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

[Strawberryblonde]

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

Do some research regarding the different types of antidepressants and weigh up your options. Some people take them and it helps them through the transition period when they get tinnitus, and then either taper off when they feel better, or decide to stay on them. For others it goes the opposite way where the tinnitus baseline increases (I think that's what happened to me). Always start at a small dose first and see how they work out for you. Have you tried any other options to manage your situation? CBT and stuff like that?

 

[Roger79]

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

@Nick47, is this combination for tinnitus?

 

[Nick47]

@Nick47, is this combination for tinnitus?

Yes. I had a consultation with Dr. Dirk De Ridder. Basically he never prescribes a single medication. It's always a low-dose cocktail of medications. There are a few lectures on YouTube he has uploaded.

 

[juliob]

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

Why the Aripiprazole if you don't mind asking? I read that it can help with OCD.

 

[SarahMLFlemmer]

Do some research regarding the different types of antidepressants and weigh up your options. Some people take them and it helps them through the transition period when they get tinnitus, and then either taper off when they feel better, or decide to stay on them. For others it goes the opposite way where the tinnitus baseline increases (I think that's what happened to me). Always start at a small dose first and see how they work out for you. Have you tried any other options to manage your situation? CBT and stuff like that?

I'm on Amitriptyline for sleep, I've been on it for about 3 months. If I get off of it, would it possibly lower my tinnitus sound or how does that work?

 

[Nick47]

Why the Aripiprazole if you don't mind asking? I read that it can help with OCD.

It rebalances the different serotonin receptors rather than increasing serotonin universally. Partial agonist at 5-HT1a, antagonist at 5-HT2a etc.

 

[Strawberryblonde]

I'm on Amitriptyline for sleep, I've been on it for about 3 months. If I get off of it, would it possibly lower my tinnitus sound or how does that work?

I was on low dose (5-10 mg) Amitriptyline for about 3 months and about 4 days of a high dose (25 mg) before I quit cold turkey. I don't know if that made things worse for me. My doctor said it was fine to do.

Has your tinnitus become louder on it? Can you sleep without it? Tapering off is a better option and a safer thing to do, but not sure if your tinnitus will become quieter off it though.

 

[ErikaS]

Has anyone (in the USA) tried out a newer antidepressant called Auvelity? it is a combination drug of Dextromethorphan and Bupropion. It says it is a category of drugs that would be known as glutamate modulators, a group that includes Ketamine.

"The difference in Auvelity's time comes from how it works in the brain. Auvelity works on changing the levels of the neurotransmitter glutamate by acting on NMDA receptors. Antidepressants currently on the market modulate neurotransmitters like serotonin and noradrenaline. Auvelity would be the first medication of its kind, Iosifescu said."​

Not sure if anyone has insight on this. I'm having a hard time with mood stabilization. Stable, down, way down, somewhat stable, etc. I am on 0.25 mg Ativan a day which helps at night some, but I now need something longer lasting and increasing the Ativan amount isn't an option. Ideally I'd love to get off the Ativan. I'm even considering Lithium orotate.

 

[Nick47]

Has anyone (in the USA) tried out a newer antidepressant called Auvelity? it is a combination drug of Dextromethorphan and Bupropion. It says it is a category of drugs that would be known as glutamate modulators, a group that includes Ketamine.

"The difference in Auvelity's time comes from how it works in the brain. Auvelity works on changing the levels of the neurotransmitter glutamate by acting on NMDA receptors. Antidepressants currently on the market modulate neurotransmitters like serotonin and noradrenaline. Auvelity would be the first medication of its kind, Iosifescu said."​

Not sure if anyone has insight on this. I'm having a hard time with mood stabilization. Stable, down, way down, somewhat stable, etc. I am on 0.25 mg Ativan a day which helps at night some, but I now need something longer lasting and increasing the Ativan amount isn't an option. Ideally I'd love to get off the Ativan. I'm even considering Lithium orotate.

