Facial tics, jaw, tongue muscle tension and pain, bruxism, teeth clenching, TMJ

[Barbarannamated]

I've taken Klonopin (brand- clonazepam requires higher dosage) qhs for bruxism since 1995. I ran out last nite and took a temazepam (hubby relinquished one but only after mandatory stupid questioning "WHY did you run out?"). I slept ok, but woke with characteristic symptoms of nighttime bruxing/clenching: orofacial pain, aching teeth, NECK TIGHTNESS/pain, slight dizziness. I know this contradicts everything about benzo tolerance, but Konopin *seems* to still be exerting some effect on nighttime bruxism. The pain pattern is EXACTLY the same as when I was battling severe TMJ that began around the time I started Zoloft. Of course, I became dependent on Klonopin/benzos early on. Every time I've missed a dose or substituted equivalent dose of generic, I've woken with same pain pattern. I currently take 1/2 of a 2mg tab. The breaking is inconsistent so dose varies, I now realize. I'd be very very bad at the slow, precise tapering you all describe.

 

I don't understand why Klonopin still "works" after 17 years, especially if my theory that Zoloft/SSRIs caused bruxism is correct. I've been off of my last SNRI for about 1 year (on succession of SS/NRIs since 1993, uninterrupted). Currently on trazodone 75 qhs. I haven't researched trazodone and bruxism. Will do that.

 

My pain doc has mentioned doing a sleep study in the past. I may proceed with that just to glean any information on the bruxism. I've been told that I am a 'very active sleeper' - talking, thrashing about, etc.

 

Dosage of Klonopin has ranged up to 4mg qhs. I decreased and increased over the years with no method aside from breaking tabs in 1/4s. (I feel a collective cringing from all benzo taperers). In addition, the detox program in 2008 DCd 2mg Klonopin cold-turkey and substituted diazepam or lorazepam. I didnt sleep well for 3 nites, woke in HORRID pain and was simultaneously CTd from opiate. They substituted ALOT of Imitrex and toradol IM and oral. Acupuncture (ear point) helped but didnt last thru night of bruxing. I left AMA after 3 days with a warning from Medical Director/Addictionologist that I'd be dead by age 48. I'm 49, so HA!! (insert bird flippin' emoticon) And I have to mention that the entire reason for going into detox (for 2 15mg tabs of oxycodone/day and 2 mg Klonopin) was "to allow SNRI/Cymbalta to work for depression". I developed offthecharts anxiety after that 3 day stint and was put on Paxil and Risperdal.

 

This was Loma Linda University Medical School detox facility. Very bad reputation, I now know.

[Barbarannamated]

I've been through extensive interdisciplinary treatments for TMJ - orthodontia, PT, biofeedback, EMDR, Scripps and Cedars-sinai maxilofacial pain programs, many many drugs. I believe it's classified as movement disorder/parkinsonism.

[Skyler]

Every time I've missed a dose or substituted equivalent dose of generic, I've woken with same pain pattern. I currently take 1/2 of a 2mg tab.

Have you tried 1 mg tabs? Sometimes the breaks in the pills vary considerably.

 

I don't understand why Klonopin still "works" after 17 years, especially if my theory that Zoloft/SSRIs caused bruxism is correct. I've been off of my last SNRI for about 1 year (on succession of SS/NRIs since 1993, uninterrupted). Currently on trazodone 75 qhs. I haven't researched trazodone and bruxism. Will do that.

The article I put up on hypnic jerks is wanting, I may be putting up a better one. I had jerks when sleeping for ooh, about 20 years.. they were an iatragenic effect from imipramine. They were very severe to the point I could not get any sleep without medication. It seems like they have finally subsided, but given that, I’m not surprised to hear about your bruxism. That sort of side effect seems to be more prevalent with Ads.. The benzo folks seem to overlook the fact klonopin is clinically effective for some extended periods of time.

 

My pain doc has mentioned doing a sleep study in the past. I may proceed with that just to glean any information on the bruxism. I've been told that I am a 'very active sleeper' - talking, thrashing about, etc

Sleep studies can be very helpful.. suggest you go for it..

 

In addition, the detox program in 2008 DCd 2mg Klonopin cold-turkey and substituted diazepam or lorazepam. I didnt sleep well for 3 nites, woke in HORRID pain and was simultaneously CTd from opiate.. I developed offthecharts anxiety after that 3 day stint and was put on Paxil and Risperdal.

Horrendous.. Risperdal? They should take it themselves. There must be a lot of people who work at detox centers who are sadists.

