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

[Nick47]

Well, I'm back after a very long absence from the Tinnitus Talk boards. Since this is the thread where many people are describing their experiences with different antidepressants, here's my update on how things went with Duloxetine, i.e., the generic form of Cymbalta.

During the time I was on Duloxetine, I experienced almost complete relief from depression. Prior to starting Duloxetine, I was having suicidal thoughts daily, but with just one dose, the suicidal thoughts went away, and I was left with a much milder form of depression. It was so mild that some days, I didn't even feel depressed at all.

Shortly after starting Duloxetine, I started to experience musical tinnitus. It lasted about 2 or 3 weeks. However, right around the time I started Duloxetine, I had to run the air conditioner almost every day due to hot summer weather. The musical tinnitus often kicked in whenever the A/C was running, and sometimes (but not always) it would stop when the A/C stopped. So, although I initially attributed the musical tinnitus to Duloxetine, it's possible that it was caused by certain types of ambient white noises, and it would have happened to me that summer even if I hadn't agreed to take Duloxetine.

Duloxetine never helped with the ear pain caused by noxacusis, nor did it help with the one-sided headache or the high-pitched tinnitus, but I stayed on my 60 mg dose for about eight months because the relief from depression was such a godsend. I would probably still be on Duloxetine today except for the fact that I was constantly hungry, and I gained between 6 and 10 pounds. At first, I thought that was a small price to pay for the improved psychological health, but then I decided to quit Duloxetine anyway, not so much because I was upset about the weight gain but because I wanted to see if my brain chemistry could do without it. By that time, the severity of my noxacusis and tinnitus was somewhat diminished, due to the mere passage of time, plus judicious hearing protection on my part, so according to my reasoning, "I have less reason to be depressed now, and therefore less need to be on an antidepressant."

Under my doctor's advice, I tapered off over the course of 28 days, going from 60 to 40 to 20 mg. I was fine until three days after my final daily dose of 20 mg, when I was hit by physical withdrawal symptoms such as all-over body aches, insomnia, and brain zaps. When those physical symptoms faded away over a week later, I was left with the horrifying realization that my depression was 100% back, including the suicidal ideation. It didn't help at all that toward the very end of the 28-day tapering period, I had an accidental noise exposure without hearing protection, resulting in a major noxacusis flare-up. I'm sure you can imagine how much self-hatred and self-pity I felt because I was careless enough to have a momentary exposure to a loud sound, right when my brain chemistry was becoming vulnerable again.

I'm currently debating whether to speak to my doctor about getting back onto Duloxetine, switching to a different antidepressant, or re-exploring ways to improve my brain chemistry naturally, such as exercise.

One other curveball to contend with: while I was away from the Tinnitus Talk boards, I developed pulsatile tinnitus in both ears, on top of the existing high-pitched tinnitus and the noxacusis that I'd already been dealing with, so now I have to see an ENT to find out why.

In short, Cymbalta or Duloxetine is awesome for depression, and I'm so grateful that it exists. But oh man, quitting this medication is really hard, even when following doctor's orders for tapering the dose slowly. That final leap from the lowest dose to zero is like jumping off a cliff without a parachute.

What is important for people to realize is that, due to the half-life of medications, the withdrawal effects tend to kick in weeks or a month or so later. I have tapered Mirtazapine from 30 mg to 22.5 mg since the beginning of March. The withdrawal effects started to kick in a week ago.

 

[Ksharky13]

I have moderate tinnitus (which progressed from mild to moderate over the last 1.5 years for no apparent reason). I also have an extreme anxiety disorder and have been trying to treat it with just therapy and related tools. However, it's not working at all. My anxiety keeps getting worse and is now quite severe. I now think that I am one of those people who need medication in order to manage this. A few medical professionals have suggested I get on an SSRI.

I was on Sertraline for over two decades but have been off it for 20 months. I never had any issues with it, including no tinnitus. I know there's no guarantee, but I would think I could go back on it with similar results.

Alternatively, it seems that Lexapro has a safer profile when it comes to tinnitus. I have a few family members on it and they have not had any issues with it. I'm wondering if there is a genetic component that would mean I would have a similar experience with it.

Any feedback would be appreciated.