A combination Dr. De Ridder uses successfully in some patients are (all low doses) Flupentixol 0.5 mg, Aripiprazole 2 mg, Clonazepam 0.5 mg. You could switch Ativan to Clonazepam but you would want a lower dose like 0.125 mg - 0.25 mg as it's stronger. It lasts longer and you don't get the quick rebound. Sometimes Dr. De Ridder adds low dose Naltrexone at night.

I left Deanxit out as it's not available in America.

I would stay away from Bupropion as it aggravates many people's tinnitus.

 

[ErikaS]

A combination Dr. De Ridder uses successfully in some patients are (all low doses) Flupentixol 0.5 mg, Aripiprazole 2 mg, Clonazepam 0.5 mg. You could switch Ativan to Clonazepam but you would want a lower dose like 0.125 mg - 0.25 mg as it's stronger. It lasts longer and you don't get the quick rebound. Sometimes Dr. De Ridder adds low dose Naltrexone at night.

I left Deanxit out as it's not available in America.

I would stay away from Bupropion as it aggravates many people's tinnitus.

Thank you, @Nick47! I was reading about NMDA receptor antagonists and how they could potentially help with tinnitus, and I know Ketamine falls under that umbrella. It's unfortunate that Bupropion can aggravate tinnitus. Our community cannot win on anything.

 

[SarahMLFlemmer]

I was on low dose (5-10 mg) Amitriptyline for about 3 months and about 4 days of a high dose (25 mg) before I quit cold turkey. I don't know if that made things worse for me. My doctor said it was fine to do.

Has your tinnitus become louder on it? Can you sleep without it? Tapering off is a better option and a safer thing to do, but not sure if your tinnitus will become quieter off it though.

I keep trying to sleep without Amitriptyline (I skip taking it at night) but then I just lie there all night, trying to fall asleep but never reaching REM. I think I might try again tonight to just take Melatonin. If that works, I'll start tapering down. Wish me luck!

 

[Lane]

Not sure if anyone has insight on this. I'm having a hard time with mood stabilization. Stable, down, way down, somewhat stable, etc. I

Hi @ErikaS -- Just to let you know (after our earlier discussion), I've been taking Methylene Blue for about a month now, and it's been an absolute game changer for me. Literally everything has changed for me; better energy, better moods, better thinking, ability to relax, and more, even slightly softened tinnitus.

Methylene Blue is supposed to increase serotonin, dopamine, and norepinephrine, so elevated brain neurotransmitters may be what's helping me. But it also can easily cross the blood brain barrier, where it purportedly greatly improves mitochondrial activity and oxygen utilization. Besides that, it's a strong anti-fungal, which I can see would improve brain function as well if there's a candida or fungal infection in the body.

In short, I don't know exactly what's improved things so dramatically for me, but at this point, I'm more grateful for this sudden turn of events than I am focused on trying to figure out exactly how it happened. I know you were looking at Methylene Blue at one point. Did you ever follow up on it and give it a trial run?

Everybody's different, so one person's success isn't going to automatically translate to another person's success. But... there are tons of testimonials online that indicates a LOT of people have gotten lots of benefits from it. For those considering taking an SSRI @Ryan Scott, but concerned about how it might affect their tinnitus, I would recommend considering a trial of Methylene Blue first, especially since its safety profile is excellent.

 

[ErikaS]

Hi @ErikaS -- Just to let you know (after our earlier discussion), I've been taking Methylene Blue for about a month now, and it's been an absolute game changer for me. Literally everything has changed for me; better energy, better moods, better thinking, ability to relax, and more, even slightly softened tinnitus.

Methylene Blue is supposed to increase serotonin, dopamine, and norepinephrine, so elevated brain neurotransmitters may be what's helping me. But it also can easily cross the blood brain barrier, where it purportedly greatly improves mitochondrial activity and oxygen utilization. Besides that, it's a strong anti-fungal, which I can see would improve brain function as well if there's a candida or fungal infection in the body.

