Sertraline-induced bruxism: a case report and review of the literature.

BACKGROUND

Bruxism, characterized by involuntary teeth grinding and jaw clenching, is an uncommon but likely underrecognized adverse effect of selective serotonin reuptake inhibitors. Sertraline is generally considered safe for anxiety disorders, yet individual pharmacogenetic variability in CYP2C19 and CYP2D6 may predispose to serotonergic-dopaminergic imbalance and movement disorders.

CASE PRESENTATION: We describe a 42-year-old Indian woman with generalized anxiety disorder (baseline HAM-A 32) who was started on sertraline 25 mg/day and titrated to 50 mg/day on day 5. About 10 days after initiation, she developed severe bruxism with jaw pain despite clear clinical improvement in anxiety (HAM-A 12). The patient's bruxism was predominantly awake bruxism, characterized by daytime jaw clenching and teeth grinding during stressful periods. A dental evaluation ruled out occlusal abnormalities, temporomandibular joint inflammation, and tooth wear, and a mouthguard was deemed ineffective. A dechallenge with tapering and discontinuation of sertraline led to the resolution of jaw pain and reduction in bruxism. Pharmacogenetic testing showed CYP2C19*2/*17 (intermediate metabolizer) and CYP2D6*2/*41 (normal metabolizer). On the basis of Clinical Pharmacogenetics Implementation Consortium recommendations, she was switched to venlafaxine 37.5 mg twice daily, which achieved anxiety remission (HAM-A 6), but mild teeth grinding persisted. Adjunctive buspirone 5 mg/day led to complete resolution within 4 weeks. The temporal relationship, improvement on withdrawal, and a Naranjo score of 9 supported a probable sertraline-induced bruxism.

CONCLUSION

This case highlights sertraline-induced bruxism as a less commonly recognized but clinically significant adverse drug reaction. It shows that pharmacogenetic-guided antidepressant selection, combined with buspirone augmentation, can optimize management in selective serotonin reuptake inhibitor-associated bruxism. Clinicians should screen for bruxism during early sertraline titration, especially in patients with CYP2C19-reduced function alleles.