Pregnant women were
most likely to respond to others' yawns
Contrary to spontaneous yawning, which is widespread
in vertebrates and probably evolutionary ancient,
contagious yawning-yawning triggered by others' yawns-is
considered an evolutionarily recent phenomenon, found in
species characterized by complex sociality. Whether the
social asymmetry observed in the occurrence of contagious
yawning is related to social and emotional attachment and
may therefore reflect emotional contagion is a subject of
debate. In this study the authors assessed whether yawn
contagion was enhanced in pregnant women, a cohort of
subjects who develop prenatal emotional attachment in
preparation for parental care, via hormonal and
neurobiological changes. They predicted that if yawn
contagion underlies social and emotional attachment,
pregnant women would be more likely to contagiously yawn
than nonpregnant, nulliparous women of reproductive age.
They gathered data in two different settings.
In the experimental setting, 49 women were exposed to
video stimuli of newborns either yawning or moving their
mouth (control) and we video-recorded the women during
repeated trials to measure their yawning response. In the
naturalistic setting, 131 women were observed in a social
environment and their yawning response was recorded. They
tested the factors influencing the yawning response,
including the reproductive status (pregnant vs. not
pregnant). In both settings, yawn contagion occurred
significantly more in pregnant than nonpregnant women. By
showing that pregnant women were most likely to respond
to others' yawns, these results support the hypothesis
that the social variation observed in yawn contagion may
be influenced by emotional attachment and that yawning in
highly social species might have been coopted for
emotional contagion during evolution.
Les femmes
enceintes sont plus sensibles à la contagion des
bâillements
Contrairement au bâillement spontané,
qui est répandu chez tous les
vertébrés donc
phylogénétiquement ancien, le
bâillement contagieux - le bâillement
déclenché par les bâillements des
autres - est considéré comme un
phénomène évolutif récent,
trouvé chez les espèces
caractérisées par une socialité
complexe. La question est de savoir si l'asymétrie
sociale observée dans la survenue du
bâillement contagieux est liée à
l'attachement social et émotionnel et peut donc
refléter une contagion émotionnelle. Dans
cette étude, les auteurs ont évalué
si la contagion du bâillement était
augmentée chez les femmes enceintes, c'est
à dire des sujets qui développent un
attachement émotionnel prénatal en
préparation aux soins parentaux, via des
changements hormonaux et neurobiologiques.
Ils ont prédit que si la contagion du
bâillement sous-tend l'attachement social et
émotionnel, les femmes enceintes seraient plus
susceptibles de bâiller de manière
contagieuse que les femmes nullipares non enceintes et en
âge de procréer. Ils ont collecté des
données dans deux contextes différents.
Dans le cadre expérimental, 49 femmes ont
été exposées à des stimuli
vidéo de nouveau-nés bâillant ou
bougeant la bouche (témoin) et ils ont
enregistré les femmes lors d'essais
répétés pour mesurer leur
réponse au bâillement. Dans le cadre
naturalel, 131 femmes ont été
observées dans leur environnement social et leur
réponse de bâillements a été
enregistrée. Les auteurs ont testé les
facteurs influençant la réponse au
bâillement, y compris le statut reproducteur
(enceinte vs non enceinte). Dans les deux cas, la
contagion du bâillement s'est produite
significativement plus chez les femmes enceintes que chez
les femmes non enceintes. En montrant que les femmes
enceintes étaient les plus susceptibles de
réagir aux bâillements des autres, ces
résultats soutiennent l'hypothèse que la
variation sociale observée dans la contagion du
bâillement peut être influencée par
l'attachement émotionnel et que le
bâillement chez les espèces hautement
sociales pourrait avoir favorisé la contagion
émotionnelle au cours de l'évolution.
Yawning: unusual and
uncommon side effect of antidepressant
medication
Yawning is a very unusual and uncommon side effect of
antidepressant medications.There are reports of excessive
yawning caused by several antidepressant medications,
including duloxetine, clomipramine, fluoxetine,
citalopram, sertraline, and paroxetine.
Research has also suggested an increased rate of
yawning in patients taking antidepressants compared to
placebos. In most case reports, there was no direct
relationship between yawning and daytime sleepiness. The
authors report a case of a patient who developed yawning
with every antidepressant she was prescribed, resulting
in discontinuation of the medication.
CASE REPORT
Ms A is a 41-year-old married white woman who had a
history of social anxiety disorder. She worked as a
teacher and had extreme difficulty with her job because
of social anxiety symptoms. Her anxiety symptoms included
increased heart rate and feelings of panic whenever she
had to present in front of her class. Anxiety would even
be severe when she had to present at regular staff
meetings. She was on oral alprazolam 0.5 mg/d as needed
for anxiety at the time of her first visit to our clinic
and stated that she could not tolerate any
antidepressants.