 

[RunningMan]

Well, I'm back after a very long absence from the Tinnitus Talk boards. Since this is the thread where many people are describing their experiences with different antidepressants, here's my update on how things went with Duloxetine, i.e., the generic form of Cymbalta.

During the time I was on Duloxetine, I experienced almost complete relief from depression. Prior to starting Duloxetine, I was having suicidal thoughts daily, but with just one dose, the suicidal thoughts went away, and I was left with a much milder form of depression. It was so mild that some days, I didn't even feel depressed at all.

Shortly after starting Duloxetine, I started to experience musical tinnitus. It lasted about 2 or 3 weeks. However, right around the time I started Duloxetine, I had to run the air conditioner almost every day due to hot summer weather. The musical tinnitus often kicked in whenever the A/C was running, and sometimes (but not always) it would stop when the A/C stopped. So, although I initially attributed the musical tinnitus to Duloxetine, it's possible that it was caused by certain types of ambient white noises, and it would have happened to me that summer even if I hadn't agreed to take Duloxetine.

Duloxetine never helped with the ear pain caused by noxacusis, nor did it help with the one-sided headache or the high-pitched tinnitus, but I stayed on my 60 mg dose for about eight months because the relief from depression was such a godsend. I would probably still be on Duloxetine today except for the fact that I was constantly hungry, and I gained between 6 and 10 pounds. At first, I thought that was a small price to pay for the improved psychological health, but then I decided to quit Duloxetine anyway, not so much because I was upset about the weight gain but because I wanted to see if my brain chemistry could do without it. By that time, the severity of my noxacusis and tinnitus was somewhat diminished, due to the mere passage of time, plus judicious hearing protection on my part, so according to my reasoning, "I have less reason to be depressed now, and therefore less need to be on an antidepressant."

Under my doctor's advice, I tapered off over the course of 28 days, going from 60 to 40 to 20 mg. I was fine until three days after my final daily dose of 20 mg, when I was hit by physical withdrawal symptoms such as all-over body aches, insomnia, and brain zaps. When those physical symptoms faded away over a week later, I was left with the horrifying realization that my depression was 100% back, including the suicidal ideation. It didn't help at all that toward the very end of the 28-day tapering period, I had an accidental noise exposure without hearing protection, resulting in a major noxacusis flare-up. I'm sure you can imagine how much self-hatred and self-pity I felt because I was careless enough to have a momentary exposure to a loud sound, right when my brain chemistry was becoming vulnerable again.

I'm currently debating whether to speak to my doctor about getting back onto Duloxetine, switching to a different antidepressant, or re-exploring ways to improve my brain chemistry naturally, such as exercise.

One other curveball to contend with: while I was away from the Tinnitus Talk boards, I developed pulsatile tinnitus in both ears, on top of the existing high-pitched tinnitus and the noxacusis that I'd already been dealing with, so now I have to see an ENT to find out why.

In short, Cymbalta or Duloxetine is awesome for depression, and I'm so grateful that it exists. But oh man, quitting this medication is really hard, even when following doctor's orders for tapering the dose slowly. That final leap from the lowest dose to zero is like jumping off a cliff without a parachute.

Thanks for the update.

That's amazing you got relief with the first dose. It normally takes weeks.

I took Sertraline for one week followed by Lexapro for seven weeks (regular dose), so that's back-to-back SSRIs for eight weeks combined, and I never got any relief from anxiety or the intermittent depression that it sometimes brings. I actually had to stop taking it because of stomach aches that started from the first dose and got unbearable about five to six weeks into it, when I was hoping I just needed to adjust. But even after being completely off any antidepressants now for 4 1/2 months, I'm still feeling stomach pains, some days worse than others, but I would say no improvement on average. It can be as debilitating as the tinnitus/anxiety, so I've gone backwards.

The half-life of Duloxetine is about 12 hours (8-17 hours), but side effects can last longer. The last jump from 20 mg to 0 mg sounds like too much of a sudden drop at 100%. Despite being on Lexapro for a shorter time, I cut my pills to 1/4 for the final week when I weaned off over two weeks, which was uneventful but disappointing that stomach pains continued then and still for months afterward.

I'm now two years and two months since my tinnitus went severe.

