Strong Link Found Between TMD and Depression

BUFFALO, N.Y. -- Persons with chronic temporomandibular disorders, or TMD, are five times more likely to be taking antidepressants than persons who go to the dentist for routine dental care, a researcher at the University at Buffalo School of Dental Medicine reports.

Results of the study were presented today (March 11) at the International Association of Dental Research General Session being held in Baltimore.

"Chronic pain has been associated with clinical depression in various studies, and we know that many patients with chronic TMD also suffer from depression." said Heidi Crow, D.M.D., associate professor of oral diagnostic sciences and senior author on the study. "We were interested in comparing the use of antidepressant medications by TMD patients with antidepressant use in non-TMD patients."

Crow and Jacob Froerer, a dental student at Indiana University where Crow was a faculty member before coming to UB, reviewed 50 randomly selected charts of patients who had come to the Orofacial Pain Clinic at the Indiana University School of Dentistry for TMD treatment. They compared TMD records with 50 charts from general dentistry patients matched to TMD patients by age (within five years), gender and socioeconomic status.

Their findings showed that 38 percent of patients seeking treatment for TMD were taking antidepressants, compared to 10 percent of general dental patients.

"Generally, the thought is that chronic pain of any type, including chronic TMD, can lead to depression," said Crow. "Certain antidepressants, typically those known as tricyclics, have been associated with pain relief, independent of their antidepressant activity.

"Chronic pain is often a major component of TMD, and it can affect the prognosis of these patients. Knowing if TMD patients are taking antidepressant medication at the time of initial treatment is important, because it can limit types of medications you may be able to prescribe for TMD," Crow said.

"The side effects of some anti-depressants are similar to side effects of some muscle relaxants, and prescribing them together may amplify problems. Dentists must make sure there is adequate communication between all prescribing doctors so that potential side effects can be avoided."

Of those patients taking antidepressants, selective serotonin reuptake inhibitors (SSRIs) -- Prozac, Zoloft and Paxil are examples of SSRIs -- were the most frequently prescribed, study results showed. Eleven of 19 (58 percent) TMD patients taking antidepressants and two of five (40 percent) control patients taking antidepressants were using SSRIs.

Other antidepressant medications used were tricyclics, taken by four of 19 (21 percent) of TMD patients and two of five (40 percent) of the general dentistry patients. The remainder of patients -- four TMD patients and one control -- were taking a combination of these two types or another type of antidepressant.

The Dental Practice Act allows dentists who treat chronic TMD or other chronic orofacial pain conditions to prescribe antidepressants for pain control, Crow noted, but not for depression.

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York.