TMD and Misinformation: Antidepressants will Fix TMD #14

TMD and Misinformation:  Antidepressants will Fix TMD

This is the 5th in a series of articles on common misinformation and misconceptions about treating TMD.

Antidepressants are commonly prescribed in the 21st Century. According to one study in 2020, “During 2015–2018, 13.2% of Americans aged 18 and over reported taking antidepressant medication in the past 30 days. Antidepressant use was higher among women than men in every age group. Use increased with age, in both men and women. Almost one-quarter of women aged 60 and over (24.3%) took antidepressants”.  According to another study in 2011, “Seven Percent of all visits to a primary care doctor now involve a prescription for antidepressants, according to the study, which was just published in the journal Health Affairs. Aug 4, 2011”.

Why are so many antidepressants being prescribed?  The answer to that is very involved and highly controversial and not appropriately covered in this article about TMD.  What is known, and factual is many prescriptions for antidepressants are written for patients with TMD symptoms, whether or not the medical provider knows those symptoms are caused by TMD.  In the practice of medicine, a huge number of prescriptions are written to address symptoms without the provider being certain of the diagnosis.  They are written just to treat the symptoms and not the cause.  Again, discussing that problem is beyond the scope of this article.  But we know many prescriptions for antidepressants are written for symptoms of head and neck pain and specifically to address bruxism. (Clenching and grinding of the teeth).  Exactly how many prescriptions per year are written for these symptoms is unknown.  The theory behind prescribing antidepressants is that bruxism is related to stress and anxiety.  And it is accepted that chronic anxiety can lead to depression.  The theory follows that to decrease the stress and anxiety and therefore bruxism, which is a known cause of TMD, prescribing antidepressants is appropriate to treat TMD.  When prescribed to reduce stress and anxiety and therefore bruxism, antidepressants are used “off label”, since antidepressants are not approved for the treatment of TMD.  As discussed in earlier articles and elsewhere, the dental and medical profession knows little to nothing about bruxism other than it is related to stress and anxiety.  There are a lot of theories about how stress and anxiety creates bruxism, but currently they are only theories.

Below is a list of the most common antidepressants. 

Rank Drug name 2021 prescriptions
1 Sertraline hydrochloride 18,337,255
2 Trazodone hydrochloride 15,175,105
3 Bupropion hydrochloride 14,849,877
4 Fluoxetine 12,925,013
5 Duloxetine 11,168,323
6 Escitalopram 9,632,164
7 Venlafaxine hydrochloride 7,995,409
8 Citalopram hydrobromide 7,181,357
9 Escitalopram oxalate 6,958,167
10 Amitriptyline hydrochloride 5,107,340
11 Mirtazapine 4,408,503
12 Paroxetine 4,114,922
13 Sumatriptan succinate 2,152,081
14 Sertraline 1,726,142
15 Sumatriptan 1,659,173
16 Citalopram 1,626,946
17 Desvenlafaxine 1,452,868
18 Nortriptyline hydrochloride 1,400,642
19 Rizatriptan benzoate 1,375,510
20 Doxepin hydrochloride 1,249,531

Fig. 1.  Data from the Definitive Healthcare ClaimsRx product. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Data accurate as of June 2022.

It is beyond the scope of the article to discuss these antidepressants and their method of action.  However, it is well known that each type and class of antidepressant has many devastating side effects associated with their use.

Using the above information, the question is why would a patient be best treated for the symptoms of TMD using antidepressants when it is accepted and proved that the symptoms of TMD are caused by inflammation within the temporomandibular joint (TMJ)?  When the inflammation within the TMJ is decreased by unloading the joint consistently and completely over a period of time, all the symptoms of TMD subside.  Why would a patient or a doctor prefer to use antidepressants with this knowledge and under these conditions?  I’ll allow the ready to answer the question and be the judge whether using antidepressants to treat TMD is mis-information.