, produced nowhere near the same level of start up akathesia as the SSRI's for myself. Amitryptaline might be worth a shot.
>I have also tried CBT and meditation...nothing >has worked. I have lost all hope.
Don't loose hope. There are options. I wouldn't put all your hope in meds, they are only one tool in the box.
Linkadge
Posted by animalib on August 25, 2007, at 0:00:17
In reply to Re: ssri/snri induced bruxism: what didn't help, posted by linkadge on August 13, 2007, at 22:27:52
well, the withdrawals from the cymbalta were horrible but i finally got it out of my system. I was/am still on klonopin 2X/day but I STILL have jaw pain even with the nightguard...so i went back to the psychiatrist today and i asked him if he had looked into adding buspar with ssri's to counteract the bruxism and he hadn't even looked into it. i was crying, frankly i am suicidal, i hate school, i have panic attacks daily, chest pains, lethargy, no highs at all. I feel like crap all the time and when it gets worse, i feel worse than crap. So you could say that when i feel "like crap" i am having a good day. On top of it all, I am doing school full time and starting a part time job because they raised tuition and didn't increase the financial aid and to top it off my 15 year old cat (the love of my life) was diagnosed with chronic renal failure and hyperthyroidism. Its too much!!! I can't handle this. I told the psychiatrist that once the cat dies, I go with her. I am tired, I hate living like this, meds don't help and neither has anything else. I have no quality of life. He decided to get me back on cymbalta regardless of my low tolerance for SNRI's or anything in the serotonin receptor family...he's afraid of suicidal ideation and having it happen on his watch, i guess. its a legal liability (i am in law school).
i am at the end of my rope (figuratively). I don't need a reply, I just need to vent. Thanks for reading.
Posted by animalib on October 11, 2007, at 23:36:33
In reply to Re: ssri/snri induced bruxism: what didn't help, posted by animalib on August 25, 2007, at 0:00:17
I am still here. Back on cymbalta 20mg once a day and Klonopin twice a day, every twelve hours. I can deal with school but I still have crying spells and panic attacks, and anxiety that lasts for hours. I still have chest pains once in a while but school and work are keeping me so busy. I am trying to stay busy and not think about how sh*tty I feel. My cat is still alive and I will ride this until the time comes when things get bad again. I quit therapy but I am still going to the psychiatrist. People around me have been less than supporting even encouraging me to kill myself and to quit whining since my life "is not that bad". I guess its difficult for people to understand that no matter how good one's life looks from the outside, it seems unbearable from the inside. I don't trust my "friends" who think meds are bad and who think that I should just "get over it". I feel alone and with the weight of the world on my shoulders. But I am still alive. That is neither good nor bad, it just is.
I still wear a mouthguard at night for the bruxism and I am seeing a chiropractor for it. He thinks he can help, we'll see.
Thanks for reading.
Posted by iforgotmypassword on October 15, 2007, at 19:19:07
In reply to Re: ssri/snri induced bruxism: what didn't help, posted by animalib on October 11, 2007, at 23:36:33
i've been trying to find a solution to bruxism myself. i don't know if it is the same as yours. mine is during the day and started with paxil several years ago. i chew my teeth all day. like my teeth are skating back and forth. i've had it with very frequent akathitic symptoms, stiffness and near-dystonic/pseudoparkinsonian outbursts. unfortunately my 12 (mostly bifrontal) ECT didn't help. i almost worry that this may be a sign that i've had my movement problems for so long that its now a form of permanent damage. but i am hoping i can get amisulpride soon, it may even help with this. they've theorized it may be hypersensitive dopamine autoreceptors at the cause:
i kinda worry about metoclopramide itself tho, it is notorious for movement disorders on its own it seems. i'd really like to get a copy of the full text of that article to read everything, especially how much they used in dosing. still not exactly sure i'd want to try it...
anyway. my 18 cat has advanced kidney disease himself, and they figured he did not have long at all when it was diagnosed several months ago. his tested kidney values improved very markedly with the special diet he was prescribed, and he is doing mostly fine now. so for you and your cat, in case it hasn't been considered or she isn't already on such a diet, it may definately be worth a shot i would think. you have to get it from the vets by prescription. my cats current food is: "MEDI-CAL" brand "Reduced Protein" Wet
"Hill's Prescription Diet" "k/d" (stands for "kidney diet") is also good. so just in case you didn't know about this stuff. it may help. :) wishing your cat better health. and you too.
(sorry for any lack of coherence.)
Posted by James R on October 18, 2007, at 14:43:50
In reply to Re: ssri/snri induced bruxism: what didn't help, posted by animalib on October 11, 2007, at 23:36:33
Hi,
I found relief from chronic tension headaches and
lock jaw by taking Topamax. I also read the article saying that buspar may help, but it was unsuccessful in my case.Best of luck,
James R
> I am still here. Back on cymbalta 20mg once a day and Klonopin twice a day, every twelve hours. I can deal with school but I still have crying spells and panic attacks, and anxiety that lasts for hours. I still have chest pains once in a while but school and work are keeping me so busy. I am trying to stay busy and not think about how sh*tty I feel. My cat is still alive and I will ride this until the time comes when things get bad again. I quit therapy but I am still going to the psychiatrist. People around me have been less than supporting even encouraging me to kill myself and to quit whining since my life "is not that bad". I guess its difficult for people to understand that no matter how good one's life looks from the outside, it seems unbearable from the inside. I don't trust my "friends" who think meds are bad and who think that I should just "get over it". I feel alone and with the weight of the world on my shoulders. But I am still alive. That is neither good nor bad, it just is.
>
> I still wear a mouthguard at night for the bruxism and I am seeing a chiropractor for it. He thinks he can help, we'll see.
>
> Thanks for reading.
This is the end of the thread.
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