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

[Nick47]

If there is a spike, it should be reversible though?

Over time yes. It's complicated as there are many serotonin receptors, so just saying increasing serotonin worsens tinnitus is not true. Maybe someone scientific can make better sense of this.

It seems agonists of 5-HT2A, 5-HT2C + 5HT7 increase excitability.

This paper mentions 5-HT1 agonists reduce tinnitus.

"It may act as a 5-HT1A serotonin agonist, directly reducing tinnitus."

→ 155 Improvement of VIIIth Cranial Nerve Function With Cariprazine

Implications when reviewing SSRI/SNRI medications? If you look at pharmacology (for instance on Wikipedia) of the medications, the lower the number, the higher the affinity for that receptor type. So a value of 3000 means a low affinity.

 

[ZFire]

Unpopular opinion here, but I wish more people would at least give antidepressants a try. From my experience and likely others as well, there is something to the limbic system being a bit more relaxed that can go a long way in dealing with the tinnitus.

Obviously, we all have that fear of tinnitus potentially worsening, but one must ask whether the pros from the drug outweigh the cons. For instance, if your tinnitus got a tiny bit louder from taking the antidepressant, but you became less bothered and anxious from it? Would you take it? I know I would. Obviously, if someone has extreme 10/10 tinnitus, they wouldn't take such a chance, but if you're somewhere in moderate to low-end severe range, there's some space to work with, there's not a huge drawback to trying.

And I firmly believe antidepressants aren't ototoxic either. I don't see how they can cause structural damage to the ear. Millions are taking antidepressants, if tinnitus was a wide spread issue, I think we would know about it by now. I was unaffected by Nortriptyline and I started at a high dose right off the bat. It's always best to explore non-drug methods first, but antidepressants are worth looking into if all else fails.

Please disregard this post if you feel differently.

 

[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, I've really looked into this to understand why it may have worked for you to such a degree.

It's the Latuda. Its pharmocology:

• 5-HT1A Agonist (inhibitory transmitter involved in hyperacusis).
• 5-HT2A Antagonist (excitatory in DCN).
• 5-HT7 Antagonist (excitatory in DCN).
• It's also an antagonist at D2/3 - We know that many drugs that increase dopamine can cause or worsen tinnitus.

Agonist = activate.
Antagonist = switch off.

This is of interest to me as it hits most of the key neurotransmitters in the right way.

 

[TLion]

Hi all,

I experienced a pretty recent worsening in my existing tinnitus 2.5 months ago, probably from Paroxetine (Paxil) withdrawal that I had taken for 6 years. The tinnitus at first was easily maskable so it was no big deal for me that it was slightly louder.

Afterwards I experienced panic attacks and very strange neurological issues I couldn't understand. I now know that it was the withdrawal. I went to a neurologist and asked because of my symptoms and tinnitus. He advised to get back on Paroxetine. I unfortunately did.

The ringing got worse but I wouldn't dare to stop taking the Paroxetine now.

It's now very, very high pitched. I can't stand the frequency. I've been back on the Paroxetine for 2.5 months, 10 mg.

I now also read about muscle spasms caused by withdrawal. I experienced this. And some involuntary movement of the muscles in my legs.

The withdrawal symptoms did subside partly, but the tinnitus is still worse.

Now that I know that reintroducing Paroxetine worsened everything, I really don't know what to to. My ears feel cramped on some days. I hate the high-pitched hiss. And I don't know if I should taper the Paroxetine now rather than later. Will I experience withdrawal again after 2.5 months of taking it? Is the tinnitus going to get worse again?

The drug seems ototoxic so I'm afraid that if I continue taking it, my hearing is going to be damaged even more. I don't know what to do. Some advice would be great.

 

[Nick47]

Hi all,

I experienced a pretty recent worsening in my existing tinnitus 2.5 months ago, probably from Paroxetine (Paxil) withdrawal that I had taken for 6 years. The tinnitus at first was easily maskable so it was no big deal for me that it was slightly louder.

