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December 28th, 2010
09:56 AM ET

On antidepressants, why the jaw pain?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Janet A. of Albuquerque, New Mexico:

I have been on antidepressants for many years and have taken almost every kind of selective serotonin reuptake inhibitors. One side effect I developed is temporomandibular joint disease symptoms and tinnitus. I also recently have been diagnosed with attention-deficit (hyperactivity) disorder. All of these medications aggravate my TMJ. The only medication that has helped me in the past is Valium. I am now taking clonazepam with less effectiveness. How common are TMJ symptoms and tinnitus with both of these medications? Any suggestions on how can I get relief for my jaw pain and ringing in my ears?

Expert answer:

Dear Janet,

Your story really points out how challenging clinical medicine can be in terms of deciding what causes what. Depression, ADHD, tinnitus and TMJ all cluster together, meaning that when someone has one, they are at increased risk for the rest. It is also true that antidepressants have occasionally been reported to cause tinnitus, and we know that they can cause teeth grinding, which can worsen TMJ. And yet antidepressants have also been widely used to treat tinnitus and TMJ.

So in your case, you may be one of the rare people who respond to antidepressants with tinnitus/TMJ, or it may be that you have underlying tinnitus and TMJ associated with your depression that the antidepressants are not adequately addressing. Your question suggests that the tinnitus/TMJ gets worse when you take antidepressants. If you've noticed this consistently, it may well be that you are one of the rare people who have tinnitus/TMJ as an antidepressant side effect.

Medicines like clonazepam and Valium (diazepam) can help TMJ and tinnitus, and if you are finding them of benefit, at least that's a start. Your doctor probably has you on clonazepam instead of Valium because it is less psychologically addictive.

I can make only a general recommendation to your question of obtaining more relief. We know that depression makes TMJ/tinnitus worse, and God knows tinnitus especially can really make people depressed. This strongly points to the fact that you need a two-pronged approach: You need to work on resolving the depression and getting the TMJ/tinnitus treated. I would start by focusing on each independently. I'd see an ear, nose and throat doctor to get state of the art treatment for the tinnitus/TMJ, and I'd discuss seriously with a mental health clinician how to best treat depression without antidepressants. In this regard, many behavioral interventions work as well as medications. This has been shown repeatedly for psychotherapy, for example.

Even if you are successful in making progress on only one front (i.e. either the depression or tinnitus/TMJ), you will get relief in the other!

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soundoff (35 Responses)
  1. Alison Mantel, DDS

    I would recommend seeing a dentist or a dentist that has received specialty training in treating TMD. Large portions of the curriculum are dedicated to this topic and often a well made night guard can go a long way if the cause of the TMD is night bruxism as a side effect of the medication.

    December 28, 2010 at 10:44 | Report abuse | Reply
  2. lee

    probably not, but they still cause people to seem like they are whacked out of their skulls.

    December 28, 2010 at 10:57 | Report abuse | Reply
  3. judy emerick

    Dear Dr,
    why do I get a chill in my lower back when I listen to excepional music, the tingle runs down the back of lmy legs at times, I have heard others say they get a ' good chill ' while listening to music, Thank You, Judy Emerick

    December 28, 2010 at 11:18 | Report abuse | Reply
  4. Billy

    More and more it seems that prescription drugs hurt people more than they help them, escpecially when dealing with psychotropic drugs.

    I am soooo sick of the freakin commercials for herpes and anti-depressants! Geez I was not depressed before your anti-depressant commercial, but now my life feels bleak. If only I had herpes and depression, then I could move my bed outside and ride horses along the beach.

    Get excercise, sleep, and eat right! The amount of people diagnosed with mental illness seems to be WAY over the statistical levels listed in medical literature, this means you have been SOLD a disease.

    December 28, 2010 at 11:36 | Report abuse | Reply
    • Sarah in Texas

      While I agree with you that many medical conditions are over-diagnosed and are promoted by the pharmaceutical industry, downplaying the seriousness of mental illness including depression is a mistake. I have struggled with depression for the past decade since my teens and only recently have pursued medical treatment which has essentially saved my life. My beliefs were much like yours that my depression was something I could pull myself out of through controlling my lifestyle. Sadly, this just is not the case for many people. It truly is a disease and ignoring it can ruin your life.

      December 28, 2010 at 11:54 | Report abuse |
    • Billy

      @ Sarah in Texas

      I think some people would benefit more from "Sarge" on the Geico commercials.

      The first thing that comes to mind with TMJ and Depression is to ask about history of stimulant use including speed, caffiene, and ritalin. (Parents SOLD many kids out on ritalin) Stimulants cause an imbalance in dopamine and seratonin, and quite often they cause jaw clenching. If you have an imbalance from stimulants it will take years until your brain will balance itself out again, and more than likely will create a wieght gain/loss roller coaster. Many psychotropic drugs also cause tardive dyskenesia which can also account for jaw tightness. While depression is real (psychogenic or not) and can be serious, I think people really need to evaluate lifestyle causes/fixes first.