You mentioned exercise. I found that if I keep my heart rate up for an hour of afternoon exercise by biking, it lowers my anxiety for the rest of the day pretty well, but by the next morning, it's like it never happened. I took a lot of morning walks, but they were not nearly as effective as the afternoon biking.

 

[ZFire]

If I ever need to consider antidepressants again, Mirtazapine would likely be my next choice. It seems to be one of the safer bets out there, and the fact that it can also improve sleep is a big bonus for me.

 

[Stayinghopeful]

If I ever need to consider antidepressants again, Mirtazapine would likely be my next choice. It seems to be one of the safer bets out there, and the fact that it can also improve sleep is a big bonus for me.

It's unreal!

7.5 mg - 15 mg for sleep/antihistamine and 30-40 mg for depression.

I use it off-label maybe once a month if I have a bad night; it works every time.

 

[ZFire]

It's unreal!

7.5 mg - 15 mg for sleep/antihistamine and 30-40 mg for depression.

I use it off-label maybe once a month if I have a bad night; it works every time.

Instant sleep relief? Wow. I thought, like with most antidepressants, it takes a few weeks for the effects to kick in. Obviously, it can depend on the person, too.

That's cool you can get instant relief from it, for yourself. I'll keep those dosages in mind, thanks.

 

[Stayinghopeful]

Instant sleep relief?
That's cool you can get instant relief from it, for yourself. I'll keep those dosages in mind, thanks.

Yep! I take a tablet, and about 10 minutes later, I'm out.

No problem!

 

[Pinhead]

I have zero problems sleeping. I need something that can help me get through the day. I'm so depressed and anxious that I've canceled all of my friendly or hobby-related obligations. I just can't deal with the constant screeching and hissing and thinking at the same time.

 

[RunningMan]

I have trouble sleeping every night after waking up at different times and am trying another new med now, which seems to be making my sleep worse at this point, but I'm still in the early going. I need a medication that I can take every night because I never have a good night's sleep without it.

Someone on Tinnitus Talk reported that as little as 2 mg of Mirtazapine was helping some with sleep but that they couldn't wean off of it. The larger doses for more effective control of depression and anxiety are said not to be as effective for sleep. They do need to be taken for a while to kick in to help with that, but they are said to take effect faster than SSRI antidepressants.

Mirtazapine can be pretty dangerous and extremely difficult to wean off of.

Reference some posts here:

https://www.tinnitustalk.com/posts/702851

 

[Nick47]

The larger doses for more effective control of depression and anxiety are said not to be as effective for sleep. They do need to be taken for a while to kick in to help with that, but they are said to take effect faster than SSRI antidepressants.

I'm not sure this is true. I went up from 15 mg to 30 mg, and my sleep remained good. It could be that people get muddled because the lower doses are just as good for sleep as the larger doses, but not that larger doses reduce sleep. I was told below 15 mg has no antidepressant effect, though. I dropped down to 22.5 mg, with a little extra anxiety creeping in after a month. Seven weeks later, I adjusted, so it was no big deal. That's a 25% reduction/taper in 4-6 weeks.

 

[BB23]

I'm not sure this is true. I went up from 15 mg to 30 mg, and my sleep remained good. It could be that people get muddled because the lower doses are just as good for sleep as the larger doses, but not that larger doses reduce sleep. I was told below 15 mg has no antidepressant effect, though. I dropped down to 22.5 mg, with a little extra anxiety creeping in after a month. Seven weeks later, I adjusted, so it was no big deal. That's a 25% reduction/taper in 4-6 weeks.

Here's how Mirtazapine works:

Under 15 mg, it has more action on the histamine receptors, which is why it is more sedating. Above that, serotonergic/noradrenaline actions are stronger than the histamine action, so it is more activating and less sedating. I think if your brain and CNS are healthy, you aren't kindled, and you don't have profound insomnia, larger doses could work for you, as well as lower doses.

Also, its stronger action in histamine at lower doses doesn't mean it has no action on serotonin at lower doses. If it had no action on serotonin, it wouldn't cause visual snow.

When I first got floxed, 15mg did nothing, but 7.5 mg knocked me out good for six straight hours. Over time, though, it hurt more than it helped...