[Tom]

My dentist had a mouth guard made for me to sleep with, but I never quite got used to it. Did it do anything for you? The reason I ask is that I know a couple of people that it really helped. Like anything, I guess it works for some and not others. I'm thinking about giving it another shot.

[Barbarannamated]

@ Schuyler - the Risperdal was started by another psychiatrist trying to clean up the mess after the detox fiasco. For me, Risperdal did nothing. Seroquel was nasty. Zyprexa made me eat nonstop. Abilify helped slightly. These were all for depression, never bipolar, psychosis, etc. Nobody checked endocrine function beyond TSH. All the crap was worsening that and 'depression'. It's tough to move past that.

 

@ Tom - yes, I've had many custom mouthguards over the years. Wore a full mouth one 24/7 for a year or so. Made my sales job interesting as I couldn't talk well - sympathy sales

That was an attempt by an orthodontist to realign my entire mouth in preparation for braces.

Weekly visits to adjust the mouthguard. It did help considerably; my whole face changed shape as my muscles relaxed after being hypertonic (?) for years. When orthodontist placed the little spacers between teeth to prepare for braces, I was in extreme pain that Vicodin wouldn't touch, so the braces were scrapped. I did have braces as a kid (12yo). Had other biteguards over years, the most interesting being a little dime-size one worn on front teeth to help proprioception. http://www.nti-tss.com/ NOT AN ADVERTISEMENT!

 

Please forgive the long answer. I become so overwhelmed when I think back on all of the treatment I've had over 18 years while no doc (even endocrinologists) looked a little deeper. I just read a brief report by endocrinologist that stated "she does have slight tremor, probably related to some of her psych medications".

[bubbles]

I've got a little mouthguard that fits over my front bottom teeth - the front four and the side couple. It is pretty small and I got used to it very quickly. I only clench at night and I only wear it at night. It makes a big difference and I notice it if I don't wear it. I am pretty sure I am still clenching (as I definitely brux if I don't wear it) so it isn't stopping it, but it is reducing the pressure on my teeth and therefore allowing it to heal a bit - I am certainly getting a *lot* less dental pain. It's a bit bigger than the one in your link, Barb.

[Skyler]

@ Schuyler - the Risperdal was started by another psychiatrist trying to clean up the mess after the detox fiasco. For me, Risperdal did nothing. Seroquel was nasty. Zyprexa made me eat nonstop. Abilify helped slightly. These were all for depression, never bipolar, psychosis, etc. Nobody checked endocrine function beyond TSH. All the crap was worsening that and 'depression'. It's tough to move past that.

 

The only thing respirdal does is turn down a person's subjective world, so if they hear voices, the voices are muted, if there is anxiety, it's less distressing. Problem is, it turns down all subjective experience, the inner world becomes lessened.

 

You were tried on drug soup, and all the crap would have worsened depression. Sounds like malfeasance to say the least.~S

[floaks]

Hi, I went off luvox (150mg) on August 1st, 2013 almost cold turkey after being on it for 4 years since 2009. I had earlier also tried to gradually (very very slowly over the course of a year) quit luvox and that time I developed peripheral neuropathy, TMJ, jaw pain, teeth problems. I went back on it and my withdrawal symptoms improved. The doctors or my psychiatrist never agreed that it could be because of luvox. Later my physician who was treating me for neuropathy admitted that it could be because of luvox doing somethig in the brain. He was never able to figure out a cure and told me to go back on it and  exercise more. I went back on luvox and with time (more than a year) and exercise my neuropathy symptoms became manageable.

 

Now that I had quit taking luvox completely again in Aug 1st 2013, I started experiencing severe sensitivity in teeth two months after stopping it. It was so bad that I wasn't able to rinse my mouth with water at room temperature. Gradually by the end of third month that developed into severe teeth and jaw ache and pain in gums and now I have to be on ibuprofen continuously. I don't know what I should do. Sometimes even ibuprofen doesn't help either or takes time to kick in. My dentists says that my teeth look alright.

 

I found this website which is a bit helpful but it is a closed forum now and is no longer operating: http://antidepressantwithdrawal.info/forum/showthread.php?149-Antidepressant-Withdrawal-Induced-Dental-Pain-Distress-and-Sensitivity

 

Any help will be much appreciated. Thanks.

Alex

[skybert]

I used to have a lot of trouble with this. Still have some small issues every now and then.

