Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides.

OBJECTIVE: To test the hypothesis that selective serotonin reuptake inhibitor (SSRI) antidepressants may have a suicide emergent effect, particularly in children and adolescents. METHOD: Detections of different antidepressants in the forensic toxicological screening of 14 857 suicides were compared with those in 26,422 cases of deaths by accident or natural causes in Sweden 1992-2000. RESULTS: There were 3411 detections of antidepressants in the suicides and 1538 in the controls. SSRIs had lower odds ratios than the other antidepressants. In the 52 suicides under 15 years, no SSRIs were detected. In 15-19-year age group, SSRIs had lower relative risk in suicides compared with non-SSRIs. CONCLUSION: The hypothesis that treatment of depressed individuals with SSRIs leads to an increased risk of suicide was not supported by this analysis of the total suicidal outcome of the nationwide use of SSRIs in Sweden over a period of 9 years, either in adults or in children or adolescents.

Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic temporomandibular joint disk displacement without reduction.

The aim of the present study was to compare the effect of transcutaneous electric nerve stimulation (TENS) with the flat occlusal splint in the treatment of temporomandibular joint (TMJ) disk displacement without reduction. Thirty-one patients were included and randomly selected to be treated 6 weeks with either TENS (90 Hz, 30 min, three times/day) or with a flat occlusal splint (24 h/day. Those selected for the TENS group had one electrode placed over the painful TMJ and another electrode over the anterior temporal muscle. The splint group used a conventional flat occlusal splint with cuspid guidance. Both treatment groups visited the clinic once a week. Symptoms and signs were registered before and after treatment. The intensity of pain was recorded with a visual analogue scale (VAS) and with an electronic pocket-sized recorder (Pain-Track) carried 1 week before and also the last week of treatment for continuous registration of pain. Measured with the VAS, half of the patients treated with splints became pain-free or their TMJ pain improved at least 50% both at rest and with jaw function compared with only 6% in the TENS-treated group. With regard to strictly chewing pain, the VAS-registered pain improved in two-thirds of the splint group, compared with 50% of the TENS group. With the Pain-Track device it was found that in most individuals pain was aggrevated at mealtimes. The conclusion was that flat occlusal splints in several respects are better than TENS in the treatment of symptoms associated with TMJ disk displacement without reduction.

Lingual numbness and speech articulation deviation associated with temporomandibular joint disk displacement.

A prospective investigation of 208 patients with painful, arthrographically verified temporomandibular joint disk displacement revealed that seven patients (3%) demonstrated lingual numbness associated with speech articulation impairment. The speech disorder was characterized primarily by a distortion in the production of /s,r,d, and t/. The lingual numbness and the speech disorder had in all cases started in association with a painful onset of permanent displacement of the temporomandibular joint disk. Local anesthetic blocking of the auriculotemporal nerve eliminated both joint pain and muscle pain and normalized tongue sensitivity and speech articulation. Placebo injections of saline solution resulted in no change. The explanation of the phenomenon is that the course of the lingual nerve for these seven patients was through the lateral pterygoid muscle rather than mesial to the muscle bundles and that an arthrokinetic myospasm resulted in compression of the lingual nerve. In order to test the hypothesis that the condition of lingual nerve entrapment in the lateral pterygoid muscle does exist, the course of the nerve was studied at dissection in 52 specimens from 26 cadaver heads. In 49 of the specimens, the lingual nerve descended deep to the lateral pterygoid muscle as has been traditionally defined. However, in three specimens, the nerve passed through the inferior belly of the muscle, revealing the condition of lingual nerve entrapment.