In short, I don't know exactly what's improved things so dramatically for me, but at this point, I'm more grateful for this sudden turn of events than I am focused on trying to figure out exactly how it happened. I know you were looking at Methylene Blue at one point. Did you ever follow up on it and give it a trial run?

Everybody's different, so one person's success isn't going to automatically translate to another person's success. But... there are tons of testimonials online that indicates a LOT of people have gotten lots of benefits from it. For those considering taking an SSRI @Ryan Scott, but concerned about how it might affect their tinnitus, I would recommend considering a trial of Methylene Blue first, especially since its safety profile is excellent.

Thank you, Lane! You know, I took it leading up to my treatment and then did IV Methylene Blue at his office twice, then I didn't continue it at home. I still have a good amount so maybe I could try it.

Remind me, what form do you take and how much daily?

 

[Lane]

Remind me, what form do you take and how much daily?

Hi @ErikaS -- I take the liquid form and measure my dosages by drops. According to the dosing table below, it's recommended I take 80 drops a day. However, since my body is extremely sensitive, I always start out slowly with just about everything I try.

So I started at 3 drops the first day. Beginning that day, and into the second day, I would pause throughout the day and notice how much more relaxed my whole body and neurological system were. After a couple days, I went up to 6 drops. Same result, but getting even better. A couple days later, I went up to 9 drops. Same calming effect, but now I began to notice increased energy.

I went up to 12 drops a couple days later (more energy), and then up to 15 drops. That's where I began to notice I was feeling a bit "buzzed", and so went back to 12 drops. That seems to be my sweet spot for now, but I anticipate I'll up it in the future as my body adapts to it all.

I can easily see myself taking this for the rest of my life. They do recommend taking a day or two off per week to allow the body to "reset". And BTW, it has a similar molecular structure to Vitamin C. The safety profile is exceptional by everything I've read. Here's a pretty good article on it.

It sounds like the primary consideration is whether a person is taking an anti-depressant. Methylene Blue increases serotonin levels, so you don't want to be dealing with serotonin syndrome. Also, if a person already has high levels of serotonin and/or dopamine, then precautions are definitely in order.

One last tidbit... In my research, I discovered Methylene Blue is also being used to treat Parkinson's Disease. Recent evidence has apparently been suggesting that Parkinson's Disease may result from a fungal overgrowth in the brain.

Subject: Methylene Blue Dosing

Basic formula: 1 drop = 0.5 mg.

DOSING FOR METHYLENE BLUE 1% SOLUTION

Body Weight: 50 kg/110 lbs: 0.5 mg/kg dose = 25 mg/day or 50 drops/day

Body Weight: 55 kg/121 lbs: 0.5 mg/kg dose = 27.5 mg/day or 55 drops/day

Body Weight: 60 kg/132 lbs: 0.5 mg/kg dose = 30 mg/day or 60 drops/day

Body Weight: 65 kg/143 lbs: 0.5 mg/kg dose = 32.5 mg/day or 65 drops/day

Body Weight: 70 kg/154 lbs: 0.5 mg/kg dose = 35 mg/day or 70 drops/day

Body Weight: 75 kg/165 lbs: 0.5 mg/kg dose = 37.5 mg/day or 75 drops/day

Body Weight: 80 kg/176 lbs: 0.5 mg/kg dose = 40 mg/day or 80 drops/day

Body Weight: 85 kg/187 lbs: 0.5 mg/kg dose = 42.5 mg/day or 85 drops/day

Body Weight: 90 kg/198 lbs: 0.5 mg/kg dose = 45 mg/day or 90 drops/day

Body Weight: 95 kg/209 lbs: 0.5 mg/kg dose = 47.5 mg/day or 95 drops/day

Body Weight: 100 kg/220 lbs: 0.5 mg/kg dose = 50 mg/day or 100 drops/day

 

[JP619]

I've developed tinnitus 2 weeks after taking Duloxetine (Cymbalta) for other reasons, so am thinking about stopping. I'm a bit confused as it's sometimes used for treating tinnitus. Anyone else develop tinnitus after taking it?