      I also suspect that many psychotropic drugs are damaging the GABA and acetylcholine receptors, though pesticide/hormone exposure should be ruled out on this. Many people using psychotropics seem to have issues with temperature regulation, muscle tightness, and other disorders of the parasymathetic nervous system. All of a sudden Sjogrens is on the rise, and I suspect a link.

      Meditation is good for straightening out the mind.

      I would be happy to go head to head with with 95% of therapists and psychiatrists in treating people, I do not have a mental health degree, but I don't get kickbacks from big pharma either.

      December 28, 2010 at 12:56 | Report abuse |
    • Fiona

      Billy, you don't know what you are talking about, and you are disrespectful of those who suffer in ways you clearly cannot imagine. You need to work on your (lack of) empathy. That "mind straightening" you speak of should be your own project for 2011.

      December 28, 2010 at 16:41 | Report abuse |
    • Billy

      @ Fiona
      Please tell me where I am wrong, I think I hit the nail on the head.

      In regards to Sarah, I am sympathetic, no empathy required. I am glad she was helped by antidepressants, but I wonder if there was a better natural solution. Exercise, sleep, and diet are biggies (routine).

      I think many people would benefit from studying cognitive dissonance theory and logotherapy. Most of us live lives with little meaning and much internal conflict.

      Psychiatrists used to look at physical issues causing mental illness, now they just write scripts.

      December 28, 2010 at 17:53 | Report abuse |
    • Halaluani

      Kudos to you, Billy, on all your posts. Sarah, and millions of others, have been sold a bill of goods and told they have a chronic disease instead of the state of mind that is truly depression. As you stated, diet plays a huge role. Improperly nourished people, of which there are plenty today, experience depression as a side effect of nutrient deficiencies. One does not have to be clinically nutritionally deficient to be improperly nourished. As long as people perceive pills to be the "easier" route, most will choose them over doing anything else.

      Even the drug company themselves confess the drugs don't work for 2/3rds of people, and it's said that 1/3rd responds to placebo, so who is left? Sarah believes the drugs helped her. What they did was the same thing that opiates or marijuana do for most people. Yet, nobody is marketing these as "antidepressants". There's more money in drugs that can be patented.

      Those who still believe the party line on these drugs need to read the following:

      Anatomy of an Epidemic - Robert Whitaker
      The Myth of the Chemical Cure - Joanna Moncrieff
      Not Crazy: You May Not Be Mentally Ill - Charles Whitfield
      The Emperor's New Drugs - Irving Kirsch

      There's no refuting the level of proof offered in these books. There is no proof of chemical imbalances, in fact, if anything, these drugs cause chemical imbalances. Some will read these and some will choose to hide their heads in the sand. The latter will be sorry some day for these drugs are damaging people's brains and bodies daily.

      Again, great posts, Billy.

      December 28, 2010 at 22:32 | Report abuse |
    • Dan

      Billy: I would agree with your point that there are many natural remedies that can help people with depression and, depending on the severity of the symptoms, could allow you to lead a normal life without medication. However, this simply isn't enough for some people. Yes, there are psychiatrists who over-prescribe and patients who are more willing to take medication than change their lifestyle, but there are some people who simply require medication as a part of their daily routine, even if they've drastically changed their habits to have a chance at leading a normal life. Obviously eating healthier, exercising, meditating, etc...is part of a well-balanced life that would be good for anyone, but depression isn't just a state of mind; it's an actual chemical imbalance in the brain that may need to be treated. If a person with very high blood pressure changed their eating habits, exercised, and still had dangerously high blood pressure, they would need medication to help manage their hypertension; in many cases, the same is true of mental illness.

      December 29, 2010 at 09:13 | Report abuse |
    • Emmaleah

      Billy, when MRI and other brain scans show a difference in someone's brain patterns, when their blood chemistry is markedly different than someone else's, when they suffer from hallucinations and paranoia, they are not being "sold" anything. Those are the symptoms of serious depressive disorders. I've watched the scans, seen the blood panels, and seen the decline of someone with genuine mental illness. I've also seen those people respond amazingly well to chemical intervention and ECT.

      There is a difference between maladaptive responses to stress and modern life and a biological disorder, but that maladaption can also spawn a permanent biological condition–so both need to be treated seriously and swiftly.

      Yes, people with maladaptive depressive conditions should seek non-chemical intervention first. I really believe that so strongly. But there is nothing pretend about biological depressive disorders, nothing at all, except that some people want to pretend they don't exist.

