Antidepressants (SSRIs, SNRIs, MAOs, TCAs, TeCAs)

[Padraigh Griffin]

I think I remember discussing with you the problems of Paroxetine. For me it was probably the worst of them all (and the first drug prescribed to me when I was 17 years old).

I think most of these drugs will have reports of tinnitus in c.1 in 100 to 1 in 1000 (though I have no knowledge on numbers on discontinuation).

For what it's worth (again), Lexapro is simpler in that you have only 10 mg, 15 mg and 20 mg - and, for me, I did not find much difference between 10 mg and 20 mg. You may want to suggest what my psych proposed, starting on 5 mg for a short period and then building up. Either way, it will take a good few weeks to start feeling the benefit, so some patience is required. During that period, I would be careful about tapering the Valium. I would have thought it would be wiser to only start thinking of this once you are stable on the AD and feel that with its benefits, you can start moving away from the benzos.

When I went into a psychiatric hospital, I was on nothing and in a very bad way. It was only after a few weeks (back) on the Lexapro that the docs started lowering the Valium (though it was hard to keep track on time in there). The Lexapro had no impact on the tinnitus, which had all but left me on the high doses of Valium.

I would go slowly, monitor (by checking in, but not obsessively) and adjust/taper according to perception of uplift in mood.

I hope it helps.

Legend. Sounds like you have been through a lot buddy. Fair play to keep going. I'm definitely going to ask them to take it slow. 5 mg Lexapro as a start and follow Ashton Manual for Valium taper.

Also, I'm never going above therapeutic dose of an AD again so 10 mg max. I have read it can take up to 12 weeks to have fully kicked in.

I've made my mind up. Now I just need to meet an amiable psych.

Thanks again.

 

[kingsfan]

Legend. Sounds like you have been through a lot buddy. Fair play to keep going. I'm definitely going to ask them to take it slow. 5 mg Lexapro as a start and follow Ashton Manual for Valium taper.

Also, I'm never going above therapeutic dose of an AD again so 10 mg max. I have read it can take up to 12 weeks to have fully kicked in.

I've made my mind up. Now I just need to meet an amiable psych.

Thanks again.

When I tried out Zoloft, I took the lowest dose pill and cut them into quarters. Just from taking a quarter of the smallest dose I could tell that it was affecting my tinnitus. Since it was such a small dose, it didn't cause anything catastrophic and I just discontinued without at any lasting ill effects.

I know I've mentioned this somewhere else, so if I'm just repeating myself I apologize.

 

[Uklawyer]

I tried out Zoloft, I took the lowest dose pill and cut them into quarters. Just from taking a quarter of the smallest dose I could tell that it was affecting my tinnitus. Since it was such a small dose, it didn't cause anything catastrophic and I just discontinued without at any lasting ill effects.

I know I've mentioned this somewhere else, so if I'm just repeating myself I apologize.

So a clear increase in volume?

I have just taken 5 mg of Amitriptyline. I saw the 1/100 reference to tinnitus.

...

 

[kingsfan]

So a clear increase in volume?

I have just taken 5 mg of Amitriptyline. I saw the 1/100 reference to tinnitus.

...

Yes it was clearly louder. I only took 3 doses before I decided I'd had enough.

I took Nortriptyline for 3 months, which is similar to Amitriptyline, and it also raised my tinnitus. I didn't have a choice but to take it at the time as I was suicidal, and it really helped me through that period. About a month after discontinuing, my tinnitus went down to what I felt was below my previous baseline.

 

[Padraigh Griffin]

Yes it was clearly louder. I only took 3 doses before I decided I'd had enough.

I took Nortriptyline for 3 months, which is similar to Amitriptyline, and it also raised my tinnitus. I didn't have a choice but to take it at the time as I was suicidal, and it really helped me through that period. About a month after discontinuing, my tinnitus went down to what I felt was below my previous baseline.

Your story is similar to mine. I am genuinely suicidal. I have a plan, etc. I'm hoping that improving my mood will give me resilience. However, I can't monitor my tinnitus due to its volatility. Like Friday 4/10, Saturday 6/10, today a massive big fat 10/10. It can change inter day as well. No predictability and different tones. I have Middle Ear Myoclonus as well as 'normal' tinnitus. If I lived in a country where it's available, I'd probably apply for VAD. Last throw of dice is psych hospital and back to trying meds that caused it in the first place. If anything, it will just satisfy my wife that I tried everything. I will see what happens.

 

[ZFire]

My psych wants me to start tapering off Nortriptyline after 1 year of use. Drug has been pretty useful for me, but I think I want to be drug free now. It has been impacting my workouts negatively for some time now.

I'm going to be tapering down to 40 mg from 50 mg. The 10 mg drop shouldn't be an issue, no? The doctor said it's fine.

