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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by raisinb on April 25, 2009, at 17:42:43
For the last week my jaw/face has been KILLING me. It's constantly tight and painful and my teeth feel as if I've been grinding them all night.
The only med change I have had recently is going from 20 to 30 mg Lexapro (2-3 weeks ago). I haven't had this SE with Lexapro before. I'm also on 50 mg Zoloft, 1 mg Xanax PRN, and Lunesta 3 mg at night.
Is this anxiety or is it the increased Lexapro? I'm not sure whether to go back to the 20 mg or stick it out.
Posted by sowhysosad on April 25, 2009, at 18:31:46
In reply to jaw clenching--likely culprit?, posted by raisinb on April 25, 2009, at 17:42:43
> For the last week my jaw/face has been KILLING me. It's constantly tight and painful and my teeth feel as if I've been grinding them all night.
>
> The only med change I have had recently is going from 20 to 30 mg Lexapro (2-3 weeks ago). I haven't had this SE with Lexapro before. I'm also on 50 mg Zoloft, 1 mg Xanax PRN, and Lunesta 3 mg at night.
>
> Is this anxiety or is it the increased Lexapro? I'm not sure whether to go back to the 20 mg or stick it out.I'll stick my neck out and say it's DEFINITELY the Lex. Had something similar on-and-off for over 3 years from it, and it's still persisting now. It was definitely dose-dependent too - noticably worse whenever my dose went back up to 20mg from 10.
My neuro says most facial movement disorders he sees from SSRI's are from Lexapro or Celexa.
The mechanism probably serotonin-mediated dopamine depletion in the basal ganglia.
Posted by SLS on April 25, 2009, at 19:00:19
In reply to Re: jaw clenching--likely culprit?, posted by sowhysosad on April 25, 2009, at 18:31:46
Yes, too much serotonin can produce bruxism and muscle tension. I have not researched what are the mechanisms involved, though. Still, I think it is good to arrive at decisions empirically rather than theoretically. For me, bruxism has sometimes been a prelude to a favorable response, after which the bruxism disappears. I wouldn't guarantee you such an outcome, but sometimes it is worth persisting with a drug trial if the initial side effects are tolerable and potentially transient.
How do dopaminergic neurons become "depleted"?
- Scott
Posted by sowhysosad on April 25, 2009, at 20:55:02
In reply to Re: jaw clenching--likely culprit?, posted by SLS on April 25, 2009, at 19:00:19
> How do dopaminergic neurons become "depleted"?
One theory I read was that dopamine release is mediated by one of the 5HT2 receptors, but the jury's out.
Certainly in my case, my dopamine AND serotonin have been low for months and my jaw has been worse than ever, so it doesn't seem to be excess serotonin alone that's caused the issue. Plus taking codeine - which they hypothesise causes dopamine release through a gaba-mediated mechanism - caused a dramatic improvement. My issue is more with fine motor control when speaking rather than constant bruxism though.
I've also noticed an improvement since quitting imipramine last Sunday, almost as if it was somehow preventing dopamine release. That contradicts research which suggests some tricyclics cause dopamine increase dopamine in some parts of the brain (maybe through its anticholinergic action?), so who knows what was going on there.
Posted by Jedi on April 25, 2009, at 21:11:49
In reply to jaw clenching--likely culprit?, posted by raisinb on April 25, 2009, at 17:42:43
> For the last week my jaw/face has been KILLING me. It's constantly tight and painful and my teeth feel as if I've been grinding them all night.
>
> The only med change I have had recently is going from 20 to 30 mg Lexapro (2-3 weeks ago). I haven't had this SE with Lexapro before. I'm also on 50 mg Zoloft, 1 mg Xanax PRN, and Lunesta 3 mg at night.
>
> Is this anxiety or is it the increased Lexapro? I'm not sure whether to go back to the 20 mg or stick it out.Hi,
Clonazepam definitely helped my bruxism which emerged while using several different antidepressants. You have to weigh the pros and cons of long term, high potency benzodiazapine use.Be Well,
Jedi
Posted by sowhysosad on April 26, 2009, at 0:00:45
In reply to Re: jaw clenching--likely culprit? » raisinb, posted by Jedi on April 25, 2009, at 21:11:49
> Clonazepam definitely helped my bruxism which emerged while using several different antidepressants. You have to weigh the pros and cons of long term, high potency benzodiazapine use.
That's really interesting, as the neuro had previously suggested clonazepam.
I didn't think it would work as Valium didn't. However, maybe clonazepam has some region-specific action in the basal ganglia which diazepam lacks, as clonazepam is effective against epilepsy.