      December 30, 2010 at 12:59 | Report abuse |
  5. Karen

    It is broadly recognized that the causes of depression are instigated by inflammation in the brain. By eliminating the dietary causes of inflammation one could counteract depression. Maybe these articles can help you any further: http://www.cutthecarb.com/category/mental-diseases/

    December 28, 2010 at 11:37 | Report abuse | Reply
    • Jenna

      Big believer in whack job science, I see.

      December 28, 2010 at 12:44 | Report abuse |
    • neurotransmitter

      That is an interesting theory and I agree that it could be one cause of mental health problems, but I don't think it applies to depression. I have depression and have had it for a long time. I believe stress is the biggest cause of mental ilness.
      I recently "discovered" that Dopamine (the pleasure and reward chemical) is stored in the brains nerve cells and that this storage gets depleted like other brain chemicals (neurotransmitters). Once this store of "Neuromelanin" gets depleted-from the constant stress on the individual and his efforts to cope- the brains nerve cells cannot fire or make signals to one another. This resuts eventually in exhaustion and ultimately illness. Replacing this Neuromelanin and Dopamine is essential for the individual just like replacing his stores of Glucose for energy. In order to do this Tyrosine (the precursor to Dopamine and Adrenaline) needs to be incorporated into that persons diet (along with Iron (ferrous sulphate)) which is also used to manufacture this important chemical. I hope this is helpful and I'm sharing this because of it's interest and hope that it will facilitate a greater understanding of how our wonderful brains need to be nurtured in order to prevent us from the effects of stress .

      July 20, 2011 at 08:16 | Report abuse |
  6. Leslie

    I didn't get TMJ until I had been on an SSRI for awhile, and it never went away. The bite splint that my dentist made for me has helped a lot. I may have started out wearing it all the time; I don't recall, but I wear it only at night now.

    December 28, 2010 at 13:13 | Report abuse | Reply
  7. Holly

    I'm in almost the exact situation as the writer (tried almost every antidepressant) and I too developed TMJ. Hmm

    December 28, 2010 at 14:01 | Report abuse | Reply
  8. Jack Howitzer

    http://67.42.80.195

    all drugs cause jaw pain, just ask anyone from the Jersey Shore

    December 28, 2010 at 14:31 | Report abuse | Reply
  9. Aimee

    Antidepressants are among a list of many drugs that can destroy the good bacteria in your gut, leading to candida, which in turn leads to depression, chronic fatigue and TMJ!!! If you are on an antidepressant take a good quality probiotic daily. I had severe TMJ and severe candida. Since stopping ALL medication, taking care of the candida through a candida diet, natural antifungals and taking a high dosage of probiotic.....my TMJ, chronic fatigue, fibromyalgia etc. has disappeared!!
    I had struggled with depression for years and feel better than ever off medication and yeast free!! I have the energy of a child again!

    December 28, 2010 at 15:01 | Report abuse | Reply
  10. Fiona

    I've had TMJ, severe depression, tinnitus and migraines for decades (and I tic all the boxes for ADHD). None of my doctors has ever linked the depression with the TMJ and tinnitus, and none has ever mentioned ADHD to me! It's news to me that these symptoms "cluster." My suggestion to any TMJ sufferer is to get your bite adjusted properly and get fitted for a bite guard or other device. It made a huge difference for me. I recommend acupuncture and physical therapy (or yoga) to train your jaw and neck muscles to relax. Once you break that feedback loop you get with jaw clenching and grinding, it does abate.

    December 28, 2010 at 16:36 | Report abuse | Reply
  11. ruby

    It makes a lot of sense to me. I was one of the unlucky ones that got so much worse when I started antidepressants. Not only did it make me suicidal (when I say suicidal I mean it, I even had repeated visions of it at any given time.) , but I developed so much jaw pain, I went to the dentist. Wisdom teeth out...jaw pain still remained. Not only that, but when the pharmacy couldn't refill for a few days, I started having a twitch and massive headaches. I had none of these problems before starting on antidepressants. I eventually weened off of them, but I still have a little case of the twitchies (not as bad, thankfully) and headaches. A new doctor tried to push me back on them, and I mean PUSHED hard. I told her that if I take them because she demanded it, she might as well put a gun to my head now, and no we cannot try another kind. I will never go there again, and I wouldn't recommend it either.

    December 28, 2010 at 17:05 | Report abuse | Reply
    • Orchid

      Wise move! Like you I've too many instances of suicidal thoughts or actions, and one drug gave me mild, recurring, non-specific homicidal thoughts as well, for over 2 years. I don't consider any SSRI to be safe for me and have refused them now for ~7 years. I'm miserable with depression most days but I, and the public, are safe.

      December 28, 2010 at 20:24 | Report abuse |
  12. jimmy

    Well, I don't have jaw pain but I do have dry eyes and a limp noodle.