Before Ms A was seen in our clinic, she was
prescribed several antidepressants but developed yawning
spells. The list of antidepressants she tried is as
follows: fluoxetine, sertraline, escitalopram,
venlafaxine, desvenlafaxine, and bupropion. She stated
that she developed yawning within the first 2 weeks of a
trial with fluoxetine 10 mg. She described that she would
have an irresistible urge to yawn. She did not feel tired
or sleepy and had to yawn every few seconds. She felt
irritated and could not stop yawning. Yawning stopped
after 2 weeks within discontinuing fluoxetine. She had a
similar pattern of yawning with each antidepressant she
tried.
Ms A reported that antidepressants helped her anxiety
symptoms, but she could not function as a teacher because
of the constant and irresistible yawning. She did not
remember each antidepressant's dose but stated that she
would develop yawning at the smallest dose of each
medication within the first 2 weeks. The yawning would
stop immediately within a couple of days of discontinuing
the antidepressant, but with fluoxetine it took 2 weeks
for the yawning to stop after discontinuation. Ms A felt
that the frequency and intensity of yawning correlated
with increased doses of the antidepressant
medications.
Ms A reported that yawning was not associated with
daytime sleepiness or fatigue. She also denied having an
insufficient sleep, as she would get up to 7 to 8 hours
of sleep each night.
Ms A denied any depressive symptoms of sad mood or
anhedonia. She denied any lack of energy. However,
excessive yawning did affect her breathing. Frequent
yawning caused "shortness of breath." The patient
reported feelings of light suffocation and needed deep
air gasps. These yawning spells were frequent throughout
the day. She reported no physical distress but admitted
to having psychological stress, as the yawning affected
work productivity.
She did not want to try another antidepressant and
wished to continue a small dose of a benzodiazepine, as
she felt it helped her. She was switched to clonazepam
0.5 mg twice/day, as alprazolam is short acting and did
not control her anxiety throughout the day.
On clonazepam 0.5 mg, she reported significant
improvement in her social anxiety symptoms and was able
to teach her classes. Also, she was able to present at
school meetings, which was very difficult without the
medication. She reported no side effects on clonazepam,
including yawning.
DISCUSSION
This case illustrates that antidepressants can cause
side effects that are not common but can cause distress
in patients' lives. Yawning should be recognized as an
adverse effect of certain selective serotonin reuptake
inhibitors and other antidepressant medications. In our
patient's case, she tried several antidepressant
medications but could not continue because of yawning.
Also, she described some subtle shortness of breath.
The relationship between antidepressants and yawning
has been described previously.3 Yawning is a natural
reaction that occurs during transit from wakefulness to
sleep.3 Studies2 have shown that yawning can occur when
the body is experiencing a state of increased fatigue and
a change of alertness. Yawning has been thought to be
associated with depression because of the common symptom
of increased sleepiness and fatigue. Patients who have
depression typically have sleep problems and tiredness
leading to increased yawning. Yawning is common during
episodes of fatigue and increases when the environmental
stimuli can no longer provide arousal. Antidepressants
taken by patients with depression can also be a source of
excessive yawning. Antidepressants have been shown to
increase yawning in several studies.
Although yawning is considered benign, it interfered
with our patient's daily activities and work life. Her
intense symptoms immediately stopped after discontinuing
each antidepressant medication.
Yawning is a complex neurophysiologic process with
unclear physiologic functions. The relationship between
antidepressants and yawning is unclear but may be related
to the effects of many different neurotransmitters.4
In our patient, discontinuation of antidepressants
led to the cessation of yawning within a few days. In the
case of fluoxetine, yawning stopped after 2 weeks of
discontinuation.
It is interesting that Ms A tried several
antidepressants and developed yawning with all of them
that affected her functioning. We acknowledge that we had
to rely on the patient's description and clinical
history, as she was not prescribed antidepressants while
in treatment at our clinic. Further studies are needed to
investigate and confirm the mechanism of how these
medications cause yawning.
1. De Las
Cuevas C, Sanz EJ Duloxetine-induced excessive
disturbing and disabling yawning. J Clin Psychopharmacol.
2007;27(1):106-107.
Temporo mandibular
pains predict depression and stress
The temporomandibular joint is the one of the most
important joints in the human body. It enables numerous
orofacial functions such as mastication, swallowing,
breathing, speech, emotional communication, and facial
expressions. The aim of the study was to evaluate the
prevalence of jaw functional limitations and oral
behaviors with respect to general health status in
patients with temporomandibular joint
disorders&emdash;myofascial pain with referral.
The study group consisted of 50 individuals (37
females and 13 males) with complete natural dentition.
