Dystonias and Dyskinesias of the Jaw Associated with the Use of SSRIs

The 5HT reuptake inhibiting antidepressants (SSRIs) were introduced into clinical practice in the late 1980s. From the time of their introduction a series of reports have appeared indicating that they were liable to produce motor (extrapyramidal),sideeffects (Meltzer et al., 1979; Bouchard et al., 1989; Baldwin et al., 1991), including dystonias (Brod, 1989; Reccoppa et al., 1990), dyskinesias (Budman and Bruun, 1991; Fallon and Liebowitz, 1991; Wils, 1992; Arya and Szabadi, 1993; Scheepers and Rogers, 1994) or restlessness (Lipinski et al., 1989; Creaney et al., 1991; Rothschild and Locke, 1991). There are theoretical grounds for suspecting that such reactions might occur, given that there is a modulatory interaction between the serotonergic and dopaminergic systems (Tricklebank, 1989; Baldessarini and Marsh, 1990; see Arya (1994) for review). Given such reactions one concern must be whether the SSRIs are liable to produce long standing dyskinetic or dystonic reactions. In 1993, Ellison and Stanziani reported four cases of SSRI-associated nocturnal bruxism, following treatment with sertraline or fluoxetine. These conditions resolved in three cases with co-administration of buspirone and in the fourth after decreasing the dose of the SSRI. In 1993, Micheli and colleagues also reported that antidopaminergic drug exposure could lead to bruxism and provided details of eight cases. In the former paper, SSRIs appeared to produce nocturnal bruxism, which the authors postulated might stem from an exacerbation of the nocturnal bruxism found normally in