Afterwards I experienced panic attacks and very strange neurological issues I couldn't understand. I now know that it was the withdrawal. I went to a neurologist and asked because of my symptoms and tinnitus. He advised to get back on Paroxetine. I unfortunately did.

The ringing got worse but I wouldn't dare to stop taking the Paroxetine now.

It's now very, very high pitched. I can't stand the frequency. I've been back on the Paroxetine for 2.5 months, 10 mg.

I now also read about muscle spasms caused by withdrawal. I experienced this. And some involuntary movement of the muscles in my legs.

The withdrawal symptoms did subside partly, but the tinnitus is still worse.

Now that I know that reintroducing Paroxetine worsened everything, I really don't know what to to. My ears feel cramped on some days. I hate the high-pitched hiss. And I don't know if I should taper the Paroxetine now rather than later. Will I experience withdrawal again after 2.5 months of taking it? Is the tinnitus going to get worse again?

The drug seems ototoxic so I'm afraid that if I continue taking it, my hearing is going to be damaged even more. I don't know what to do. Some advice would be great.

@TLion, first of all there is far too much paranoia over ototoxicity to the point it drives most of us crazy. Very few drugs damage the inner ear. The Neil Baumann character needs hanging as he's caused much distress. I would at least look at the way Dirk De Ridder goes about medications. He says SSRIs can sometimes make tinnitus worse. For those reason he does not prescribe them. There is a good presentation he made last year at the TRI. You can view it on YouTube.

 

[TLion]

@TLion, first of all there is far too much paranoia over ototoxicity to the point it drives most of us crazy. Very few drugs damage the inner ear. The Neil Baumann character needs hanging as he's caused much distress. I would at least look at the way Dirk De Ridder goes about medications. He says SSRIs can sometimes make tinnitus worse. For those reason he does not prescribe them. There is a good presentation he made last year at the TRI. You can view it on YouTube.

Ok, but even if it is not ototoxic, it made my tinnitus higher, finer, high pitched, more screeching. So yes, it is worse now.

 

[Nick47]

Ok, but even if it is not ototoxic, it made my tinnitus higher, finer, high pitched, more screeching. So yes, it is worse now.

@TLion, I'm validating your experience pal, truly. But ototoxicity is something different.

 

[TLion]

@TLion, I'm validating your experience pal, truly. But ototoxicity is something different.

OK. But despite that, not sure what to do. Try to taper again? Stay on it for a while?

 

[ajc]

OK. But despite that, not sure what to do. Try to taper again? Stay on it for a while?

Seriously, how do you expect anyone to tell you what to do? You can get worse by withdrawing, you can get worse by staying on it. Nobody can tell you what to do, not even a qualified doctor. You try your luck and see what happens.

Overall though, the less drugs you are on, the better. Some research suggests that you should taper Paroxetine over a longer period of time than other antidepressants, because Paroxetine has a half-life of around 1 day, which is shorter than many other antidepressants.

Go speak with a doctor about how to taper it safely.

 

[Nick47]

OK. But despite that, not sure what to do. Try to taper again? Stay on it for a while?

@TLion, or read my posts in the thread. Non-SSRI medications seem the way to go, like Aripiprazole, Latuda, LDN, Cariprazine, Mirtazapine or Deanxit.

 

[andronici]

OK. But despite that, not sure what to do. Try to taper again? Stay on it for a while?

If I were you, I would create an account at Surviving Antidepressants and ask for advice there. It looks like they are open for new registrations again on January 27th. I wouldn't make any sudden changes with your Paroxetine dosage. If you ultimately decide to taper again, it would probably be best to do so very slowly.

 

[juliob]

Over time yes. It's complicated as there are many serotonin receptors, so just saying increasing serotonin worsens tinnitus is not true. Maybe someone scientific can make better sense of this.

