Dental Health Library Article
TMJ and Depression - Is There a Link?
National Institute of Health statistics show that over 25% of the population suffers from some form of headache problems. Statistics also show that 25% of the population also suffers from some form of depression or “mental stress.”
Could there be a relationship between headaches and mental problems? Could there be a relationship between stress, headaches, mental issues, and health deficiencies?
It is believed by many tmj treatment specialists that there is indeed a dynamic link. This article will provide the anatomy of the dynamic.
Today, over 50% of people who suffer with some sort of depression remain undiagnosed. The remaining 50% receive treatment that is inadequate. 20% of sufferers become chronically depressed, while than 6% of patients who suffer with depression are properly managed. Alarming statistics!
Headaches ... possible migraines... ears ringing ... vision problems that seemingly can't be corrected. Ineffective chiropractic treatment. Feelings of being irritated, angry, bitter and losing control over sensory processes. Reports of frequent colds and flu are common.
Physically, the body doesn't seem to be working anymore. Life feels miserable and no one seems to understand why and what can be done.
TMJ Jaw Relationships
It has been shown that many TMJ related problems go undiagnosed by an alarming number of dentists and doctors. The Trigeminal nerve has also been proven to affect certain brain processes. Most chronic head pain conditions present with NO clinical signs of any jaw joint damage or jaw to jaw misbalance problems.
Many people report consulting with TMJ dentists who find nothing wrong. Similar results occur with consults with physicians and medical doctors. Most physicians can only prescribe medications and send the patient home. Remarks like "it’s all in your head" are frequent.
Yes... the problem is indeed "in your head." Precisely the reason why a skilled facial/head pain specialist takes jaw joint x-rays and finds a chronic problem with TMJ and a poor alignment of a patient's jaws. This is all too common.
The Cycles: Pain - Stress - Depression
The pain cycle may have started early in life. It may have waited until later years. It does not matter what the timing may be. What is important is to understand that pain leads to multiple health problems, including depression.
Does stress have anything to do with this cycle? What does stress do to your health? Is it related to pain? Does pain cause stress, or vice versa? Does stress cause you to grind your teeth? Does stress wear out your jaw joints? Does stress have any effects on your jaw and neck muscles? The answer is usually: Yes to all of the above.
Stress can cause pain, and vice versa. Stress can induce jaw misalignment problems by starting a vicious cycle of tooth grinding and clenching. Stress can cause postural problems. Stress can exacerbate many health conditions. Stress can lead to depression by causing a cascade of physical changes and problems.
Popular Medications: Ineffectual Long Term Benefit
Many of the patients we treat in our practice come to us with chronic pain conditions. They have spent tens of thousands of dollars on useless treatments. Many have exhausted their personal resources for continued treatment. Unfortunately, during this process many have been prescribed antidepressant medications and/or mood enhancing drugs. These “poisons” have helped the condition to a certain extent, but have done nothing to address the underlying problems that are causing the pain. The patient progressively gets worse and these common drugs (such as Prozac, Effexor, Elavil) no longer have any effect.
Pain and Depression Cycle - An Anatomy
The anatomy behind the pain and depression cycle can be explained. Inside the brain, there are various areas that perform different functions. One of these areas is the Hippocampus and the Amygdala, which together process emotions, learning, memory, fears, and the “flight-fight” response.
C.A.N.E. - Neurotransmitter Overproduction
Typically, patients who suffer with pain and/or are under a lot of stress have chemical compounds (cortisol, adrenaline, and norepinephrine C.A.N.E., for short) are released in high concentrations by the adrenal glands. This is commonly referred to as an “adrenaline rush.” This is due to the fact that the body processes the pain and/or stress as a fearful and life threatening event that it must defend against “fight” phenomenon of the sympathetic nervous system. The C.A.N.E. rush slowly poisons and damages the Amygdala and Hippocampus. These brain center areas subsequently start to lose their normal levels of serotonin and dopamine (neurotransmitters) which they use to process emotions, learning, memory, and fears. The nerve tissues themselves undergo atrophy.
Adrenaline speeds the transport of oxygen rich blood to the brain and muscles in order to prepare it for “fighting.” Consequently, adrenaline also places more physical stress on the body and organs because it increases heart rate, respiration, rate, and blood pressure in order to prepare the body for a QUICK defensive measure. This is the reason that pain and stress are correlated with high blood pressure, stroke, and many other illnesses.
The actions of these neurotransmitter hormones (C.A.N.E) are normally only supposed to be short term. Problems begin when prolonged periods of stress and continued pain start to damage brain cells, especially in the Amygdala and Hippocampus. Therefore, persistent, long-term pain and stress, affects processing of emotions, memory, and learning.
Consequently, as this damage continues, the immune system is also compromised and the patient begins to suffer numerous injuries and diseases (numerous colds and flus as the most common). The immune system views the problem as a low grade infection! Arthritis, obesity, infections, diabetes, and Alzheimer’s have also been linked to this vicious cycle.