It kind of felt like my teeth didn't fit in my mouth anymore, or something was just wrong with my whole mouth. It was painful and caused me a lot of headache.

I think it is because we clench our teeth at night. 

You could wear a mouth guard or something like that. It is to my understanding pretty common in withdrawal.

It gets better.

Hang in there:)

[floaks]

Thank you Skybert. You have given me a lot of hope.

 

While I was on luvox I started having these symptoms and pain in jaw and cheek bones. My dentist at that time also said that probably I am clenching my teeth in night. Now that I have completely stopped luvox this pain has become unbearable. (I read Dr. Glenmullen's book, Prozac backlash where he says that these drugs can cause these conditions and also suppress the symptoms while you are on it. But once off these meds, these symptoms appear in full swing.) Usually my pain pain is worse in the morning when I wake up which again means that I am clenching in the night. I also feel like there are stones in my mouth instead of teeth. Also my gums have become red and swollen.

 

I tried one of the mouth guards that we get over the counter in wallgreens or CVS pharmacy. It seemed to help for two days but afterwards when I would wear it my teeth started feeling stiff and would hurt as if someone is holding them tighter than normal. So I had to just remove it from my mouth. Probably I have to ask my dentist to get a custom made one. But I am not sure if that would help. May be the size of that mouth guard was shorter or may be my teeth have moved. Have you tried any over the counter mouth guards? Thank you again for your reply.

[floaks]

Also, one question I want to ask is that is it OK to take ibuprofen to get some relief from this pain. I am on ibuprofen continuously. If I don't take it every 8 hours the pain becomes unbearable. I have to take 400 to 800mg every 8 hours. I try to take less and at larger time intervals but sometimes it is just not possible. I also try to alternate between acetaminophen and ibuprofen. Is this ok or could this cause further problems for me? Are their any alternatives? Thanks.

[skybert]

This sounds very familiar indeed:P You describe just what I experienced. I never got around to get a mouth guard. 
Maybe because I'm very used to this kind of pain from my younger days I wore braces and all kinds of crazy stuff to fix my messed up teeth. 
But the fact that you get pain from over the counter mouth guards make very much sense and that tight feeling is classic when it's not custom made.
Maybe there is something better for this problem out there. This topic have been discussed here:
http://survivingantidepressants.org/index.php?/topic/1058-bite-guard-for-teeth-grinding-clenching-bruxism/?hl=clenching
 
I used some ibuprofen thing for this problem.  I can't really give very much advise about using ibuprofen or acetaminophen. I'm fairly new on this forum and maybe someone with more experience would chime in on that subject. Just don't overdo it I guess and pay attention to how it makes you feel.
But try not to worry about it. It will pass:)

[floaks]

Thanks Skybert. The link you gave is quite helpful. I am more hopeful now after talking to you.

[floaks]

Hi Skybert

 

I also want to mention that probably my teeth ache is not just because of grinding in the night. I think that the nerves in my teeth are inflamed. If my nerves die then I would need a root canal like what happened with one of my tooth. If they get better then everything should be fine. I am saying this because when I gradually stopped luvox last year I started getting peripheral neuropathy. So, in my opinion ssri meds also affect the peripheral nervous system. 

 

Also I came across the website "the road back" and ordered their supplements. I am sure you must have also heard about this website. I was initially worried to order anything from there because no one knows whether they are trying to make money or are really trying to help.  Also I had not other option and at this point I had already wasted so much money on dental treatment that spending a few dollars on their supplements didn't seem that I would lose anything. Within 30 minutes of taking their supplement I found immediate relief. The uneasiness in my teeth is till there but it has only been a day that I have taken their supplement. After about 20-25 days of being on too much ibuprofen, yesterday was the first day that I could do without it. My TMJ hasn't improved at all on taking this supplement but I am glad that tooth ache is in control and I can live without ibuprofen.  I am hoping that continued use of their supplement as they prescribe should help me with the withdrawal. I am just so relived that i do not have to take ibuprofen. I emailed them before ordering anything from their website. They provide free consultation over email and suggested me to only take neuro endure mini. They have other supplements listed on their website as well but they said that for my particular case I only need neuro endure mini and not anything else. Because they did not try to lure me to purchase all the supplements that they sell I am thinking that may be the are really trying to help. I thought that I should let you know. I will also keep updating about how I am doing on this supplement and whether my symptoms improve or get worse. I am hoping they don' get worse.