It seems agonists of 5-HT2A, 5-HT2C + 5HT7 increase excitability.

This paper mentions 5-HT1 agonists reduce tinnitus.

"It may act as a 5-HT1A serotonin agonist, directly reducing tinnitus."

→ 155 Improvement of VIIIth Cranial Nerve Function With Cariprazine

Implications when reviewing SSRI/SNRI medications? If you look at pharmacology (for instance on Wikipedia) of the medications, the lower the number, the higher the affinity for that receptor type. So a value of 3000 means a low affinity.

Considering this and given what you know, do you think adding NAC when you are on antidepressants could be unsafe tinnituswise?

I found this:
N-acetylcysteine blocks serotonin 1B agonist-induced OCD-related behavior in mice

I am trying to find out something to help me deal with OCD and my benzo tapering but I am afraid everything interacts with Serotonin receptors.

 

[Nick47]

Considering this and given what you know, do you think adding NAC when you are on antidepressants could be unsafe tinnituswise?

I know only the basics from what I've read. I watched Dr. De Ridder's video on 'medication for tinnitus' that he gave as part of the TRI Academy series last year. In fact, I watched it about 30 times and then sought out the papers he cited. I then looked at studies on neurotransmitters in the DCN and how they change in tinnitus. I also looked at what people here had success with.

Yes, 5-HT1B IS involved, especially in hyperacusis (Elgoyhen); see attachment. In fact, most of the 5-HT1 neurons are. The question is then how to proceed pragmatically? Not all medication cross the blood brain barrier or reach the areas you want. The pharmacology is something I'm learning still. Do you go for an agonist or antagonist?

The image is side effect profile to make it more confusing and it seems the longer the line, the more causative. Sertraline has a short line so less likely to cause side effects, for example.

I would appreciate any input from other members. The take home message I got is monotherapy where the GP just updoses the SSRI you are on is not the way, however, multiple medications in low doses might be.

 

[Lane]

I am trying to find out something to help me deal with OCD

Hi @juliob -- I highly recommend the following (pretty amazing) article on how it originally became clear a simple B vitamin could successfully treat OCD. Best of luck to you getting your OCD under control. I feel confident you can do it!

LISTENING TO INOSITOL: CLINICAL NOTES

 

[Tomas80]

@Mike2022, I've really looked into this to understand why it may have worked for you to such a degree.

It's the Latuda. Its pharmocology:

• 5-HT1A Agonist (inhibitory transmitter involved in hyperacusis).
• 5-HT2A Antagonist (excitatory in DCN).
• 5-HT7 Antagonist (excitatory in DCN).
• It's also an antagonist at D2/3 - We know that many drugs that increase dopamine can cause or worsen tinnitus.

Agonist = activate.
Antagonist = switch off.

This is of interest to me as it hits most of the key neurotransmitters in the right way.

View attachment 52634
View attachment 52635
View attachment 52636
View attachment 52637

But Latuda is a very interesting medicine. It is quite new. And it works on DCN! I will ask the doctor to try it.

Latuda has the active ingredient Lurasidone. But the drug Reagila (trade name in Slovakia) has the active substance Cariprazine. Cariprazine is mentioned in the materials. Should I ask the doctor about the medicine Latuda - Lurasidone, or Reagila - Cariprazine. Thank you very much!

 

[Nick47]

But Latuda is a very interesting medicine. It is quite new. And it works on DCN! I will ask the doctor to try it.

Latuda has the active ingredient Lurasidone. But the drug Reagila (trade name in Slovakia) has the active substance Cariprazine. Cariprazine is mentioned in the materials. Should I ask the doctor about the medicine Latuda - Lurasidone, or Reagila - Cariprazine. Thank you very much!

@Tomas80, this is all a theory with ONLY case reports to back it up. There are 2 things with any medication that bother me:

1) How much of it crosses the blood-brain barrier? It's different for all medicines.
2) How much gets to the DCN or brainstem in the first place.

