When Mental Health Medications Attack Your Teeth: Navigating Antidepressants Linked to Teeth Grinding at Night

Story-at-a-Glance

• Antidepressants—particularly SSRIs and SNRIs—are linked to teeth grinding at night in up to 73% of users in recent studies. This side effect often goes unrecognized by both patients and healthcare providers

• The connection involves disrupted dopamine signaling in the brain. Medications that increase serotonin inadvertently suppress dopamine’s normal function of inhibiting jaw muscle activity

• Symptoms typically emerge 3-4 weeks after starting medication or increasing dosage. They can range from morning jaw pain to severe tooth fractures requiring dental intervention

• Practical management strategies exist without abandoning mental health treatment entirely. These include adding buspirone (which helps 65-75% of cases), switching to bupropion or mirtazapine, or using protective mouthguards while adjusting medication

• The real challenge isn’t choosing between mental health and dental health—it’s understanding the trade-offs and working with healthcare providers to find solutions that honor both priorities

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When Dr. Andrew Garrett, a neurologist formerly at Walter Reed National Military Medical Center, examined a 40-year-old woman with persistent right-sided jaw pain, the initial diagnosis seemed straightforward. It appeared to be temporomandibular joint disorder. She couldn’t open her mouth fully and survived on soft foods. Even botulinum toxin injections failed to help. The breakthrough came when she mentioned something her previous doctors had missed—her symptoms started exactly when she began taking sertraline for depression two years earlier.

Within three days of stopping the antidepressant, her jaw pain vanished completely. She could open her mouth again. But her depression returned with force. When she tried venlafaxine instead, the grinding came back (though less severely). Only after switching to bupropion did both her mental health and jaw symptoms find equilibrium. This case, published in Neurology: Clinical Practice in 2018, illustrates a dilemma millions face: how do you weigh relief from depression against the physical toll of nighttime teeth grinding?

Here’s what surprised Garrett and his colleague Dr. Jason Hawley most: when they reviewed the medical literature, they found antidepressant-induced bruxism mentioned repeatedly in dental journals but barely recognized in neurology. The phenomenon was hiding in plain sight.

The Neurotransmitter Tug-of-War Behind the Grinding

The mechanism behind antidepressants linked to teeth grinding at night centers on an unintended consequence of how these medications work. Most modern antidepressants—selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro)—increase serotonin availability in the brain. Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta) work similarly. That’s exactly what we want for treating depression.

But serotonin doesn’t act in isolation. In the mesocortical tract, a neural pathway connecting the midbrain to the cortex, dopamine normally acts as a brake on spontaneous jaw movements. When antidepressants boost serotonin, that serotonin blocks dopaminergic signaling—essentially removing the brake. The jaw muscles, particularly the masseter, become overactive. Acetylcholinesterase and creatinine kinase levels rise, biochemical markers of muscle overwork.

Think of it like this: dopamine is the “don’t move” signal for your jaw. Serotonin is the “move freely” signal. Antidepressants tip the balance heavily toward movement.

The Australian Dental Association notes that “medication-induced bruxism is under-recognized in dentistry,” but the numbers are striking. A 2024 study in BMC Psychiatry found that people taking antidepressants are 10 times more likely to report bruxism than those on any other type of medication. Another recent study from Turkey, published in October 2024 in the Journal of Oral Rehabilitation, discovered that 73.3% of patients taking antidepressants experienced bruxism, compared to just 28.2% of controls.

The Rising Context: More People, More Medications, More Grinding

These statistics matter more now than ever because antidepressant use has surged dramatically. According to the CDC’s 2025 data brief, 11.4% of American adults—roughly 29 million people—took prescription medication for depression in 2023. That’s up from 13.2% in 2015-2018 data and just 10.6% in 2009-2010.

The increase is even more pronounced among young people. A 2024 study in Pediatrics analyzing more than 221 million prescriptions found that antidepressant dispensing to adolescents and young adults increased 66.3% between 2016 and 2022. Starting in early 2020, the rate accelerated significantly—63.5% faster than earlier trends—coinciding with expanded telehealth access that removed geographical and scheduling barriers to mental health care, increased mental health screening protocols in schools and primary care settings, and measurably reduced stigma around seeking treatment for depression and anxiety. This increase was driven almost entirely by increased dispensing to young women and girls (129.6% higher for females aged 12-17).

