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LETTER TO EDITOR
Year : 2015  |  Volume : 37  |  Issue : 2  |  Page : 249-250  

Venlafaxine-induced severe sleep bruxism in a patient with generalized anxiety disorder


Department of Psychiatry, Chalmeda Ananda Rao Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India

Date of Web Publication22-Apr-2015

Correspondence Address:
Dr. Sam Padamadan Jose
Department of Psychiatry, Chalmeda Ananda Rao Institute of Medical Sciences, Karimnagar - 505 001, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.155679

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How to cite this article:
Jose SP. Venlafaxine-induced severe sleep bruxism in a patient with generalized anxiety disorder. Indian J Psychol Med 2015;37:249-50

How to cite this URL:
Jose SP. Venlafaxine-induced severe sleep bruxism in a patient with generalized anxiety disorder. Indian J Psychol Med [serial online] 2015 [cited 2019 Jul 19];37:249-50. Available from: http://www.ijpm.info/text.asp?2015/37/2/249/155679

Sir,

Sleep bruxism is a stereotyped movement disorder, which occurs during sleep characterized by teeth grinding. [1] The imbalance of neurotransmitters, including serotonin, norepinephrine, and dopamine during the nonrapid eye movement (NREM) phase of sleep is a postulated mechanism of nocturnal bruxism and the medications affecting these neurotransmitter systems can potentially induce this NREM sleep disorder. [2] Here, we present the case of a patient with generalized anxiety disorder who developed severe sleep bruxism with a serotonin-norepinephrine reuptake inhibitor-venlafaxine, which resolved on substituting it with a selective serotonin reuptake inhibitors-escitalopram.

A 35-year-old businessman presented with 9 years history of persistent anxiety symptoms, generalized apprehension related to day-to-day events and constant sense of restlessness. He had significant autonomic symptoms such as palpitations and sweating of palms. He would report of difficulty to relax and this had caused significant dysfunction in his personal and occupational facets of his life. He was treated in the past with varying doses of benzodiazepines - clonazepam (0.5-1 mg) and alprazolam (0.25-1 mg). However, he would not take these medications due to sedation, which affected his work. He had undergone therapy with an emphasis on relaxation training. However, due to his busy schedule at work, he was unable to regularly attend therapy sessions. He was initiated on tablet venlafaxine with dose escalated from 37.5 to 150 mg/per day (dose escalation was 37.5 mg once in every 4 days). At 1 week after the initiation of venlafaxine, his wife reported that he started having very severe grinding of teeth during sleep at night. When this persisted for a week consistently, he came back and mentioned that it would be unable to continue the medication with this concern happening. The medication was stopped and was substituted with escitalopram with its dose starting at 5 mg/day hiked up by 5 mg every 4 days to 20 mg/day given at night. Within 2 days of stopping venlafaxine, bruxism disappeared, and he did not have similar side-effect on escitalopram. Within 2 months of initiation of escitalopram, he reported of significant improvement in anxiety symptoms.

A potential hypothesis that explains the mechanism of bruxism is based on the role of cerebral neurotransmitter control over the sleep-wake cycle. [3] Even though, dopamine is the most implicated neurotransmitter, [4] the role of other monoamines is also highlighted as a mechanism, as evidenced by the use of the adrenergic system modulating agents such as clonidine and propranolol to alleviate bruxism. [5],[6],[7] Overall, brainstem release phenomenon from higher cortical control has been considered to be a compelling mechanism. [1] In our patient, bruxism occurred with a dual acting agent venlafaxine, which has effects on both the serotonin and norepinephrine neurotransmitters. The Naranjo et al. probability scale suggested a possible relationship between venlafaxine and this adverse event. [8] Indeed, venlafaxine induced nocturnal bruxism has been reported previously. [9],[10],[11] This adverse effect had a temporal relationship with initiating venlafaxine and it remitted on stopping this drug in our patient. It did not reoccur on substituting it with escitalopram, which has a very selective action on serotonin. This calls for an increased awareness among the practitioners, of this distressing adverse effect with venlafaxine.

 
   References Top

1.
Bader G, Lavigne G. Sleep bruxism; an overview of an oromandibular sleep movement disorder. Review article. Sleep Med Rev 2000;4:27-43.  Back to cited text no. 1
    
2.
de la Hoz-Aizpurua JL, Díaz-Alonso E, LaTouche-Arbizu R, Mesa-Jiménez J. Sleep bruxism. Conceptual review and update. Med Oral Patol Oral Cir Bucal 2011;16:E231-8.  Back to cited text no. 2
    
3.
Lobbezoo F, Lavigne GJ, Tanguay R, Montplaisir JY. The effect of catecholamine precursor L-dopa on sleep bruxism: A controlled clinical trial. Mov Disord 1997;12:73-8.  Back to cited text no. 3
    
4.
Chen WH, Lu YC, Lui CC, Liu JS. A proposed mechanism for diurnal/nocturnal bruxism: Hypersensitivity of presynaptic dopamine receptors in the frontal lobe. J Clin Neurosci 2005;12:161-3.  Back to cited text no. 4
    
5.
Huynh N, Lavigne GJ, Lanfranchi PA, Montplaisir JY, de Champlain J. The effect of 2 sympatholytic medications - propranolol and clonidine - on sleep bruxism: Experimental randomized controlled studies. Sleep 2006;29:307-16.  Back to cited text no. 5
    
6.
Sjöholm TT, Lehtinen I, Piha SJ. The effect of propranolol on sleep bruxism: Hypothetical considerations based on a case study. Clin Auton Res 1996;6:37-40.  Back to cited text no. 6
    
7.
Amir I, Hermesh H, Gavish A. Bruxism secondary to antipsychotic drug exposure: A positive response to propranolol. Clin Neuropharmacol 1997;20:86-9.  Back to cited text no. 7
    
8.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.  Back to cited text no. 8
[PUBMED]    
9.
Alonso-Navarro H, Martín-Prieto M, Ruiz-Ezquerro JJ, Jiménez-Jiménez FJ. Bruxism possibly induced by venlafaxine. Clin Neuropharmacol 2009;32:111-2.  Back to cited text no. 9
    
10.
Kuloglu M, Ekinci O, Caykoylu A. Venlafaxine-associated nocturnal bruxism in a depressive patient successfully treated with buspirone. J Psychopharmacol 2010;24:627-8.  Back to cited text no. 10
[PUBMED]    
11.
Jaffee MS, Bostwick JM. Buspirone as an antidote to venlafaxine-induced bruxism. Psychosomatics 2000;41:535-6.  Back to cited text no. 11
    




 

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