Then of course it's a question of if there are any side effects...

If you have a cooperative doctor, then give one of them a go for a few weeks.

Yes, I noticed Latuda has only been on the market since around 2010, so relatively unknown and untested for tinnitus/hyperacusis.

 

[juliob]

Hi @juliob -- I highly recommend the following (pretty amazing) article on how it originally became clear a simple B vitamin could successfully treat OCD. Best of luck to you getting your OCD under control. I feel confident you can do it!

LISTENING TO INOSITOL: CLINICAL NOTES

This clinical reports are interesting! Thank you for sharing them. Before this I just saw the two papers on Inositol of the same author saying that associating with a SSRI wasn't effective. But this reports give hope.

The thing I am over the fence is something that is mentioned on the post:

"Drug Interactions: As already mentioned, inositol can boost the effects of SSRIs. When adding inositol to an SSRI, be aware that SSRI side effects can emerge, similar to what happens when starting or increasing an SSRI.".

I now wonder if this association is safe tinnitus wise as Inositol also somehow works on serotonin. I don't know if I should add Inositol or if I updose Luvox. I wish I was med free to try Inositol monotherapy.

My OCD is being very hard these days with one episode of racing thoughts that made me have a peak of stress that made my tinnitus spike. I decided that I will try anything more than ERP (Exposure and Response Prevention) alone because tapering Diazepam is sending my OCD to another level.

Is there anyone in the thread that started Inositol while on SSRI to share the experience?

 

[juliob]

I hope people with OCD can relate, or others can help me here.

I think I am going to increase my SSRI due to debilitating OCD even with it spiking tinnitus.

I hope that if I do this, the tinnitus goes back to the baseline with time. The two times I tried updosing Fluvoxamine, it temporarily made my tinnitus more piercing, but went back to the baseline as soon as I went back to the previous dose. I am at 100 mg which is sub-optimal for OCD.

I know it's dangerous, but I don't know if anyone here can relate. I have severe pre-existing OCD and I am also dealing with adrenal fatigue now, in parts I guess the stress of OCD is contributing to it. There is also the Diazepam withdrawal that might be causing Glutamate excess possibly contributing to it.

Note that the severe OCD was pre-existing before tinnitus and there are different obsessive thoughts that are making me suffer. I am NOT taking Fluvoxamine for the tinnitus. I am doing CBT therapy but it isn't enough.

I don't know if anyone here have decided to do something similar, given the quality of life with OCD and tinnitus.

Your thoughts or any motivation are welcomed.

 

[tpj]

I hope people with OCD can relate, or others can help me here.

I think I am going to increase my SSRI due to debilitating OCD even with it spiking tinnitus.

I hope that if I do this, the tinnitus goes back to the baseline with time. The two times I tried updosing Fluvoxamine, it temporarily made my tinnitus more piercing, but went back to the baseline as soon as I went back to the previous dose. I am at 100 mg which is sub-optimal for OCD.

I know it's dangerous, but I don't know if anyone here can relate. I have severe pre-existing OCD and I am also dealing with adrenal fatigue now, in parts I guess the stress of OCD is contributing to it. There is also the Diazepam withdrawal that might be causing Glutamate excess possibly contributing to it.

Note that the severe OCD was pre-existing before tinnitus and there are different obsessive thoughts that are making me suffer. I am NOT taking Fluvoxamine for the tinnitus. I am doing CBT therapy but it isn't enough.

I don't know if anyone here have decided to do something similar, given the quality of life with OCD and tinnitus.

Your thoughts or any motivation are welcomed.

Have you considered trying Clomipramine for your OCD?

 

[juliob]

Have you considered trying Clomipramine for your OCD?

I was on Clomipramine before I switched to Sertraline in the past. I decided to change due to the fatigue but if it doesn't increase the tinnitus, then maybe that's an option.