Final review on Nortriptyline:

Pros

• Made sleep easier
• Got rid of my brutal migraines
• Lowered anxiety levels
• No negative effect on tinnitus
• Improved mood

Cons

• Slightly lower libido
• Fatigued and feel weak often
• Needle + tingling sensations in the feet
• Dry mouth sometimes

If you have constant migraines, Nortriptyline is worth looking into IMO. It obliterated my migraines to nothing after 1 week of use. I've never had migraines ever on while on it.

 

[Nick47]

The best combination so far is what I use now, Flupentixol with Doxepin (by that we try to mimic Deanxit which is unavailable in Poland).

Sorry to ask again, but who better to ask than someone with experience.

Did this combination change your tinnitus volume or just make you feel better/care less?

As you may gather, I'm struggling like many to decide my route here. I have reactive tinnitus/hyperacusis. The pain element has gone but boiling a kettle sounds like I'm in an electrical firestorm.

Regards,
Nick

 

[Mentos]

Sorry to ask again, but who better to ask than someone with experience.

Did this combination change your tinnitus volume or just make you feel better/care less?

As you may gather, I'm struggling like many to decide my route here. I have reactive tinnitus/hyperacusis. The pain element has gone but boiling a kettle sounds like I'm in an electrical firestorm.

Regards,
Nick

I think it's a combination of both, it seems to be lower which results in me caring less.

You will never know until you try.

 

[AfroSnowman]

Going into a psychiatrist for first time on Thursday to see if we can play with my brain chemistry to improve QoL. All of my problems are really just pain, so no underlying anxiety or depression other than as a side effect of you know.

Thoughts, tips for a novice, things to stay away from? He also does TMS.

I've already tried Clonazepam at different doses and it didn't really do anything for me, even sleep wise.

 

[SmallRonnie]

Going into a psychiatrist for first time on Thursday to see if we can play with my brain chemistry to improve QoL. All of my problems are really just pain, so no underlying anxiety or depression other than as a side effect of you know.

Thoughts, tips for a novice, things to stay away from? He also does TMS.

I've already tried Clonazepam at different doses and it didn't really do anything for me, even sleep wise.

Gabapentin works well for some for pain. Lyrica is another name for it.

Personally, I'm taking every anti-inflammitory supplement I can for pain.

Benzos are not a long-term solution. Some antidepressants help pain a lot but sometimes they have strong side effects and are not always a long-term option either.

 

[AfroSnowman]

Gabapentin works well for some for pain. Lyrica is another name for it.

Personally, I'm taking every anti-inflammitory supplement I can for pain.

Benzos are not a long-term solution. Some antidepressants help pain a lot but sometimes they have strong side effects and are not always a long-term option either.

Thanks. To be clear, when I refer to pain, I mean the loud piercing screech in my brain.

 

[SmallRonnie]

Thanks. To be clear, when I refer to pain, I mean the loud piercing screech in my brain.

Probably something for anxiety is best then. For sure I would try to get diet and exercise on point first though. And sleep, if that's possible. It all ties in together.

Personally, I want to avoid going back to antidepressants again because I don't see an end to it once it gets started and they sometimes seem to have very bad side effects if taken over years.

Then again, some people are fine taking something like Nortriptyline for 20 years so it could be alright. I'm not even 30 though so I don't want to be taking those drugs for most of my life.

 

[Ultra]

Gabapentin works well for some for pain. Lyrica is another name for it.

Lyrica is actually the brand name for another molecule: Pregabalin. Gabapentin and Pregabalin (created as an improved version of Gabapentin by the same lab) do have some similarities, but also some wildly different effects as well.

 

[SmallRonnie]

Lyrica is actually the brand name for another molecule: Pregabalin. Gabapentin and Pregabalin (created as an improved version of Gabapentin by the same lab) do have some similarities, but also some wildly different effects as well.

I thought they were the same thing for so long.

I see people talk about using Gabapentin for pain a lot. Especially nerve pain.

 

[Lane]

Pregabalin. Gabapentin and Pregabalin

They can all cause or exacerbate tinnitus.

 

[Nick47]

They can all cause or exacerbate tinnitus.

Or relieve it.

 

[Lane]

Or relieve it.

Right, it's a crap shoot. I think it's much safer to try as many non-drug therapies as a person can discover or think of before resorting to drugs that may result in permanently worsened tinnitus. Drugs can be extremely dangerous, and IMHO, should be a last resort, not a first resort, as is usually the case.

 

[SmallRonnie]

Right, it's a crap shoot. I think it's much safer to try as many non-drug therapies as a person can discover or think of before resorting to drugs that may result in permanently worsened tinnitus. Drugs can be extremely dangerous, and IMHO, should be a last resort, not a first resort, as is usually the case.

I also think a lot of people go straight to drugs too much. My doctor gave me antidepressants very quickly but I'm off them again now.

I'm currently taking a large amount of supplements and they are acting like a mild antidepressant without as many side effects which is much better for me, really.

I recently decided I will try everything I can before going back on to antidepressants again because I don't ever see an end to them if I start again.

