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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by sam K on April 20, 2009, at 20:07:24
venting/please read
ever since I took LUVOX ive had this sensation in my teeth that DOESNT GO AWAY. It annoys me all day. If i stop taking antidepressants it goes away. I cant take any meds that help me feel better without this happening anymore. YOU have no idea how much this annoys me. It affects my voice, my expression. I hate it. every second of the day its happening. I just feel my teeth. when I talk, read, write, whatever I feel them. And its not a good feeling. It feels like they are moving/fallingout/weird cracking/bending feeling. Theres nothing i can do besides try something else. It makes me incredibly angry. I just want to move on and start lviing again.
My doctor says its an obsession. I say yea, probably is. But then I realize its actually happening. I physically feel sensation in my teeth. I cant even think,I always feel this in my teeth. Its incredibly hard to describe and Im sure no one will beleive me.
I feel my teeth right this second. The only time I don't feel them is when I rage, or distract myself.
Im on Trileptal, which is fine. I dont mind taking at all.
Then I added strattera, its good, but its causing the tooth thing.
I mean trully there is nothing anyone can do. Its really all up to me, and I hate that, sometimes I want someone else to do some work too. GOD.
gods an a**hole sometimes
Posted by sowhysosad on April 20, 2009, at 23:27:34
In reply to PERMANENT DAMAGE, posted by sam K on April 20, 2009, at 20:07:24
I've got a really similar problem: a bad reaction to SSRI's last year left me with a movement disorder in my jaw which affects my speech.
Whilst I've no doubt the disorder is organic to an extent, it's become grossly exaggerated as I feel constantly hyper-aware of my mouth and jaw. and the "awareness" heightens the symptoms.
I wondered if it was, like your doc said, a kind of obsessive behaviour, perhaps even with some crossover of symptoms with "pure" OCD. I figure the psychological symptoms could be the result of some rebound in the serotonin system (obsessive thoughts usually being related to serotonin), whilst the physical symptoms are almost certainly low dopamine.
Posted by Phillipa on April 21, 2009, at 0:12:00
In reply to Re: PERMANENT DAMAGE » sam K, posted by sowhysosad on April 20, 2009, at 23:27:34
I've taken low dose luvox for years no side effects like that but fears many fears. Love Phillipa
Posted by mattdds on April 21, 2009, at 1:31:49
In reply to PERMANENT DAMAGE, posted by sam K on April 20, 2009, at 20:07:24
> venting/please read
>
> ever since I took LUVOX ive had this sensation in my teeth that DOESNT GO AWAY. It annoys me all day. If i stop taking antidepressants it goes away. I cant take any meds that help me feel better without this happening anymore. YOU have no idea how much this annoys me. It affects my voice, my expression. I hate it. every second of the day its happening. I just feel my teeth. when I talk, read, write, whatever I feel them. And its not a good feeling. It feels like they are moving/fallingout/weird cracking/bending feeling.Sounds frustrating! Sorry to hear you are having a tough time.
SSRIs such as fluvoxamine are well-known to increase nocturnal bruxism (teeth clenching and grinding), which could be causing your current increased awareness of your teeth. They also seem to increase masticatory muscle tone (chewing muscles) during the daytime, and may be causing you to clench your teeth together during the daytime. Over time, this can strain the ligaments that attach your teeth to the bone, as well as your temporomandibular joint, and associated ligaments and muscles.
You are likely not even aware of this if you clench your teeth during the day and at night you are asleep so you certainly are not aware of it.
Try becoming aware of whether your teeth touch during the daytime. If they touch together outside of chewing or swallowing, this is considered "parafunctional". In other words, you are overworking your chewing muscles and teeth, which could contribute to the hyperawareness you are experiencing.
Try the following:
1. Leave a distance of 2-3 mm between your teeth at all times. Don't let them touch unless you are chewing or swallowing. You may be surprised at how much extra work your chewing muscles are doing.
2. Try soft foods for a week or so, give your chewing muscles a rest.
3. If your doc is willing, try amitriptyline 10 mg at night an hour before bedtime. This might help with the nighttime component over which you have little direct control. Flexeril might be a good option as well if you can handle the sedation.The good news is - I really doubt this is permanent. This is actually more common than not with SSRIs.