 

[momus]

I think I might try again tonight to just take Melatonin.

Melatonin made it easy for me to get to sleep and I had no side effects, but like some others, the vivid dreams were at times quite disturbing, so I had to stop taking it.

 

[SarahMLFlemmer]

I've developed tinnitus 2 weeks after taking Duloxetine (Cymbalta) for other reasons, so am thinking about stopping. I'm a bit confused as it's sometimes used for treating tinnitus. Anyone else develop tinnitus after taking it?

I'm sure it's completely possible! I hope it fades for you, but I imagine you would taper off of it.

 

[juliob]

I updosed Luvox yesterday from 100 mg to 112.5 mg and I am having a tinnitus spike.

In your experience, does such a spike go away with time staying on the dose, or is it better to get back to 100 mg as soon as possible?

Maybe I should give up on SSRIs.

 

[Ben Winders]

@Nick47, I'm considering going back on Deanxit - Dr. De Ridder prescribed it to me once, 2 years ago. It helped a lot back then. I always described it as: my tinnitus and the OCD I have surrounding it, is like a big wheel that I constantly grab on to and get anxiety as a result.

The Deanxit is like a soap that covers that wheel so I can't grab onto it... It makes me care less about the tinnitus.

Only thing that scared me at the time was that it has been banned in a couple of countries. But it is allowed in my home country Belgium, which is not a 3rd world country regarding medicine.

Dr. De Ridder said back then that he has a couple of patients on Deanxit for life, but at a low dose... I would have to pick up with him again to see how low that dose could be.

Still - Deanxit has a couple of bad entries (about banning in India etc) if you Google for it, so I wonder if there is anything else I could try at low dose that is safe and won't make my existing tinnitus worse.

After 3 years I really only need a little "soap" to cover the OCD wheel when I need it.

 

[Nick47]

Hey @Ben Winders, great to hear from you. So to give you some background, my tinnitus is moderate-severe-disabling and very unstable. It also gets louder and shrieks to external sound in a sort of metallic way.

I had a consultation with Dr. De Ridder in early February this year. It was my only hope of getting to trial some medications for this condition in the UK. Upshot is that I was prescribed Deanxit, Aripiprazole and Clonazepam.

He also made the following points:

1. Never take an SSRI or an SNRI for tinnitus
2. If medication is necessary, it's always a cocktail at low doses
3. Cyclobenzaprine was recommended due to my tinnitus being somatic
4. Some patients have been on the cocktail for 20 years
5. I introduced him to Latuda as an alternative to Aripiprazole based on my research and the pharmacology, he had not heard of this, but looked it up and said in 'theory' it is a good choice
6. Clonazepam is to eliminate the side effects of the cocktail

I would say Deanxit has not been licensed in many countries, which is different to it being banned. Again, I think some misinformation is putting people off. It is a low-dose tricyclic and low-dose antipsychotic. My GP refused to prescribe it, however I have obtained a 10 day trial pack from a friend in Belgium.

I think low-dose Deanxit is 1 pill a day. I think Dr. De Ridder is in NZ for 5-6 months.

Couple of questions:

1. Did you experience any side effects from Deanxit?
2. How long did it take to start taking effect?

Stay Strong!

 

[Ben Winders]

Hey @Ben Winders, great to hear from you. So to give you some background, my tinnitus is moderate-severe-disabling and very unstable. It also gets louder and shrieks to external sound in a sort of metallic way.

I had a consultation with Dr. De Ridder in early February this year. It was my only hope of getting to trial some medications for this condition in the UK. Upshot is that I was prescribed Deanxit, Aripiprazole and Clonazepam.