More than two-thirds of these prescriptions were for SSRIs, with sertraline, fluoxetine, and escitalopram being the most commonly dispensed. These are precisely the medications most frequently associated with grinding.

What does this mean? Millions more people are experiencing a side effect they might not even recognize as medication-related. (Does your jaw ache when you wake up? Do you have unexplained tooth sensitivity? Your sleep partner might hear grinding even if you don’t.)

Three Cases That Reveal the Real-World Impact

The published medical literature contains dozens of documented cases, but three stand out for what they reveal about the varied presentations and solutions.

Case 1: The 61-Year-Old Woman Who Shattered Her Teeth

Dr. Michael Jaffe described this case in a landmark 2000 Journal of the American Dental Association study. The woman reported severe nighttime teeth grinding that began soon after starting Zoloft (sertraline). The grinding was so severe it caused extensive damage to her teeth—the kind of destruction that takes months or years to develop but can happen remarkably quickly with medication-induced bruxism. When researchers added buspirone, an antianxiety medication that also acts on serotonin receptors differently, her symptoms improved dramatically.

Case 2: The Middle Eastern Patient with Multiple Sclerosis

In a challenging case published by researchers from multiple institutions, a patient with both depression and multiple sclerosis developed severe bruxism while taking 200mg of sertraline daily. The grinding was so intense he broke a tooth despite trying multiple interventions. Buspirone helped only partially. Gabapentin did nothing. Low-dose quetiapine (an antipsychotic sometimes used off-label) finally worked—but caused sedation, constipation, and concerning weight gain. When they reduced his sertraline to 100mg and tried clonazepam, he found better balance, though the solution remained imperfect.

This case illustrates something important: management isn’t always clean. Sometimes you’re choosing between different sets of side effects.

Case 3: The Breastfed Infant

Perhaps the most striking case involved a 9-month-old female infant who developed sleep bruxism—unusual for someone so young. The mother had recently started taking citalopram (10mg daily) for anxiety. Within two weeks of the mother’s medication initiation, the infant showed clear signs of teeth grinding during sleep. Medical examination found nothing else wrong. When the mother discontinued citalopram, the infant’s bruxism disappeared.

This case, while rare, demonstrates that the effects of these medications can extend beyond the person taking them, particularly through breast milk. (It also raises questions about how careful we need to be about assuming bruxism is always a primary condition.)

The Practical Question: What Do You Actually Do About It?

If you’re reading this and recognizing yourself—waking with jaw pain, noticing worn teeth, or having a partner who complains about nighttime grinding—here’s where the research points to actual solutions.

The Buspirone Addition Strategy

Based on Garrett and Hawley’s systematic review, adding buspirone is the most commonly successful intervention, reported effective in 20 of the 46 cases they analyzed. Buspirone typically works at doses of 5-30mg daily, split into 1-3 doses. The mechanism makes sense: buspirone is a 5-HT1A partial agonist that increases dopamine release in the prefrontal cortex, essentially restoring some of the braking action your SSRI or SNRI removed.

Here’s what’s interesting: buspirone takes 2-3 weeks to work for bruxism, suggesting it acts through adaptive neuronal changes rather than immediate receptor effects. This means you need patience—but also means the effects tend to persist.

The Medication-Switching Approach

Some antidepressants appear less likely to cause grinding. Based on the case report evidence and Garrett’s analysis:

• Bupropion (Wellbutrin) is a norepinephrine-dopamine reuptake inhibitor (not a serotonin drug) and is rarely associated with bruxism. Multiple case reports show successful switching from SSRIs to bupropion resolved grinding while maintaining depression treatment.
• Mirtazapine (Remeron) works differently from SSRIs and isn’t heavily implicated in bruxism literature, though we need more data.
• Tricyclic antidepressants like amitriptyline have been successfully used in some cases, though they carry their own side effect profiles.