That said, he's now refusing to give me any meds that could induce depression (like benzos) as I've been pretty depressed and currently have no antidpressant coverage. Seems like a reasonable call at the moment.
Posted by jedi on April 26, 2009, at 0:51:15
In reply to Re: jaw clenching--likely culprit? » Jedi, posted by sowhysosad on April 26, 2009, at 0:00:45
> That's really interesting, as the neuro had previously suggested clonazepam.
>
> I didn't think it would work as Valium didn't. However, maybe clonazepam has some region-specific action in the basal ganglia which diazepam lacks, as clonazepam is effective against epilepsy.
>
> That said, he's now refusing to give me any meds that could induce depression (like benzos) as I've been pretty depressed and currently have no antidpressant coverage. Seems like a reasonable call at the moment.Hi,
It is tough with no coverage for antidepressants.
My insurance just went to a huge deductible, then only 50% coverage on brand name meds. So I switched to a totally catastrophic health savings plan that is all out of pocket until 10 Grand (Ouch).Jedi
http://www.walmart.com/cservice/contextual_help_popup.gsp?modId=553159
WALMART/SAM'S CLUB $4 Prescription Drug Program
Mental Health Medications
List Effective March 24, 2009
$4 30-DAY / $10 90-DAY
DRUG NAME AND DOSAGE QUANTITY
AMITRIPTYLINE 10MG TAB 30 90
AMITRIPTYLINE 25MG TAB 30 90
AMITRIPTYLINE 50MG TAB 30 90
AMITRIPTYLINE 75MG TAB 30 90
AMITRIPTYLINE 100MG TAB 30 90
BENZTROPINE 2MG TAB 30 90
BUSPIRONE 5MG TAB 60 180
BUSPIRONE 10MG TAB* 60 180
CARBAMAZEPINE 200MG TAB* 60 180
CITALOPRAM 20MG TAB 30 90
CITALOPRAM 40MG TAB 30 90
DOXEPIN HCL 10MG CAP 30 90
DOXEPIN HCL 25MG CAP 30 90
DOXEPIN HCL 50MG CAP 30 90
DOXEPIN HCL 75MG CAP 30 90
DOXEPIN HCL 100MG CAP 30 90
FLUOXETINE 10MG TAB* 30 90
FLUOXETINE 10MG CAP 30 90
FLUOXETINE 20MG CAP 30 90
FLUOXETINE 40MG CAP 30 90
FLUPHENAZINE 1MG TAB 30 90
HALOPERIDOL 0.5MG TAB 30 90
HALOPERIDOL 1MG TAB 30 90
HALOPERIDOL 2MG TAB 30 90
HALOPERIDOL 5MG TAB 30 90
LITHIUM CARBONATE 300MG CAP* 90 270
NORTRIPTYLINE 10MG CAP 30 90
NORTRIPTYLINE 25MG CAP 30 90
PAROXETINE 10MG TAB* 30 90
PAROXETINE 20MG TAB* 30 90
PROCHLORPERAZINE 10MG TAB 30 90
THIORIDAZINE 25MG TAB 30 90
THIORIDAZINE 50MG TAB 30 90
THIOTHIXENE 2MG CAP 30 90
TRAZODONE 50MG TAB 30 90
TRAZODONE 100MG TAB 30 90
TRAZODONE 150MG TAB 30 90
TRIHEXYPHENIDYL 2MG TAB 60 180
Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. View complete Program Details in English. Detalles del Programa or see your Walmart Pharmacist for details.* Prices may be higher in CA, HI, MN, MT, PA, TN, WI and WY.
Prepackaged drugs are covered only in unit sizes specified on Drug List.
Posted by sowhysosad on April 26, 2009, at 2:39:59
In reply to Re: jaw clenching/No antidepressant coverage » sowhysosad, posted by jedi on April 26, 2009, at 0:51:15
Ouch! That sucks jedi!
But when I said "antidepressant coverage" I meant in the sense of "treatment" - my pdoc enforced a drug-free period before reassessing me next month.
Turned out to be an excellent idea, although maybe not for the reason she planned: I suspected imipramine was worsening my depression and it looks like I was right. Felt pretty lousy for the first couple of days but after a week I feel considerably improved.
In terms of financial "coverage" for meds, I'm pretty lucky to live in a country where all scripts are subsidised by the government, so a month's supply of any med costs only about $11. Kids, senior citizens, students, the unemployed and some low-income families get prescriptions completely gratis too.
Only drawback is, if the med's off-patent you'll always get a generic (like the delightfully-named "Prozit" fluoxetine I once got). Plus, on occasion docs might try and fob you off with an older off-patent drug instead of its newer sibling - eg. generic citalopram for Lexapro - but that's fairly unusual.
