Citalopram-induced bruxism

There have been several reported incidents of iatrogenic bruxism (involuntary clenching or grinding of the teeth). These have involved diurnal bruxism (Micheli et al, 1993), felt to be associated with dopaminergic blockade, and nocturnal bruxism. Nocturnal bruxism has been reported with venlafaxine, a serotonin/noradrenaline reuptake inhibitor, which responded to gabapentin (Brown & Hong, 1999), as well as three selective serotonin reuptake inhibitors (SSRIs), paroxetine (Romanelli et al, 1996), fluoxetine and setraline (Ellison & Stanziani, 1993). In both reports the SSRI-associated bruxism was treated with buspirone.

I report two cases of nocturnal bruxism secondary to the SSRI citalopram, a previously unreported adverse effect. One patient was started on citalopram 20 mg/day. After 6 weeks the dose was increased to 40 mg. Ten days later nocturnal bruxism developed to such an extent that extraction of a molar was required. Buspirone was started and the bruxism ceased.

Another patient with panic disorder and moderate depression with somatic symptoms was referred to the clinic. The existing medication was a tricyclic and buspirone. Subsequent to non-response, medication was changed to citalopram, eventually reaching 40 mg/day. After an improvement in mood a behavioural programme was used to treat his anxiety symptoms. Four months into the programme the buspirone was reduced from 10 mg twice daily to none. Three weeks later he reported nocturnal bruxism. This ceased after reducing the citalopram to 20 mg/day. Thus, in this case, occult nocturnal bruxism was revealed by the reduction of a treatment agent.

These cases highlight that nocturnal bruxism can occur in response to any of the SSRIs, and that induction may be dose-dependent. They add to the literature suggesting that nocturnal bruxism can be treated with buspirone.