Does Cymbalta cause bruxism? (1+ case reports)

In this article, we will talk about Cymbalta-induced bruxism. We will also look into some case studies of Cymbalta-induced bruxism, factors contributing to bruxism, and the alternatives to duloxetine.

Does Cymbalta cause bruxism?

Yes, Cymbalta can cause bruxism in some individuals. Cymbalta-induced bruxism is a rare side effect; not all individuals who take Cymbalta experience this side effect. Bruxism is a movement disorder which involves clenching and grinding of teeth. (1)

Bruxism is most commonly reported with the use of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, venlafaxine and sertraline. Bruxism can be dose-dependent and can occur within 3-4 weeks of antidepressant therapy. The frequency and duration of the occurrences may vary between individuals. (2)

If you experience bruxism after taking Cymbalta and if it is affecting your day-to-day activities, seek medical help. Your physician may decrease the dose of Cymbalta or switch to another antidepressant. Do not stop taking your medication because of bruxism. Abrupt discontinuation of Cymbalta may lead to withdrawal symptoms and worsen your condition. 

What does the research suggest? 

Individuals being treated with duloxetine for depression have reported cases of bruxism. A case reported by Sahin et al. of a 44-year-old woman who was being treated with duloxetine 60mg/day for fibromyalgia came with complaints of severe teeth clenching, which was associated with loud grinding noises during sleep. As an intervention, duloxetine was reduced to 30mg/day, and even with dose reduction, bruxism continued, which led to the discontinuation of the drug. (3)

When duloxetine was reintroduced after three weeks, bruxism reappeared, which was then treated with amitriptyline 25mg/day, and after two months of this combination therapy, bruxism was resolved. (3)

Another case report of duloxetine-induced bruxism was reported in a patient who was being treated for generalised anxiety disorder. (4) There are two types of bruxism, namely awake bruxism, which is characterised by bracing or thrusting of the mandible when you are awake and sleep bruxism, which involves repetitive jaw muscle activity with clenching or grinding of teeth while you are asleep. (5)

What are the factors contributing to bruxism while taking duloxetine? 

Here are some factors which can contribute to bruxism: 

• Medications: Antipsychotics and other antidepressants, such as Celexa, Wellbutrin, Effexor, etc., can cause jaw clenching, which is associated with bruxism. 
• Stress and anxiety: Stress and anxiety can contribute to bruxism. Individuals may unconsciously clench or grind their teeth when they are stressed and anxious. 
• Mental illnesses: Disorders such as ADHD, PTSD, schizophrenia, etc, have an increased risk of causing bruxism. 
• Sleep disorders: Disorders such as sleep apnea, irregular sleep patterns or imbalance in sleep cycles can contribute to sleep bruxism. 
• Malocclusion: Misaligned teeth or dental imperfections can cause bruxism. 
• Caffeine and stimulants: Excess use of caffeine and substance abuse can increase the risk of bruxism 
• Genetics: Genetics can be a factor. If someone in your family suffers from bruxism, it is more likely that you will have it, too. 
• Neurological disorders: Disorders that affect CNS, such as Parkinson’s disease or Huntington’s disease, can contribute to bruxism. 

What to do if duloxetine causes bruxism? 

If you are experiencing bruxism after initiation of your therapy with duloxetine, consult your physician for guidance. Sometimes, bruxism caused by duloxetine is dose-dependent and needs careful tapering of the drug. Your physician may decrease your dose of duloxetine at first, and if the problem does not resolve, your physician may suggest switching to another antidepressant. 

Other drugs, such as low-dose pergolide, propranolol, clonidine and amitriptyline, have been shown to treat drug-induced bruxism effectively. However, further studies need to be conducted. Choosing a drug to treat bruxism should be done by a qualified physician. 

Even after discontinuing the medication, bruxism may persist for some time before it gets resolved. Do not stop taking the medication suddenly if you are experiencing bruxism. All antidepressants need careful tapering and monitoring before discontinuing the drug, as they can cause withdrawal symptoms and worsen your condition. 

What are the alternatives for duloxetine that causes bruxism? 

If you are experiencing bruxism after taking duloxetine, you can switch the medication to other antidepressants such as: 

• SSRI: fluoxetine, sertraline, paroxetine, citalopram
• SNRI: venlafaxine, desvenlafaxine, milnacipran
• Tricyclic antidepressants: amitriptyline, nortriptyline, imipramine
• Monoamine oxidase inhibitors (MAOIs): Phenelzine, isocarboxazid.
• Atypical antidepressants: bupropion, mirtazapine, trazodone. 

Non-pharmacological approaches include the following: 

• Biofeedback therapy involves procedures for individuals to help control and reduce their muscle tension consciously. 
• Cognitive behavioural therapy helps manage stress and address negative emotions, which are often linked with bruxism. 
• Practice relaxation therapy, such as deep breathing, muscle relaxation, yoga and meditation, to help reduce overall stress and muscle tension. 
• Night guards or splints can help protect the teeth, and dental correction in case of misalignment of teeth can help reduce the risk of bruxism. 
• Limit your caffeine intake and avoid alcohol as they may interact with the medication, causing an increased risk of side effects. 
• Maintaining proper sleep hygiene and sleep schedule may decrease the frequency of bruxism.
• Consider massage and specific exercises for jaw muscles to help reduce muscle tension.
• Maintain a healthy and balanced diet. 

In my experience, duloxetine may cause bruxism in a few individuals. Bruxism can be managed by behavioural and biofeedback therapy. If the adverse effect is severe, then it can be managed by either reducing the dose of the drug or discontinuing the medication.

Any adjustment to the drug regimen should be done under a qualified physician. I recommend you consult your physician if you are experiecning any side effects after taking duloxetine. 

References