$10 for a 90-day supply on that Walmart plan can't be beaten though! I wonder if they'll ship them overseas...
> Hi,
> It is tough with no coverage for antidepressants.
> My insurance just went to a huge deductible, then only 50% coverage on brand name meds. So I switched to a totally catastrophic health savings plan that is all out of pocket until 10 Grand (Ouch).
>
> Jedi
>
> http://www.walmart.com/cservice/contextual_help_popup.gsp?modId=553159
>
> WALMART/SAM'S CLUB $4 Prescription Drug Program
> Mental Health Medications
> List Effective March 24, 2009
> $4 30-DAY / $10 90-DAY
> DRUG NAME AND DOSAGE QUANTITY
> AMITRIPTYLINE 10MG TAB 30 90
> AMITRIPTYLINE 25MG TAB 30 90
> AMITRIPTYLINE 50MG TAB 30 90
> AMITRIPTYLINE 75MG TAB 30 90
> AMITRIPTYLINE 100MG TAB 30 90
> BENZTROPINE 2MG TAB 30 90
> BUSPIRONE 5MG TAB 60 180
> BUSPIRONE 10MG TAB* 60 180
> CARBAMAZEPINE 200MG TAB* 60 180
> CITALOPRAM 20MG TAB 30 90
> CITALOPRAM 40MG TAB 30 90
> DOXEPIN HCL 10MG CAP 30 90
> DOXEPIN HCL 25MG CAP 30 90
> DOXEPIN HCL 50MG CAP 30 90
> DOXEPIN HCL 75MG CAP 30 90
> DOXEPIN HCL 100MG CAP 30 90
> FLUOXETINE 10MG TAB* 30 90
> FLUOXETINE 10MG CAP 30 90
> FLUOXETINE 20MG CAP 30 90
> FLUOXETINE 40MG CAP 30 90
> FLUPHENAZINE 1MG TAB 30 90
> HALOPERIDOL 0.5MG TAB 30 90
> HALOPERIDOL 1MG TAB 30 90
> HALOPERIDOL 2MG TAB 30 90
> HALOPERIDOL 5MG TAB 30 90
> LITHIUM CARBONATE 300MG CAP* 90 270
> NORTRIPTYLINE 10MG CAP 30 90
> NORTRIPTYLINE 25MG CAP 30 90
> PAROXETINE 10MG TAB* 30 90
> PAROXETINE 20MG TAB* 30 90
> PROCHLORPERAZINE 10MG TAB 30 90
> THIORIDAZINE 25MG TAB 30 90
> THIORIDAZINE 50MG TAB 30 90
> THIOTHIXENE 2MG CAP 30 90
> TRAZODONE 50MG TAB 30 90
> TRAZODONE 100MG TAB 30 90
> TRAZODONE 150MG TAB 30 90
> TRIHEXYPHENIDYL 2MG TAB 60 180
> Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. View complete Program Details in English. Detalles del Programa or see your Walmart Pharmacist for details.
>
> * Prices may be higher in CA, HI, MN, MT, PA, TN, WI and WY.
>
> Prepackaged drugs are covered only in unit sizes specified on Drug List.
>
>
>
>
Posted by raisinb on April 26, 2009, at 22:12:34
In reply to jaw clenching--likely culprit?, posted by raisinb on April 25, 2009, at 17:42:43
Looks like you guys were right. I experimented with skipping Lexapro altgether today and took an extra Xanax during the day. My jaw feels 100% better.
Posted by sowhysosad on April 26, 2009, at 22:20:30
In reply to Re: jaw clenching--likely culprit?, posted by raisinb on April 26, 2009, at 22:12:34
> Looks like you guys were right. I experimented with skipping Lexapro altgether today and took an extra Xanax during the day. My jaw feels 100% better.
Interesting stuff - thanks for keping us posted.
The absence of an AD and the addition of NADH seems to be helping my jaw a great deal.
Posted by jane d on April 27, 2009, at 0:40:23
In reply to jaw clenching--likely culprit?, posted by raisinb on April 25, 2009, at 17:42:43
> For the last week my jaw/face has been KILLING me. It's constantly tight and painful and my teeth feel as if I've been grinding them all night.
>
> The only med change I have had recently is going from 20 to 30 mg Lexapro (2-3 weeks ago). I haven't had this SE with Lexapro before. I'm also on 50 mg Zoloft, 1 mg Xanax PRN, and Lunesta 3 mg at night.
>
> Is this anxiety or is it the increased Lexapro? I'm not sure whether to go back to the 20 mg or stick it out.