 

 

Thanks

[floaks]

Also I found this forum on neuropathy induced by SSRIs

http://ehealthforum.com/health/neuropathy-from-using-prozac-t187252.html

[floaks]

Now it seems to me that I have written the above post too fast. I am still feeling uneasy as if having a flu. My face seems swollen and limbs are achy too

[floaks]

And now that I have been up from my bed for a while the stuffy feeling in face is disappearing. the symptoms get worse when I lie down.

[Barbarannamated]

FYI

 

Drug-induced bruxism

 

http://legacy.uspharmacist.com/index.asp?show=article&page=8_1418.htm

[UnfoldingSky]

I am wondering how many other people have this?

I might have tardive dyskinesia from having taken and reacted to several drugs (one an antipsychotic used off label for another drug reaction.)  The symptoms are so mild now though that I forget I might actually have it.

 

However, every, oh, year or so, I'll have a problem where my jaw won't close, then it moves sideways on its own.  It happens, freaks me out (my jaw will just get stuck for a minute or so), and then it moves, then hurts a lot, then it clears up.

 

So it has happened tonight just out of the blue...only it still feels like my jaw is off.  Seems worse than the last time it happened.  Feels like it could get stuck again, and also like I'm having some mild troubling swallowing.  Like I have to think too much about swallowing.

 

I'd stopped really thinking about TD and  sort of convinced myself it was gone.  Now I don't know what to  think.  I know jaw problems can come with it, but do others have this who DON'T have other signs of TD?  (other signs are things like uncontrollable blinking, jerking of hands/feet/limbs)

 

Also, what do I do if it locks or starts moving uncontrollably???  I can't take benzos, or other psych drugs...next time they will be likely to kill me.  Are there other remedies in case this gets worse?

I feel so, so, so terrible for people with severe TD, any "doctor"  who gives anyone TD belongs in jail. 

[Meimeiquest]

That is a problem with the TMJ (temporal mandibular joint or something like that). It is a common problem even apart from tardive dyskinesia. I think a dentist would be the first point in getting help, but I could be wrong. It might be caused by grinding your teeth in your sleep. Sorry you have one more thing to deal with!

[UnfoldingSky]

Hi Meimei, and thank you so much for your reply.  Is it possible if I don't grind my teeth that it's still TMJ?  I'll gladly believe it's that over TD, this is very scary to have to deal with.  I haven't had many of the other symptoms of TD recently, so I am hoping it really isn't that. 

[Meimeiquest]

Absolutely it could not involve teeth grinding. Absolutely it could be from tardive dyskinesia. And it would still be aTMJ problem. It's also possible a dentist can't help you, but that is where I would start. Maybe others have seen it done other ways as well. We had a friend who had a total life nightmare from TMJ, but you've already had your total life nightmare .

[UnfoldingSky]

Definitely have had my life's fill of nightmares...Thanks for responding Meimei.  It's calmed down some since I posted about it, but there's a strange feeling left over in my jaw that makes me think it'll start up again. 

[UnfoldingSky]

Well now I have spoken to a relative who doesn't have TD but also has similar issues.  So it's looking like you were right Meimei...I think that it could be caused by TD but led to TMJ.  His description is quite similar to what I have.

 

Apparently the nonsurgical treatments include acupuncture, which I am doing.  So hopefully that will be enough to keep this under control.

 

He also said he hasn't read about anyone having their jaw lock and not unlock, so that was comforting.

[LexAnger]

Jaw pain is a common wd effects as it did to me, although I now am thinking it was more likely caused by the generic lexapro. It was so intense one time in the early stage of the wd it actually triggered my first ever panic attack. It has been with me for a whole year now I only started feeling a tiny bit better after 6 months back to name brand. Now I can bite without much pain. I never had closing mouth problem though but hard to open my mouth. It also causes head pain, shoulder pain and even back pain when it's really bad.

 

I went to my dentist and he recommended another dentist specializing in Tmj. I will update after seeing him.

 

Jaw pain has been reported by others as wd symptom from other ADs

[UnfoldingSky]

LexAnger, so sorry to hear you are experiencing the same problems. I hope the dentist can help.  I may see my doctor to see if this isn't linked to something he might be willing to actually diagnose, then probably a dentist too as I expect that won't go well. 

[LexAnger]

Thank you unfoldingsky!

Surprisingly, I had a very good day today with minimal pain. I actually started having on and off windows in the past week. Changes made include 1) switched back to brand for 6 months 2) stopped PPI 3 weeks ago. Don't know which is causing the effect or maybe just timing since tapering. No matter what the reason is, this indicates my brain is not permanently damaged in terms of the pain. So there seems hope and hang on there. If it continue improving, jaw doctor visit may not be necessary. I will keep you updated.