Good luck,
Matt
Posted by yxibow on April 21, 2009, at 3:02:15
In reply to Re: PERMANENT DAMAGE » sam K, posted by mattdds on April 21, 2009, at 1:31:49
I believe there could be an organic component to it but I also believe that there is a good chance that it may not be everlasting.
I think that there is some validity that it is in the OC Spectrum range of conditions, and that its not something to be taken personally, even though it sounds that way.
It also sounds sort of akin almost to a somatoform or conversion disorder where anxiety is causing a physical sensation.
Combined with some form of OC, this accelerates the worry over what is a -very- real sensation but is not necessarily organic, or has a low component of one.
Of course, this is what I am diagnosed, although its much more complicated than this situation, so I can't say that I don't have any bias in observing what it could be, but its more common than one thinks.
-- Jay
Posted by sowhysosad on April 21, 2009, at 3:33:23
In reply to Re: PERMANENT DAMAGE » mattdds, posted by yxibow on April 21, 2009, at 3:02:15
Yeah, there's definitely a BIG psychogenic component with mine Jay - the symptoms get better with hypnotherapy.
I had fairly mild physical symptoms for around 3 years from Cipralex (Lexapro), but they got much worse when I had had akathisia on Zoloft then spiralled into a deep rebound depression.
It's become something of an obsession since then as it's very socially disabling and is preventing me from working. My theory is that low serotonin is fuelling repetitive thoughts and rumination about the issue - almost to an "OCD-like" level - and this is making the manifestation of the symptoms worse.
I don't think it's conversion disorder as such (although it IS similar to a psychogenic dystonia which is associated with CD), as I've not had any MAJOR life traumas that would trigger it.
Going off at a tangent, I've been taking 60mg of codeine every night for a few days as an antidepressant (yeah, not ideal I know but I'm in a "med-free" period and it works!) and it's caused a sudden and dramatic improvement in the movement disorder.
It's gotta be the associated dopamine release that's doing it, which ties in with my original theory that the PHYSICAL aspect of the condition was caused by dopamine depletion. It makes a lot of sense - Lex & Celexa are the most selective SSRI's for serotonin so have a high risk for dopamine depletion, and my neuro says he sees the most SSRI-related facial dystonias from those two meds. Also, SSRI akathisia is caused by a huge hike in serotonin and a corresponding big drop in dopamine. It all fits.
I also wonder whether this "hyper-awareness" of the facial region and abnormal movements that Sam and I are experiencing are a type of region-specific akathisia? Kinda like RLS of the face! I do find myself obsessively using my jaw by chewing on lips and fingers and sometimes feel an urge to move it for no apparent reason.
> I believe there could be an organic component to it but I also believe that there is a good chance that it may not be everlasting.
>
> I think that there is some validity that it is in the OC Spectrum range of conditions, and that its not something to be taken personally, even though it sounds that way.
>
> It also sounds sort of akin almost to a somatoform or conversion disorder where anxiety is causing a physical sensation.
>
> Combined with some form of OC, this accelerates the worry over what is a -very- real sensation but is not necessarily organic, or has a low component of one.
Posted by SLS on April 21, 2009, at 7:16:00
In reply to PERMANENT DAMAGE, posted by sam K on April 20, 2009, at 20:07:24
It seems to be true that Cymbalta effectively treats the somatic pain that depression can produce. Also, there is Ixel (milnacipran), a new drug that might be even more well suited to address your present dilemma. Depression can cause tooth pain in my experience.
There is a chance that you have had tooth pain as a vulnerability that lay dormant. It could be that your exposing your CNS to Luvox caused the tooth pain that can be a symptom of depression to emerge. If this is true, it would make sense that the pain would recede when effective antidepressants are administered. However, in my experience, this tooth pain can get worse towards the beginning of treatment before it disappears altogether.
I truly hope that your experience with tooth pain is similar to mine. You might actually see it disappear as your depression disappears.