But aren't tricyclics very ototoxic? After the onset, it seems that I am very sensitive to increases in serotonin: 1 mg of Lexapro caused a nasty spike, updosing Luvox made the noise more piercing for a while.

I am kinda afraid that from now on, boosting serotonin is the issue. After all I used antidepressants for more than a decade if I sum the different periods, maybe that's a factor too.

Despite the different class, is there a particular reason for you to think that Clomipramine might be less harmful in terms of the hearing? I can search more about others' experiences.

 

[tpj]

I was on Clomipramine before I switched to Sertraline in the past. I decided to change due to the fatigue but if it doesn't increase the tinnitus, then maybe that's an option.

But aren't tricyclics very ototoxic? After the onset, it seems that I am very sensitive to increases in serotonin: 1 mg of Lexapro caused a nasty spike, updosing Luvox made the noise more piercing for a while.

I am kinda afraid that from now on, boosting serotonin is the issue. After all I used antidepressants for more than a decade if I sum the different periods, maybe that's a factor too.

Despite the different class, is there a particular reason for you to think that Clomipramine might be less harmful in terms of the hearing? I can search more about others' experiences.

Hi @juliob, my question about Clomipramine was more about its apparent effectiveness in treating OCD than how it may affect tinnitus.

The loaded question about ototoxicity. I have read many stories on Tinnitus Talk where someone considers a particular drug a lifesaver but another person thinks that exact same drug ruined their life by causing or making tinnitus worse. It is very difficult for us. I suppose it's a case of trial and error and what you're willing to live with.

 

[juliob]

Hi @juliob, my question about Clomipramine was more about its apparent effectiveness in treating OCD than how it may affect tinnitus.

The loaded question about ototoxicity. I have read many stories on Tinnitus Talk where someone considers a particular drug a lifesaver but another person thinks that exact same drug ruined their life by causing or making tinnitus worse. It is very difficult for us. I suppose it's a case of trial and error and what you're willing to live with.

You are right, in the end it's a matter of trial and attempt. I am now over the fence if I try to taper up Luvox very slowly or if I swap to Clomipramine. I wish there were other alternatives for OCD that don't affect serotonin though.

Do you also deal with OCD? What medication is working for you? I am considering high doses of NAC but I don't know if it's something safe in the long term.

 

[tpj]

You are right, in the end it's a matter of trial and attempt. I am now over the fence if I try to taper up Luvox very slowly or if I swap to Clomipramine. I wish there were other alternatives for OCD that don't affect serotonin though.

Do you also deal with OCD? What medication is working for you? I am considering high doses of NAC but I don't know if it's something safe in the long term.

I am a hoarder which I've read is a form of OCD. I don't take anything for that but if I was going to try something, I would go down the natural path first and use Inositol. I know you have concerns about that because you already take an SSRI.

Good luck with whatever you decide to do.

 

[TinniGone]

I take a very small dosage of Cipralex to help with anxiety. I also took small dosage of Xanax and multivitamins at the onset of my tinnitus. Today my tinnitus and reactive sensitivity are more than 90% gone and I'm enjoying a very normal life.

But these medications must be carefully taken in small dosages under the guidance of a doctor and they take time to kick in.

 

[JimmyR]

Just a follow up on my post above of a couple months ago.

I believe Amitriptyline helped. Now, long after the month or so that I was on it (10 mg with 12 mg Diphenhydramine nightly), my tinnitus is consistently lower in volume on average than before, and it doesn't spike to the high volumes that it did before the Amitriptyline. I still use Diphenhydramine, about 10 mg/night. I might even try another month of Amitriptyline, as I still have a bottle of it. I still want to go off Diphenhydramine. Will get around to it.

Update: I posted on taking 10 mg Amitriptyline a bit before bedtime, along with about 10 mg or so of Diphenhydramine. I didn't want to be on the latter, so I got off it last summer. Since then, I've had considerable success with this:

1. 10 mg Amitriptyline an hour before bedtime, two or three nights in a row (no more!), it knocks the tinnitus down.
2. Three or four weeks later, when tinnitus has gotten worse, repeat the two- or three-night sequence.