[UnfoldingSky]

Good to hear things are improving for you Lex.  I wonder if there was some interaction between the SSRI and the PPI that caused your problem?  Were you on the PPI the whole time you were taking Lexapro?

[LexAnger]

Thank you, upholdingsky!

Yes I have been on ppi for 15 yrs until 3 weeks ago. I'm happy to tell my pain (jaw, head, neck, back) is continuing improving. I actually had the best day ever since one yr ago starting tapering! I used all recommendations like mouth guard, Mg, fish oil, relax and support (supplement from a tapering program from POINT OF RETURN), alcupuncture, massage, chiropractoring, nothing really helped except for some temp and slight relieve (chiropractor Is the one helped most).

 

For the first time in the year, I regained feeling of enjoyment of being alive, music is dance to, sky is blu, and can laugh again. I know I still have a long way to go to be completely off, but really am grateful to the break and the confidence it provides.

 

Since you are off the AD for 3+ yrs and most other symptoms are gone. With the severity of your jaw problem, I would think it important to see a TMJ doctor to have it checked out. The bad news is TMJ specialist is very expensive and usually not taking insurance. If that's a concern, you may want to try to use a mouth guard first for a while see if it helps. You can get one round 20-30 bucks from drug store. Also, my chiropractor is really good at it too for pain. I did alcupuncture by a nationally recognized Chinese doctor but did not help.

 

I do hope something will help and eventually fix it. I know how miserable it feels. Since Yous is not WD anymore, there should be some professional who can help.

[UnfoldingSky]

Thank you for your concern Lex!  Glad to hear that you are improving.  Sounds like you are in a window, may it continue indefinitely!

 

Re TMJ specialists, I am in Canada so likely it is covered for me.  Chiropractors aren't usually though...I may try the mouth guard anyway though since I am getting tired of the pain.  I wake up sometimes with sharp pain in my ear on the side I have been sleeping and that certainly isn't helping a sleeping issue I developed because of the drugs. 

[LexAnger]

You are exactly right unfoldingsky! What I am getting is windows as today was not as good as the past two days, although still better than before. This is still hopeful to me as I was thinking the damage is permanent since my brain seemed not doing anything and the pain never lessened regardless what I did in the past year.

 

I had the ear pain sometimes too, most time in middle of nights and it did go away in the morning or so.

 

I'm glad you are covered for the tmj. I have to pay co-insurance for chiropractor too, but with the 24/7 pain for that long, I feel it worthwhile for the short break chiropractor provides.

 

If no structure changes to your jaw, time is the main force eventually takes effect. The jaw problems is believed caused by too much stress hormone so avoiding stress is important.

 

Another thing I tried and helped is the guided medication for pain management.

http://quietmindcafe.com/pain-management.html

 

Hope you feel better soon.

[UnfoldingSky]

Thank you Lex!  Sorry to hear your window isn't as strong today.  At least you know though you are not permanently damaged.  Hopefully tomorrow will be a better day for you.

 

I didn't realize that stress was such a big component of this.  I figured it would be involved but it sometimes just seems to have a mind of its own.  The first time it came on I was on vacation...not doing anything stressful.  Or maybe I was and just didn't realize it..maybe I need a vacation from my vacation, lol.

 

Thank you for the pain management meditation, I am going to try that.  I will also pass it on to someone I know who has chronic pain from an unrelated health problem.  We've been looking for some alternative solutions so your timing is perfect!

[LexAnger]

It is believed Ssri changes the hormone cortisol level which in turn causes muscle tension including jaw pain. During withdrawal, cortisol level is much more controlled by the drug changes than the physical environment.

 

http://www.shape.com/lifestyle/mind-and-body/symptoms-stress

 

Hope less pain to all of us, day after day, even it's extremely slow.

[UnfoldingSky]

I hope so too, Lex.

[Meimeiquest]

If you put your thumb inside your mouth and fingers outside, near the joint, are the muscles tight and painful? Sometimes massaging them in that position helps me. I just bought a mouth guard but I need to fit it still. Sometimes I wake up with my lower front teeth jammed over the top ones.

[LexAnger]

Good tip on massaging! That's also what was suggested by my chiropractor. Need to start doing it. It is important to have a month guard not only for the pain, also for the tooth protection. My teeth are wored out a lot more than they are supposed topper my dentist.