    December 28, 2010 at 17:09 | Report abuse | Reply
  13. Downside Danny

    Yes, antidepressants can cause jaw pain. I know this firsthand. Having taken several SSRI medications a various times I can report that Welbutrin was 100% responsible for jaw pain in my case. Before Welbutrin never had a complaint with my jaw. During Welbutrin, jaw pain. After Welbutrin, jaw pain resolved. My primary care physician, who prescribed the meds, downplayed any link (since he'd not ever heard of it) but after much searching on the Inet I found a medical reference which reported the association. I stopped the Welbutring and felt better shortly thereafter.

    December 28, 2010 at 17:51 | Report abuse | Reply
  14. Anne

    I, too, take an antidepressant. . . generic Zoloft (50 mg/day). I had been on a stronger dose, but have been able to cut back to the 50 mg. I had been having awful teeth clenching and resultant jaw pain as well. Ibuprofen can help to alleviate the symptoms. I did some research on the Web and found that for some people magnesium and/or a combination of calcium/magnesium can help. I started to take magnesium, and it has helped tremendously. I cannot recall the dosage; I take one capsule a day at night. It began helping me almost immediately. Check the Web and do a bit of research; I'm sure you will find the information. Good Luck!

    December 28, 2010 at 18:09 | Report abuse | Reply
  15. Jeff

    This sounds like what is called a "dystonia," and I had it, myself. It eventually lead to full-blown tardive dyskinesia, which I had for two years after i went off the antidepressant.

    December 28, 2010 at 18:31 | Report abuse | Reply
    • Halaluani

      Jeff, you're right. This is a low degree dystonia. But this is not something about which drug companies educate doctors. It's one of the many dirty little secrets about antidepressants.

      December 28, 2010 at 22:11 | Report abuse |
  16. Kate

    I had jaw pain after I started Zoloft. It lasted a couple of weeks.

    December 28, 2010 at 21:14 | Report abuse | Reply
  17. Ryan

    I have been on Paxil for two years now, but have also taken several other SSRI's. One noticeable side effect that always pops up when I take these drugs is the uncontrollable urge to yawn, followed by the shaking of my jaw. Anyone else ever have this?

    December 28, 2010 at 22:11 | Report abuse | Reply
  18. Suzanne

    I have been on an SSRI since shortly after the birth of my first child (22 years ago) first it was Prozac and now it's Paxil. I have gotten myself down from 40mg daily to 10mg daily with the help of my Naturopath a supportive husband (first husband was part of the problem) and regular exercise. I too have Tinnitus that has been prevalent for the past 10 years. I don't seem to have TMJ but do find my jaw is tight and dentist says I have huge jaw muscles. I believe as well that the Paxil has caused my Restless Leg Syndrome as it has gotten better with the reduction of my dose. I take a product called Natural Calm at night (a magnesium powder) and it does help settle my legs most of the time. In general I think that Anti-depressants are useful to help bring someone out of a deep depression ( I have been there) but don't feel they are beneficial for long-term usage. I have seen and heard of too many people with major side effects (I worked in Pharmacy for almost 10 years). My biggest issue right now is the Tinnitus....I sure wish I could stop this buzzing in my head even for a day.

    December 28, 2010 at 22:25 | Report abuse | Reply
  19. Scott

    A little wine, a little weed is all you need.

    December 28, 2010 at 22:43 | Report abuse | Reply
  20. Jessica

    Many anti-depressants can cause bruxism (grinding of the teeth) and clenching. I've had TMJ disorder for a long time, and jaw pain can be very difficult to deal with. This may seem obvious, but since the pain is in your head, it is ever present & hard to ignore. Anyway, one place I've found support and info is TMJ hope.... http://www.tmjhope.org
    They have a pretty active Facebook page, too. Hope you feel better...I wouldnt wish jaw pain on my worst enemy!

    December 29, 2010 at 01:26 | Report abuse | Reply
  21. vel

    I remember constantly clenching my jaw when I was on Zoloft. It hurt for about two weeks but finally went away. I'm guessing it was a side-effect that was in place during the acclimatization to the drug. As for the people who fantasize about conspiracies by the drug companies, there are millions of people who need those drugs, like my husband who is bipolar. If he didn't have them, I am quite sure he would be long DEAD. It's often the patients who demand the drugs as much as the companies shill them. If they can't think for themselves and make informed decisions, who is really to blame here?

    December 29, 2010 at 09:11 | Report abuse | Reply
  22. razzlea

    http://razzlea.blogspot.com/

    December 29, 2010 at 09:47 | Report abuse | Reply
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    Yes there should realize the opportunity to RSS commentary, quite simply, CMS is another on the blog.

    August 27, 2011 at 23:39 | Report abuse | Reply
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