Raisinb,I had something like this happen with dose increases of both Prozac and Wellbutrin. As I recall, it started almost immediately when I raised the dose and went away in a few weeks. However my experience was much less severe than what you describe - uncomfortable rather than painful. I remember noticing off and on during the day that I was clenching my teeth and my jaw would be a little bit sore. I think that I was also doing it during sleep.
Would it be possible to increase the dose more slowly? Perhaps by splitting pills?
jane
Posted by Sigismund on April 27, 2009, at 3:29:07
In reply to Re: jaw clenching--likely culprit?, posted by SLS on April 25, 2009, at 19:00:19
I dunno about depletion.
A decent dose of amphetamine will make you grind your teeth while there's plenty of dopamine around.
Posted by Sigismund on April 27, 2009, at 3:31:15
In reply to Re: jaw clenching--likely culprit? » Jedi, posted by sowhysosad on April 26, 2009, at 0:00:45
>I didn't think it would work as Valium didn't.
Buggered if I would really know, but I think it would if you took enough.
Posted by raisinb on April 27, 2009, at 13:42:40
In reply to Re: jaw clenching--likely culprit? » raisinb, posted by jane d on April 27, 2009, at 0:40:23
Hi Jane,
I'm going to experiment a bit and ramp it up more slowly. I was on 20 mg and doing fine before a lot of stressful things happened, too, so it's possible that will do it for me in the next few months (I'm a teacher, so summer's just around the corner).
Posted by elanor roosevelt on April 27, 2009, at 22:13:42
In reply to jaw clenching--likely culprit?, posted by raisinb on April 25, 2009, at 17:42:43
lexapro might be the culprit
but zoloft gave me awful sores in my mouth
perhaps you need to decrease on at a time
Posted by raisinb on April 28, 2009, at 23:06:54
In reply to Re: jaw clenching--likely culprit?, posted by elanor roosevelt on April 27, 2009, at 22:13:42
Thanks for the response, Eleanor. And I like your username--she was a pretty freaking cool person.
Zoloft has been a life-saving med for me. Sounds like too much serotonin in general is my problem.
I'm experimenting with decreasing the Lexapro day by day. I'm pretty sure it's the one causing my issue. On the one hand, I need serotonin. On the other, seems like I need a certain amount and beyond that causes some issues.
Posted by manic666 on April 30, 2009, at 12:51:11
In reply to jaw clenching--likely culprit?, posted by raisinb on April 25, 2009, at 17:42:43
on most meds, a side effect is grinding your teeth, its tucked away with the other 2 million side effects on the inside leaflet.
Posted by sowhysosad on April 30, 2009, at 18:31:39
In reply to look on the label of your meds, posted by manic666 on April 30, 2009, at 12:51:11
Yeah, mine manifested itself more as a kind of action dystonia or myoclonus rather than constant bruxism, but they've been known to hide more worrying side effects behind more innocuous descriptions, like "jaw clenching".
> on most meds, a side effect is grinding your teeth, its tucked away with the other 2 million side effects on the inside leaflet.
Posted by raisinb on April 30, 2009, at 22:07:01
In reply to look on the label of your meds, posted by manic666 on April 30, 2009, at 12:51:11
Saw my pdoc today and she and I agreed to take me back down on the Lexapro dose. I've never experienced anything like that kind of facial pain--glad it's over.
Posted by sowhysosad on May 1, 2009, at 0:49:31
In reply to Re: look on the label of your meds » manic666, posted by raisinb on April 30, 2009, at 22:07:01
That's good news. Mine's never really manifested as pain as such.
I wonder why this seems so common with Celexa and Lex compared to other SSRI's?
They claim those two are more selective for serotonin than the other SSRI's but in real world I doubt it makes much difference - you'd have to take obscenely high doses of the other SSRI's before they affected reuptake of other monoamines.
> Saw my pdoc today and she and I agreed to take me back down on the Lexapro dose. I've never experienced anything like that kind of facial pain--glad it's over.
Posted by manic666 on May 1, 2009, at 4:42:55
In reply to Re: look on the label of your meds, posted by sowhysosad on May 1, 2009, at 0:49:31
listen at this i got terrible aches, in my back teeth years ago ,it was driving me nuts , a dentist took out my wisdom teeth , it still was there so he dug in my mouth again said oo ive left a piece in , i thought i had a grenade explode in my mouth an it was full of stiches. do you no what the was f**kall wrong with my teeth it was nuralgier, sorry for the spelling but you no what i mean , a common fault with anxierty of coures i made it worse with it never leaveing my mind,now im minus 4 teeth for nothing ,
This is the end of the thread.
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