The average age was 23.36 years with ± 0.30 as a
standard error. All subjects underwent clinical
examination and were diagnosed with myofascial pain with
referral according to the Diagnostic Criteria for
Temporomandibular Disorders. The survey was conducted in
connection with the Jaw Functional Limitation Scale-8
(JFLS-8), Jaw Functional Limitation Scale-20 (JFLS-20),
Patient Health Questionnaire-4 (PHQ-4), Patient Health
Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7
(GAD-7), Patient Health Questionnaire-15 (PHQ-15), and
Oral Behaviors Checklist (OBC).
The most common functional problems in the entire
study group were chewing tough food and yawning. In terms
of gender, statistically significant differences were
noted for chewing tough food and smiling (p = 0.015451; p
= 0.035978, respectively). With respect to Bonferroni
correction and Benjamini-Hochberg procedure, the observed
differences were not statistically significant. There
were no statistically considerable differences in
mastication, mandibular mobility, verbal and emotional
communication, or global limitations (p0.05). Over half
(56%) of the respondents had depression of varying
severity. Somatic symptoms of different severity were
found in 78% of the patients, and 44% of the respondents
declared anxiety disorders. The score of the Oral
Behavior Checklist (OBC = 27.18) highlighted a high
tendency for developing craniomandibular disorders.
Patients with myofascial pain with referral,
demonstrated a disturbed biopsychosocial profile. The
restrictions in yawning and smiling as well as
limitations in mastication, mobility, verbal and
emotional communication, and global limitations appear to
be significant predictors of craniomandibular
dysfunction. Depression, stress, and somatic disorders
are important factors predisposing patients to the
occurrence of myofascial pain with referral. The
progression of oral behaviors may indicate the role of
somatosensory amplification.
Les douleurs
temporo-mandibuiares en bâillant prédisent
souvent la dépression et le stress
L'articulation temporo-mandibulaire est l'une des
articulations les plus importantes du corps humain. Elle
permet de nombreuses fonctions orofaciales telles que la
mastication, la déglutition, la respiration, la
parole, la communication émotionnelle et les
expressions faciales. Le but de l'étude
était d'évaluer la prévalence des
limitations fonctionnelles de la mâchoire et des
comportements oraux en ce qui concerne l'état de
santé général chez les patients
atteints de troubles de l'articulation
temporo-mandibulaire-douleur myofasciale avec
référence.
Le groupe d'étude était composé
de 50 individus (37 femmes et 13 hommes) avec une denture
naturelle complète. L'âge moyen était
de 23,36 ans avec ± 0,30 comme erreur standard. Tous
les sujets ont subi un examen clinique et ont reçu
un diagnostic de douleur myofasciale avec
référence selon les critères
diagnostiques des troubles temporo-mandibulaires.
L'enquête a été menée en lien
avec la Jaw Functional Limitation Scale-8 (JFLS-8), la
Jaw Functional Limitation Scale-20 (JFLS-20), le Patient
Health Questionnaire-4 (PHQ-4), le Patient Health
Questionnaire-9 (PHQ -9), Trouble d'anxiété
généralisée-7 (TAG-7), Questionnaire
de santé du patient-15 (PHQ-15) et Liste de
contrôle des comportements oraux (OBC).
Les problèmes fonctionnels les plus courants
dans l'ensemble du groupe d'étude étaient
la mastication d'aliments durs et le bâillement. En
termes de sexe, des différences statistiquement
significatives ont été notées pour
la mastication des aliments durs et le sourire (p =
0,015451; p = 0,035978, respectivement). En ce qui
concerne la correction de Bonferroni et la
procédure de Benjamini-Hochberg, les
différences observées n'étaient pas
statistiquement significatives. Il n'y avait pas de
différences statistiquement considérables
dans la mastication, la mobilité mandibulaire, la
communication verbale et émotionnelle ou les
limitations globales (p0,05). Plus de la moitié
(56 %) des répondants souffraient de
dépression de gravité variable. Des
symptômes somatiques de gravité
différente ont été retrouvés
chez 78% des patients et 44% des répondants ont
déclaré des troubles anxieux. Le score de
l'Oral Behavior Checklist (OBC = 27,18) a mis en
évidence une forte tendance à
développer des troubles cranio-mandibulaires.
Les patients souffrant de douleur myofasciale ont
montré un profil biopsychosocial perturbé.
Les restrictions dans le bâillement et le sourire
ainsi que les limitations dans la mastication, la
mobilité, la communication verbale et
émotionnelle et les limitations globales semblent
être des prédicteurs significatifs de la
dysfonction cranio-mandibulaire. La dépression, le
stress et les troubles somatiques sont des facteurs
importants prédisposant les patients à la
survenue de douleurs myofasciales avec
référence. La progression des comportements
oraux peut indiquer le rôle de l'amplification
somatosensorielle.