The most commonly implicated culprits? Fluoxetine (12 cases in Garrett’s review), followed by sertraline and venlafaxine (7 cases each). If you’re on one of these and experiencing grinding, switching within the SSRI class rarely helps—they all work similarly. You need a mechanistically different drug.

The Dose Reduction Option

Some cases resolve with lowering the antidepressant dose, though success is mixed. In Garrett’s review, 7 cases improved with dose reduction. The challenge: will your depression symptoms remain controlled at the lower dose? This requires close collaboration with your prescriber.

The Protective Approach While You Figure It Out

While adjusting medications, you need to protect your teeth. A custom-fitted mouthguard from your dentist provides the best protection (over-the-counter guards work less well but are better than nothing). Hypnosis techniques may also help modify the underlying neuromuscular patterns, particularly for stress-related grinding that coexists with medication effects.

Physical measures matter too: jaw rest during the day, gentle stretching exercises, hot and cold packs for pain relief, and avoiding triggers like excessive caffeine or alcohol, which can worsen bruxism independently.

Understanding What We Don’t Yet Know

Despite strong evidence of association, researchers acknowledge significant gaps. A 2023 study in the Journal of Clinical Psychiatry examining drug exposure data found something puzzling: bruxism appeared more strongly associated with norepinephrine transporter (NET) activity than serotonin transporter (SERT) activity when they analyzed the drugs’ binding profiles. This contradicts the prevailing theory that it’s primarily about serotonin’s effects on dopamine.

Additionally, we don’t have good data on:

• The true incidence in the general population (most data comes from case reports and small studies)
• Why some people develop grinding and others don’t on the same medication
• Whether genetic variants in neurotransmitter receptors predict susceptibility
• Long-term outcomes for those who develop bruxism—does it resolve on its own?

This uncertainty means your experience might differ from what’s “typical.” Some people develop grinding within days; others take months. Some cases resolve spontaneously after 4-6 weeks without intervention. Your body’s response is individual.

The Decision Framework: Trading Off Mental and Dental Health

Here’s where we return to the opening insight about weighing trade-offs. Dr. John Michael Bostwick of the Mayo Clinic, who co-authored the 2000 study that brought wider attention to SSRI-induced bruxism, told Reuters: “We don’t know how common this problem is, but we suspect that if physicians begin to ask about it, they will find it to be quite common.” He emphasized that patients “don’t necessarily have to live with their pain” and can often “keep the benefit of their antidepressant” while managing the grinding.

The framework for decision-making looks something like this:

If grinding is mild to moderate (occasional jaw soreness, no tooth damage): Consider protective measures first (mouthguard, stress reduction) while monitoring. The grinding may resolve spontaneously.

If grinding is moderate to severe (consistent pain, visible tooth wear, sleep disruption): Try adding buspirone while maintaining your current antidepressant. Success rate appears to be 65-75% based on case series.

If buspirone doesn’t work or isn’t tolerated: Discuss switching antidepressants with your prescriber. Bupropion is often the best alternative if your depression symptoms are appropriate for it (it works better for certain depression subtypes).

If you can’t tolerate medication changes: Focus on maximal tooth protection and consider adjunctive treatments like low-dose aripiprazole (which worked in the obsessive-compulsive disorder case where SSRIs couldn’t be discontinued) or gabapentin (though evidence is weaker).

Throughout all of this, remember: the goal isn’t choosing between mental health and dental health. It’s finding an approach that respects both. Depression is serious. Untreated depression has profound consequences. But so does severe bruxism—jaw joint damage, chronic pain, and thousands of dollars in dental work add up.

What Dentists and Physicians Need to Know

If you’re a healthcare provider reading this: ask your patients on antidepressants about jaw pain, morning headaches, and teeth grinding. The symptoms usually begin 3-4 weeks after medication initiation or dose increase. Listen for bed partners reporting audible grinding. Look for masseter hypertrophy, tooth wear patterns, tongue scalloping.

The Australian Dental Association’s observation that medication-induced bruxism is “under-recognized” applies doubly in the United States, where dentists and psychiatrists often don’t communicate about this connection. Garrett and Hawley noted this phenomenon is “less commonly recognized among neurologists” despite being “a well-described phenomenon” in dental literature. We need better cross-disciplinary awareness.