Neurotransmitter Overproduction inceases Muscle Compression
C.A.N.E. hormones tense muscles. This tension continues without the patient being aware of the actions. The result is that muscle/skeletal pain begins. Significant implications develop for the the actions of the muscle bracing phenomenon of the jaws, head and neck, which exacerbates the pain cycle.
Where does the TMJ come into the picture? Muscle compression, bracing, and jaw joint damage causes the trigeminal nerve to become pinched. This compression, along with tension in the muscles of the head and neck, leads to abnormal function in the other nerves of the head (facial, hypoglossal, vagus, accessory, etc.) As these nerves are affected the patient starts to experience many of the wide ranging symptoms often reported by pain patients with unsuccesful treatment histories.
The trigeminal nerve also feeds many of its impulses into the Hippocampus and the Amygdala. As the trigeminal sends numerous and constant “bad” messages into this area, the processing of external events (emotions, learning, memory) becomes affected. The Hippocampus and the Amygdala stop being able to process normal impulses due to the fact that they are being annoyed by the trigeminal nerve and destroyed by the C.A.N.E. Therefore, the trigeminal bombards/annoys the area of the brain that processes happy emotions, proper learning, and adequate memory recall. Add the insult already being caused by C.A.N.E. and it is easy to see why the patient begins a cycle of depression and pseudo-retardation.
Many patients wonder if they were born with the problem or if stress induced their issues. One thing is certain: any misbalance of the jaws and/or jaw joint damage will cause a variety of mental problems.
If the patient was born with a jaw misalignment there is a very high likelihood that the balance problem has slowly led to many of the health issues. If stress has caused jaw joint damage through grinding or clenching, then two problems exist that must be addressed: the cause and the effect. Treatment aimed solely at healing the joint cannot be predicted or successful without addressing the cause – STRESS!
Many of the patients we treat have a higher than average stress level in their lives. If they were born with a jaw misalignment than the damage and symptoms are exponentially increased. It’s like adding fuel to the fire! Many of these same patients do not believe or “feel” as though they are under a lot of stress. It takes less than a 5 minute interview to figure out exactly how much stress a person is under.
Although not a generalization, the following is a list of common denominators for those who do not believe that stress is affecting their lives:
- Heavy daily workloads with few breaks
- Work routines that have little meaning and no satisfaction
- Minimal participation with co-workers in decision making
- Limited interaction with friends and family
- Poorly defined expectations in life, work, love, and friendships
- Unpleasant or dangerous work environments
- Addiction to alcohol, drugs, or sweets
- Paying little attention to diet and/or liquid consumption
If three or more of the above items pertain to you, take a serious look at your stress level and consider the consequences of the release of C.A.N.E that may most likely be happening in your body. Remember the “fight” response. Also consider whether a pre-existing or developing jaw problem is contributing to the problem
Common Stress Symptoms
Other popular symtoms that are reported with headaches, jaw pain, neck pain, ear aches/tinnitus include:
- Sleep problems
- Upset stomach
- Low morale
- Weight gain
- Poor concentration
- Untreatable burning/sore throat
- Multiple flus and cold
- Asthma or asthma-like symptoms
- Difficulty reading, driving, or learning
- Loss of short term memory
If you answered yes to more than 3 of the above, maybe you should re-consider your stress level and “way of life.”
Do common drugs such as Elavil, Prozac, Nardil, or Zoloft help? This is a tough question to answer because many patients do exhibit clinical improvement when these medications are managed properly. Proper protocol for these medications usually involves using a combination of these antidepressants, due to the fact that each drug used alone cannot provide adequate help.
Most of these drugs act by helping to raise the level of neurotransmitters in the nervous system and especially in the Hippocampus and Amygdala. These drugs raise the level of certain neurotransmitters (serotonin, norepinephrine, and dopamine) which are highly effective in allowing the Hippocampus and Amygdala to continue functioning properly. In other words, these drugs serve to make up for the loss of the chemicals that C.A.N.E. has caused in these areas of the brain.
Depression - TMJ Pain Treatment Summary
The answers for any particular patient require more explanation than what has been provided in this article. Pain patients are advised that the underlying cause of the pain or stress must be uncovered.
Medications cannot get to the root of the problem. They are useful to the extent that they aid the system and permit symptom management. Treatment should be focused on correcting the physical problem, addressing the stress issues, working closely with psychotherapy, and coordinating efforts with many other health professionals (physical medicine, ENT, neurology, nutritionist, pulmonologist, chiropractor, etc.).
Unfortunately, proper facial pain diagnosis and implications of jaw misalignment problems are not being currently addressed by an alarming number of physicians and dentists. Components of jaw to jaw misbalance and jaw joint damage have a huge impact on many symptoms of depression.
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