- Scott
Posted by Amelia_in_StPaul on April 21, 2009, at 13:17:07
In reply to Re: PERMANENT DAMAGE » mattdds, posted by yxibow on April 21, 2009, at 3:02:15
I hate to give a "me too" answer, but me too--I agree with everything Jay has said, and as someone with a complex pure O OCD that makes the line between an actual occurrence and my obsession over whether something is occurring very blurry, I can sympathize.
> I believe there could be an organic component to it but I also believe that there is a good chance that it may not be everlasting.
>
> I think that there is some validity that it is in the OC Spectrum range of conditions, and that its not something to be taken personally, even though it sounds that way.
>
> It also sounds sort of akin almost to a somatoform or conversion disorder where anxiety is causing a physical sensation.
>
> Combined with some form of OC, this accelerates the worry over what is a -very- real sensation but is not necessarily organic, or has a low component of one.
>
> Of course, this is what I am diagnosed, although its much more complicated than this situation, so I can't say that I don't have any bias in observing what it could be, but its more common than one thinks.
>
> -- Jay
Posted by sowhysosad on April 21, 2009, at 15:24:33
In reply to Re: PERMANENT DAMAGE, posted by sowhysosad on April 21, 2009, at 3:33:23
Another observation - I've deprived myself of sleep to try and correct my circadian rhythms, and sleep deprivation causes dopamine release.
The dopamine boost is borne out by the fact that cigarettes are making me feel extremely nauseous, as they do after I've taken opiates.
Again, the symptoms are very much improved.
I've ordered some enada NADH supplements to boost my dopamine - fingers crossed it alleviates my problems!
> It's gotta be the associated dopamine release that's doing it, which ties in with my original theory that the PHYSICAL aspect of the condition was caused by dopamine depletion. It makes a lot of sense - Lex & Celexa are the most selective SSRI's for serotonin so have a high risk for dopamine depletion, and my neuro says he sees the most SSRI-related facial dystonias from those two meds. Also, SSRI akathisia is caused by a huge hike in serotonin and a corresponding big drop in dopamine. It all fits.
Posted by sam K on April 21, 2009, at 21:48:06
In reply to Re: PERMANENT DAMAGE, posted by sowhysosad on April 21, 2009, at 15:24:33
THANK YOU ALL for the posts. I didnt expect ANY!! I read them all word for word. but i will respond more tomorrow, im really outof it/tired. THANK YOU cya
Posted by manic666 on April 22, 2009, at 12:25:11
In reply to Re: PERMANENT DAMAGE, posted by sowhysosad on April 21, 2009, at 3:33:23
if you look on the label for side effects in your med box , one is grinding your teeth, so it must be a known side effect
Posted by sowhysosad on April 22, 2009, at 19:15:58
In reply to Re: PERMANENT DAMAGE, posted by sowhysosad on April 21, 2009, at 3:33:23
Saw the neuro today and he suggested that codeine might be improving my movement disorder because it SUPRESSES dopamine?! That contradicts EVERYTHING I've read about opiates stimulating dopamine release, possibly through a GABA-mediated process.
If we decide to go with that theory he wants to try an atypical AP like quetiapine or olanzapine to antagonise the D2 receptors. Might also have the advantage of working synergistically with an SSRI against depression/anxiety when I go back on one.
He's open to my "dopamine depletion" theory too, but I'm not keen on his idea of going with levodopa to test it. Seems unnecessarily heavy-handed and risky to me. I'd prefer to stick to my plan to try NADH to stimulate dopamine.
I also suggested pramipexole as a DA agonist. He's not used it for a while but is open to looking into it again. He didn't like the idea of amantadine in a depressive as he claims it'll make me "mad" (to use his highly technical terminology).
However, either way, he's insisting my depression is under control before he adds another med to the mix which seems reasonable.
> Going off at a tangent, I've been taking 60mg of codeine every night for a few days as an antidepressant (yeah, not ideal I know but I'm in a "med-free" period and it works!) and it's caused a sudden and dramatic improvement in the movement disorder.
>
> It's gotta be the associated dopamine release that's doing it, which ties in with my original theory that the PHYSICAL aspect of the condition was caused by dopamine depletion.
This is the end of the thread.
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