The Bigger Picture: What This Reveals About Medication Side Effects

The story of antidepressants linked to teeth grinding at night illustrates something larger about how we think about medication effects. For years, official side effect profiles of SSRIs focused on sexual dysfunction, weight gain, and GI symptoms. Bruxism was barely mentioned, dismissed as rare. Yet now we’re seeing it might affect 15-25% of users (or higher in some studies).

Why the discrepancy? Partly reporting bias—patients don’t always connect their new jaw pain to medication started a month ago. Partly clinical awareness—if doctors don’t ask, patients don’t mention it. And partly the complexity of the mechanism—this isn’t a simple on-target effect but a downstream consequence of neurotransmitter rebalancing.

This suggests other “rare” side effects might be similarly underrecognized. It also highlights why patient advocacy matters: the woman in Garrett’s case only found relief because she made the connection herself and insisted on trying medication discontinuation despite her providers’ initial skepticism.

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FAQ Section

Q: What are SSRIs and SNRIs?

A: SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are classes of antidepressant medications. SSRIs work by increasing serotonin availability in the brain by blocking its reabsorption (reuptake) into neurons. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), paroxetine (Paxil), and fluvoxamine (Luvox). SNRIs work similarly but affect both serotonin and norepinephrine. Common SNRIs include venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). Both classes are first-line treatments for depression and anxiety disorders.

Q: What is bruxism?

A: Bruxism is the medical term for teeth grinding and jaw clenching. It can occur during sleep (sleep bruxism) or while awake (awake bruxism). Sleep bruxism is characterized by repetitive jaw-muscle activity, often producing an audible grinding sound that bed partners notice. It’s considered a movement disorder rather than a sleep disorder per se. Bruxism can lead to tooth wear, fractures, jaw pain, headaches, temporomandibular joint (TMJ) problems, and disturbed sleep. The condition affects 5-20% of adults generally, but rates appear much higher among antidepressant users.

Q: What is dopamine and why does it matter for jaw movement?

A: Dopamine is a neurotransmitter—a chemical messenger in the brain that helps control movement, motivation, and reward. In the context of jaw muscles, dopamine acts as an inhibitory signal that prevents spontaneous, unwanted movements. Dopamine receptors in the mesocortical tract (a neural pathway connecting the midbrain to the cortex) regulate motor activity, including jaw clenching and teeth grinding. When dopamine levels or signaling decrease, the normal “brake” on jaw muscle activity is released. This leads to increased grinding. This is why conditions like Parkinson’s disease (which involves dopamine loss) are associated with movement problems, and why medications that alter dopamine signaling can cause movement side effects.

Q: What is the difference between neurotransmitters and receptors?

A: Neurotransmitters are chemical messengers that neurons (brain cells) use to communicate. Think of them as letters. Receptors are specialized proteins on the surface of neurons that receive these messages—think of them as mailboxes. For a neurotransmitter to have an effect, it must bind to its specific receptor. The relationship is like a lock and key. Serotonin (neurotransmitter) binds to serotonin receptors, and dopamine binds to dopamine receptors. However, some receptors are more like master keys—for instance, serotonin can influence dopamine signaling by binding to certain receptors that regulate dopamine release. This is why medications that target serotonin can inadvertently affect dopamine-controlled functions like jaw movement.

Q: What is buspirone and how does it work for bruxism?

A: Buspirone (brand name BuSpar) is primarily prescribed as an anti-anxiety medication, but it has proven effective for antidepressant-induced bruxism. It works as a partial agonist at serotonin 5-HT1A receptors in the brain, particularly in areas like the prefrontal cortex and striatum. “Partial agonist” means it partially activates these receptors. It’s not as strong as serotonin itself, but enough to modulate the system. For bruxism specifically, buspirone appears to increase dopamine release in the prefrontal cortex, helping restore the dopamine “brake” on jaw muscles that SSRIs/SNRIs reduced. It typically takes 2-3 weeks to show effects for bruxism (compared to 4-6 weeks for anxiety), suggesting it works through adaptive neuronal changes. Typical doses range from 5-30mg daily, usually split into 2-3 doses.