 

[ECP]

I found that if I keep my heart rate up for an hour of afternoon exercise by biking, it lowers my anxiety for the rest of the day pretty well, but by the next morning, it's like it never happened. I took a lot of morning walks, but they were not nearly as effective as the afternoon biking.

Interesting. Did you ever try biking for an hour in the morning instead of the afternoon? Just wondering if that would give you all-day relief from anxiety.

I'm not a morning person, so I tend to put off exercise until later in the day, then kick myself for not having done it sooner. Starting this week, I'm going to squeeze in some morning exercise in the hopes of boosting my alertness.

I hope your stomachaches go away soon.

 

[RunningMan]

Interesting. Did you ever try biking for an hour in the morning instead of the afternoon? Just wondering if that would give you all-day relief from anxiety.

I'm not a morning person, so I tend to put off exercise until later in the day, then kick myself for not having done it sooner. Starting this week, I'm going to squeeze in some morning exercise in the hopes of boosting my alertness.

I hope your stomachaches go away soon.

I haven't tried morning biking, just walking. I'm not really geared up for more intense exercise in the morning, and it's a lot cooler in the morning, even most days in the summer, which I do not prefer for biking. I should try it sometime or use exercise equipment. My first bike ride this spring didn't go so well. My tinnitus was screaming in a single tone louder after the ride, and I didn't feel any drop in anxiety after some recovery time. Another ride was on a hissy tinnitus day and went better. I'll see if I get a consistent benefit again this summer.

 

[James Jorgenson]

My tinnitus was TRIGGERED by Amitriptyline prescribed by my doctor to help me sleep better. The tinnitus began two days after starting the Amitriptyline. I immediately stopped taking it, but the high-pitched tones have gone on now for six years. It is not (or hardly) noticeable when my mind is occupied. It is most noticeable when I'm tired, often in the evenings, and also when I think, read, or hear about tinnitus—waiting for a miracle drug that will stop this sound that is always with me.

 

[BlueMoon86]

My doctor increased my Mirtazapine dose up to 30 mg, and I had a rubbish night last night. I lay there in fear of not sleeping for about 2 hours and just couldn't get past the tinnitus. I did eventually sleep, but I tossed and turned and woke up shattered. At 15 mg, I was asleep within half an hour. I did have a heated argument with someone beforehand, and I was worried about going to an appointment today so that it might have been that. I'll try 30 mg tonight, and if I get the same thing, I'm reducing it back. I know it doesn't affect my tinnitus because I had been off it for months when it worsened.

I'm seeing my psychiatrist next week (my family is making me), and I know she wants to put me on Prozac or Effexor, and I don't want that shit. I've taken both and even stopped them cold turkey in the past without any problems, but once tinnitus sets in your brain, it's not the same brain anymore. I'm not taking the risk even though I'm currently suicidal.

 

[Curadh]

I'm looking for some thoughts on this - I have had tinnitus for over three years, and it has destroyed my life. I've tried lots, from stem cells to HBOT. Only a clean diet with no stimulants and a good night's sleep seems to help; even then, it's no guarantee.

I have 28x 10 mg Amitriptyline tablets prescribed to me a year ago for neuropathy, which I never took. I'm wondering if it might be worth trying a course? Any consensus? 10 mg daily for one week, then twice daily?

 

[Nick47]

I have 28x 10 mg Amitriptyline tablets prescribed to me a year ago for neuropathy, which I never took. I'm wondering if it might be worth trying a course? Any consensus? 10 mg daily for one week, then twice daily?

It's certainly worth a try. Many ENTs prescribe it to tinnitus patients. However, if you go the medication route, be aware that many do not recommend a single medication. No medication is favored. However, if necessary, you will see some take a low-dose cocktail.

 

[kingsfan]

If I ever need to consider antidepressants again, Mirtazapine would likely be my next choice. It seems to be one of the safer bets out there, and the fact that it can also improve sleep is a big bonus for me.

I worry about Visual Snow Syndrome with Mirtazapine. I would use it at a low dose occasionally for sleep, but I already found out I do not handle it well. I'd have to mark off the entire next day on my calendar. At low doses, it acts as an H1 histamine receptor antagonist. At a higher dose (>15 mg), it acts on Adrenergic, Serotonergic, and Noradrenergic receptors.