He also made the following points:

1. Never take an SSRI or an SNRI for tinnitus
2. If medication is necessary, it's always a cocktail at low doses
3. Cyclobenzaprine was recommended due to my tinnitus being somatic
4. Some patients have been on the cocktail for 20 years
5. I introduced him to Latuda as an alternative to Aripiprazole based on my research and the pharmacology, he had not heard of this, but looked it up and said in 'theory' it is a good choice
6. Clonazepam is to eliminate the side effects of the cocktail

I would say Deanxit has not been licensed in many countries, which is different to it being banned. Again, I think some misinformation is putting people off. It is a low-dose tricyclic and low-dose antipsychotic. My GP refused to prescribe it, however I have obtained a 10 day trial pack from a friend in Belgium.

I think low-dose Deanxit is 1 pill a day. I think Dr. De Ridder is in NZ for 5-6 months.

Couple of questions:

1. Did you experience any side effects from Deanxit?
2. How long did it take to start taking effect?

Stay Strong!

Thanks for taking the time to write such a clear response.

I did not experience any side effects from Deanxit. It did not take long to have effect on my anxious reaction towards my humming tinnitus. Maybe 1 - 1.5 days.

I just have these periods in my life where I lack the energy or the mindset to fight it / ignore it. Usually brought on by other stress factors. Aside from tha,t the tinnitus also fluctuates, sometimes the humming is as loud as a generator next door and even comes out over the sound of an electric razor close to my ear. Some days it's a lesser hum, but even with the less strong hum, when I don't have the energy, that's enough to cause a fight or flight reaction.

I guess I'm toying with the idea of Deanxit / or any other Dr. De Ridder low-dose cocktail because I really don't want to suffer, live an anxious life, if I really don't have to.

Obviously I have always tried to do it without any meds, but what if just popping a small dose of Deanxit could increase my quality of life with no real health consequences, it would be a shame if I didn't try it.

For me, Dr. De Ridder prescribed the Deanxit and Clonazepam cocktail. No Aripiprazole. I voiced my concerns about having to be on those meds for the rest of my life to Dr. De Ridder and he replied: "some of my patients are on this cocktail for life, but they take a very low maintenance doses, I haven't seen any adverse effects."

I agree with the Deanxit not being licensed in x countries, that's a different thing than it being banned in those countries of course.

Dr. De Ridder saying to never take SSRIs for tinnitus, is he basing this on research because I can't really find any study to back up why it would be dangerous / make tinnitus worse?

 

[Nick47]

Dr. De Ridder saying to never take SSRIs for tinnitus, is he basing this on research because I can't really find any study to back up why it would be dangerous / make tinnitus worse?

Yes, a few years back now there was a study showing universally increasing serotonin may increase tinnitus. There was also a study I saw in 2015 showing that serotonin exerts an excitatory response on the DCN via activation of 5-HT2a/c and 5-HT7. I saw the study in 'Frontiers.'

Whether you should take it is up to you. If your tinnitus is causing a disability, then I would say yes!

 

[DeanD]

I have been prescribed an SSRI (Citalopram) for anxiety.

This isn't because of my severe tinnitus but I have been experiencing dysphagia (swallowing problems) along with throat tightening, swelling when eating, soreness and breathing difficulties - which has been going on for 2 months now!

A full upper GI endoscopy and barium swallow showed nothing.

My concern is many on here have struggled with SSRIs with their tinnitus, and as @Nick47 says, Dr. De Ridder recommends against SSRIs.

I've been holding off for a couple of weeks but my GP has asked I seriously think about the SSRI as anxiety may be making the symptoms worse (even though I do not feel it is the cause).

When you're left like this, you feel between a rock and a hard place!

 

[Nick47]

I have been prescribed an SSRI (Citalopram) for anxiety.

This isn't because of my severe tinnitus but I have been experiencing dysphagia (swallowing problems) along with throat tightening, swelling when eating, soreness and breathing difficulties - which has been going on for 2 months now!

A full upper GI endoscopy and barium swallow showed nothing.