 

[Nick47]

@Mentos, @grate_biff, I had some years old Prochlorperazine left over from labyrinthitis dx years ago. I popped 1 yesterday and my tinnitus has been mild-moderate for 24 hours.

Upshot, there may be more value in dopamine modulators than many here give credence to!

I've mentioned you as you steered me towards this route after your experience with Flupentixol. It's early days though so could just be a milder day I get occasionally.

Having said that, the fact that Prof. Dirk De Ridder likes the dopamine modulators and there is a trial using a dopamine antagonist for COVID-19 induced tinnitus suggests a movement away from the dreaded benzo route that helps many live with tinnitus, but leaves them feeling drugged and deeply depressed.

Fingers crossed!

 

[Mike2022]

I've been taking Lexapro 10 mg and Latuda 20 mg for about 2-3 weeks and they have helped my tinnitus tremendously.

Before this I was taking Wellbutrin and the tinnitus was 10/10 screeching badly with some hyperacusis.

Now it is 3/10 and no hyperacusis.

 

[Nick47]

I've been taking Lexapro 10 mg and Latuda 20 mg for about 2-3 weeks and they have helped my tinnitus tremendously.

Before this I was taking Wellbutrin and the tinnitus was 10/10 screeching badly with some hyperacusis.

Now it is 3/10 and no hyperacusis.

@Mike2022, do you have hearing loss or noise-induced tinnitus? What made the doctor try Latuda?

 

[Mike2022]

@Mike2022, do you have hearing loss or noise-induced tinnitus? What made the doctor try Latuda?

My tinnitus is not hearing loss or noise induced. The Latuda was brought on as an alternative to Abilify. I used to take Abilify but it gave me a huge appetite!

 

[Nick47]

My tinnitus is not hearing loss or noise induced. The Latuda was brought on as an alternative to Abilify. I used to take Abilify but it gave me a huge appetite!

@Mike2022, hahaha empty fridge syndrome! Did Abilify help as much as the new med? I see Dr. Dirk De Ridder often prescribes it?

 

[Diego LR]

I've been taking Lexapro 10 mg and Latuda 20 mg for about 2-3 weeks and they have helped my tinnitus tremendously.

Before this I was taking Wellbutrin and the tinnitus was 10/10 screeching badly with some hyperacusis.

Now it is 3/10 and no hyperacusis.

What do you think is helping the most, Latuda or Lepraxo? My tinnitus spiked with Lepraxo 10 mg.

 

[Mike2022]

What do you think is helping the most, Latuda or Lepraxo? My tinnitus spiked with Lepraxo 10 mg.

To me it is hard to tell.

I've never taken Latuda before, and I am now taking it and my ringing has been much better.

I've taken Abilify before and had horrid ringing, depending on what SSRI was paired with it.

I feel like together the two medications (Latuda and Lexapro) are probably working together to help make the tinnitus more of a background noise, rather than the nightmare it was for so long.

Lots of the day goes by and I barely notice my tinnitus now. When I was on Wellbutrin I wanted to jump off a bridge, the tinnitus was so bad.

So long story short, Latuda and Lexapro are helping me. I am doing better than I have with tinnitus in 11 months since I developed severe tinnitus.

Hope this helps, and hope you all can find a small measure of hope in this.

 

[Nick47]

I've taken Abilify before and had horrid ringing, depending on what SSRI was paired with it.

I expect it was the SSRI. In some people they can make the tinnitus worse.

 

[Nick47]

Using a combination of in vitro electrophysiology and optogenetics in mouse brain slices, we found that 5-HT directly enhances the excitability of fusiform principal cells via activation of two distinct 5-HT receptor subfamilies, 5-HT2A/2CR (5-HT2A/2C receptor) and 5-HT7R (5-HT7 receptor). This excitatory effect results from an augmentation of hyperpolarization-activated cyclic nucleotide-gated channels (Ih or HCN channels).

Serotonergic Regulation of Excitability of Principal Cells of the Dorsal Cochlear Nucleus

Implications for choice of medication.

 

[CRGC]

Serotonergic Regulation of Excitability of Principal Cells of the Dorsal Cochlear Nucleus

Implications for choice of medication.

Very interesting article. This passage appears specifically interesting to me:

Activation of the serotonergic raphe-DCN pathway could increase excitability and reduce acoustic thresholds of fusiform cells. It may be that this pathway functions as a "gain-setter" in controlling DCN output.

Could SSRIs/SNRIs then cause or worsen hyperacusis by increasing central gain?

 

[Nick47]

Could SSRIs/SNRIs then cause or worsen hyperacusis by increasing central gain?

It seems those that stimulate 5HT2A, 5HT2C and 5HT7 can cause excitement.

 

[ZFire]

Serotonergic Regulation of Excitability of Principal Cells of the Dorsal Cochlear Nucleus

Implications for choice of medication.

If there is a worsening, it should be temporary and reversible though?

The drugs are affecting serotonin in the brain, but once stopped, I'd imagine the tinnitus should return to baseline. I've seen that to be the case for quite a few people here.