Q: What is the temporomandibular joint (TMJ)?

A: The temporomandibular joint connects your jawbone (mandible) to your skull, specifically to the temporal bones on each side of your head. You have two TMJs, one in front of each ear. These joints work together with muscles, ligaments, and cartilage to allow you to open and close your mouth, chew, speak, and swallow. TMJ disorder (TMD) refers to problems with these joints and the surrounding muscles. Symptoms include jaw pain, difficulty opening the mouth, clicking or popping sounds when moving the jaw, headaches, and ear pain. Chronic teeth grinding from antidepressants can exacerbate or contribute to TMD, creating a cycle of jaw dysfunction and pain.

Q: What does “underrecognized” mean in medical contexts?

A: When researchers say a condition or side effect is “underrecognized,” they mean it occurs more frequently than medical professionals and the general public realize. Underrecognition happens when: (1) patients don’t know to report symptoms because they don’t connect them to their medication; (2) doctors don’t routinely ask about specific symptoms during visits; (3) symptoms are attributed to other causes. It also happens when (4) the phenomenon is mentioned in some medical specialties’ literature but not others; or (5) reporting systems don’t capture the true frequency. Antidepressant-induced bruxism is considered underrecognized because it appears in dental journals but is rarely discussed in psychiatric or neurological literature, leading to poor awareness among the doctors who prescribe these medications.

Q: How do I know if my grinding is medication-related vs. stress-related?

A: Timing is the biggest clue. Medication-induced bruxism typically begins 3-4 weeks after starting a new antidepressant or increasing the dose. If you notice jaw pain, morning headaches, or your sleep partner reports new grinding sounds around this timeframe, medication is the likely culprit. Stress-related bruxism, by contrast, correlates with specific stressful periods in your life and may fluctuate with stress levels. However, the two can coexist—stress may cause some baseline grinding, which medication then worsens. Another differentiator: medication-induced bruxism often resolves within 3-4 weeks of discontinuing the offending drug, while primary stress-related bruxism may persist despite stress management efforts unless the underlying stressors change.

Q: Can I just stop my antidepressant if I develop grinding?

A: Never stop antidepressants abruptly without medical supervision. SSRIs and SNRIs require gradual tapering to avoid withdrawal symptoms (sometimes called discontinuation syndrome). These can include dizziness, nausea, flu-like symptoms, irritability, insomnia, and return of depression/anxiety symptoms. More importantly, if your antidepressant is working for your mental health, stopping it risks a depressive episode—which can be dangerous. Instead, talk to your prescriber about the grinding. Often, adding buspirone or switching to a different antidepressant class can solve the problem while maintaining treatment for depression. The goal is finding an approach that works for both your mental health and your jaw.

Q: How effective are over-the-counter mouthguards?

A: Over-the-counter (OTC) boil-and-bite mouthguards provide moderate protection and are much better than nothing—they typically cost $20-40 and can prevent significant tooth damage while you work on addressing the underlying medication issue. However, custom-fitted guards from a dentist fit better and are more comfortable for sleeping. They also provide superior protection. They cost $300-800 but may be worth it for severe grinders. The key principle: any guard is better than no guard if you’re grinding enough to damage teeth. OTC guards are a reasonable temporary solution while you’re adjusting medications, while custom guards make sense if you need long-term protection.

Q: What is a systematic review?

A: A systematic review is a research method that comprehensively identifies, evaluates, and synthesizes all relevant studies on a particular topic. Unlike a regular literature review (where an author might selectively discuss papers), systematic reviews follow rigorous protocols. They define clear search strategies, specify inclusion/exclusion criteria, systematically screen all identified papers, and extract data in standardized ways. They often perform statistical analysis (meta-analysis) if appropriate. Garrett and Hawley’s systematic review on antidepressant-induced bruxism searched databases using specific terms, found 71 articles, excluded 42 that didn’t meet criteria, and analyzed data from 46 patients across 29 articles. This method provides stronger evidence than individual case reports because it identifies patterns across multiple cases. When you see “systematic review” in medical literature, it generally represents high-quality evidence.