My concern is many on here have struggled with SSRIs with their tinnitus, and as @Nick47 says, Dr. De Ridder recommends against SSRIs.

I've been holding off for a couple of weeks but my GP has asked I seriously think about the SSRI as anxiety may be making the symptoms worse (even though I do not feel it is the cause).

When you're left like this, you feel between a rock and a hard place!

Then look at medications Dr. De Ridder uses that are non-SSRI. Deanxit at low doses is anti-anxiety/antidepressant. Aripiprazole the same.

 

[DeanD]

Then look at medications Dr. De Ridder uses that are non-SSRI. Deanxit at low doses is anti-anxiety/antidepressant. Aripiprazole the same.

Maybe I need to speak to my GP again.

She has offered me Propranolol or Citalopram - but said in terms of anxiety medication, this is all she could offer me.

I tried Propranolol last year, along with Mirtazapine, but after some eye issues I stopped both.

My neurologist also recommended Propranolol.

Maybe I will mention Deanxit next time time I see my GP, but that surgery are funny about medication that isn't their standard prescriptions - and even wanted a letter from my neurologist before prescribing Melatonin.

 

[Nick47]

Maybe I will mention Deanxit next time time I see my GP

You would need a prescription from Brai3n.

 

[DeanD]

You would need a prescription from Brai3n.

Did you manage to get a prescription from Dr. De Ridder for Deanxit, and accepted by UK pharmacies?

He was ready to provide me a prescription during my consultation with him in January but I was concerned it wouldn't be accepted within the UK.

 

[Nick47]

Did you manage to get a prescription from Dr. De Ridder for Deanxit, and accepted by UK pharmacies?

You would need to take it to a psychiatrist. My GP refused. I don't know about pharmacy as I have not tried. Deanxit is not available in UK, but could sub out Melitracen or Amitriptyline for Doxepin and add Flupentixol which would equal Deanxit. Aripiprazole and Clonazepam are available in the UK. Cyclobenzaprine and LDN are not available here but can be bought through a Canadian pharmacy. All the info is out there.

 

[andronici]

Does anyone know what antidepressants are most or least likely to worsen tinnitus? I know tinnitus is a potential risk for all of them, but it seems that some are riskier than others.

For example, I've been told by a doctor that Wellbutrin and Pristiq are particularly associated with tinnitus.

Anecdotally, I feel like I've seen online a lot of cases with tinnitus from Zoloft, though the doctor didn't seem to think Zoloft had any higher risk than the other SSRIs.

 

[Nick47]

Does anyone know what antidepressants are most or least likely to worsen tinnitus? I know tinnitus is a potential risk for all of them, but it seems that some are riskier than others.

Tricyclic antidepressants are least likely to worsen tinnitus, although Amitriptyline has both reduced and increased tinnitus depending who took it. I have not seen Doxepin and Melitracen worsen anyone.

2nd generation antipsychotics at low doses (so not antipsychotic action) often have antidepressant effects. These include Aripiprazole, Lurasidone and Cariprazine.

Mirtazapine also has a good profile.

The problem is our condition is largely ignored and the immediate response of an MD is to ignore the tinnitus and treat the depression, with bog standard SSRIs or SNRIs. This can worsen tinnitus.

Up until recently I thought the less medications, the better.

After my consultation with Dr. De Ridder, I realised that 3-4 medications at low doses is better than 1 medication at a high dose, which does nothing for the symptoms. Plus it's easier to taper off low doses, rather than climbing down from, say 45 mg of Mirtazapine.

It's not that the SSRIs are ototoxic, they do not damage the inner ear at all. It's the fact they universally increase serotonin and therefore stimulate most of the serotonin receptors. Some of these serotonin receptors like 5-HT2a/b and 5-HT7 are found in areas of the brainstem that generate tinnitus.

Dr. De Ridder saying to never take SSRIs for tinnitus, is he basing this on research because I can't really find any study to back up why it would be dangerous / make tinnitus worse?

This was the 2015 study on serotonin:

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