I like this. I almost never have very bad days, and even bad days are unusual. This has been a great success. (The "no more!" indicates that a fourth day of the dosage seems to bring the tinnitus back up.)

But I am also finding that plenty of weight lifting right before dinner and a lengthy brisk walk after dinner, with a hot water bottle applied to my back, sides and abdomen right before dozing off seem to have a similar, though not quite as profound, effect. So, I am trying to use the Amitriptyline even less in coordination with this increased exercise regime.

It seems that depth and quality of sleep drive my tinnitus levels, to a considerable degree.

 

[Roger79]

Hello,

My doctor wants to put me on Fluvoxamine because of my anxiety. I am currently on Mirtazapine 3.75 mg at night to get better sleep.

Any experiences with Fluvoxamine?

 

[Nick47]

Hello,

My doctor wants to put me on Fluvoxamine because of my anxiety. I am currently on Mirtazapine 3.75 mg at night to get better sleep.

Any experiences with Fluvoxamine?

Generally they do not recommend SSRIs for tinnitus. Some do OK on them, but SSRIs seem to worsen many. I'm only going on what the 'experts' say. They tend to prescribe tricyclic antidepressants or 2nd generation antipsychotics like Aripiprazole.

You could give Fluvoxamine a try.

 

[juliob]

Hello,

My doctor wants to put me on Fluvoxamine because of my anxiety. I am currently on Mirtazapine 3.75 mg at night to get better sleep.

Any experiences with Fluvoxamine?

I have. I am currently at 100 mg of Fluvoxamine.

I did the swap from Sertraline which caused two tones of tinnitus: one at 50 mg and another on 150 mg. I only insisted because I thought that it might be something that had always been there but I never paid attention. I entertained this thought due to some hearing loss on the audiograms but then the second tone made my mind about playing with Serotonin.

About Fluvoxamine, the swap was fine and I feel like the tinnitus level didn't change when I switched.

BUT... I am in a sub-optimal dose for OCD and the two times I tried to updose from 100 mg to 125 mg, my tinnitus got more piercing and went back to the baseline after lowering the dose back.

Your experience can be different as I don't know the cause of your tinnitus. I had used antidepressants for more than a decade in total and had no issues until when I tried Sertraline.

Before Sertraline, I was taking Clomipramine, and had already taken Paroxetine and Fluoxetine, all them with no tinnitus. Maybe there is a sort of cumulative effect? I don't know.

Unfortunately, there is no guarantee you will or will not experience a worsening of tinnitus. It's a rare side effect I guess. There are people for whom Paroxetine triggered tinnitus, while I didn't have any issues tinnituswise.

I miss being able to max out the dose of antidepressants without worries about tinnitus. My OCD wasn't an issue when using the proper doses.

I think there is a study with the prevalence of tinnitus for each drug in a particular population. Just be cautious because I remember the sample size of people on Escitalopram was small and it's easy to misinterpret the results. Actually, I think Escitalopram is one of the SSRIs I see more anedoctal reports of tinnitus.

Anyway, good luck and I hope you find a way to feel fine with or without meds!

 

[Ryan Scott]

Generally they do not recommend SSRIs for tinnitus. Some do OK on them, but SSRIs seem to worsen many. I'm only going on what the 'experts' say. They tend to prescribe tricyclic antidepressants or 2nd generation antipsychotics like Aripiprazole.

You could give Fluvoxamine a try.

You take any antidepressant, Nick? I think I would benefit from one but, like you said, I'm scared to take SSRIs and make my tinnitus worse.

 

[Nick47]

You take any antidepressant, Nick?

Only Mirtazapine. I do have a prescription for Deanxit, Aripiprazole and Clonazepam but not been agreed by my UK doctors.