I'm about to try and get a psych appointment to try something else. I originally went to try and get an ADHD diagnosis last summer, and they said my insurance wouldn't cover anything until I failed at depression treatment. Lo and behold, it's been almost a year, and I haven't managed to schedule another appointment even though I think about it every day. I swear executive dysfunction is ruining my life alongside tinnitus.

 

[BB23]

At low doses, it acts as an H1 histamine receptor antagonist. At a higher dose (>15 mg), it acts on Adrenergic, Serotonergic, and Noradrenergic receptors.

Mirtazapine doesn't work like computer code. Even at lower doses, it still hits all these receptors you listed. At higher doses, the stimulant activity (serotonin, noradrenaline, etc.) becomes stronger than the histamine action, meaning those receptors get hit harder. On top of that, it also hits dopamine; Google search for proof. All in all, Mirtazapine is a very dirty drug that hits many receptors at once.

 

[kingsfan]

Mirtazapine doesn't work like computer code. Even at lower doses, it still hits all these receptors you listed. At higher doses, the stimulant activity (serotonin, noradrenaline, etc.) becomes stronger than the histamine action, meaning those receptors get hit harder. On top of that, it also hits dopamine; Google search for proof. All in all, Mirtazapine is a very dirty drug that hits many receptors at once.

So it's still hitting the histamine receptor at higher doses? That would definitely be a no-go for me. I seem to be too sensitive to it.

 

[Curadh]

It's certainly worth a try. Many ENTs prescribe it to tinnitus patients. However, if you go the medication route, be aware that many do not recommend a single medication. No medication is favored. However, if necessary, you will see some take a low-dose cocktail.

Thanks for your reply @Nick47. Do you have any tips on what Amitriptyline is usually paired with? Relaxants like Xanax? Corticosteroids? Natural supplements like Ginkgo biloba? I'm just wondering, not intending to seek and implement medical information.

I started the Amitriptyline last night, 10 mg before bed. I slept OK, but it had no effect on my tinnitus.

 

[Nick47]

Normally, a TCA like Amitriptyline or Nortriptyline is paired with Flupentixol or Aripiprazole, Clonazepam or Gabapentin, and Magnesium or Vitamin B2. These are medical cocktails from Hamid Djalilian and Dirk De Ridder.

I've seen others on here take e.g., Deanxit and Clonazepam & Carbamazepine and Keppra. People refer to it as a stack.

I take daily 22.5 mg of Mirtazapine and 300-600 mg of Gabapentin + 600 mg of Alpha-Lipoic Acid. On days when my tinnitus is very severe, I take Clonazepam, Deanxit Gabapentin, and Betahistine in a small cocktail. This is maybe once a week.

 

[AverageJoe12]

Mirtazapine doesn't work like computer code. Even at lower doses, it still hits all these receptors you listed. At higher doses, the stimulant activity (serotonin, noradrenaline, etc.) becomes stronger than the histamine action, meaning those receptors get hit harder. On top of that, it also hits dopamine; Google search for proof. All in all, Mirtazapine is a very dirty drug that hits many receptors at once.

Clomipramine is purported to help hyperacusis and is also a very 'dirty drug.'

 

[Ant_BXL]

I take daily 22.5 mg of Mirtazapine and 300-600 mg of Gabapentin + 600 mg of Alpha-Lipoic Acid. On days when my tinnitus is very severe, I take Clonazepam, Deanxit Gabapentin, and Betahistine in a small cocktail. This is maybe once a week.

Is Deanxit helping you? Do you take it as a one-off, and how long does it help you get rid of symptoms?

Thanks!

 

[Nick47]

Is Deanxit helping you? Do you take it as a one-off, and how long does it help you get rid of symptoms?

Thanks!

I take Deanxit for a couple of days, with Clonazepam and Gabapentin. I don't take it on its own. I use this cocktail on a low-maintenance dose, so if I'm struggling, I take the medications for a couple of days and then stop. I do this a few times a month.

 

[Curadh]

Normally, a TCA like Amitriptyline or Nortriptyline is paired with Flupentixol or Aripiprazole, Clonazepam or Gabapentin, and Magnesium or Vitamin B2. These are medical cocktails from Hamid Djalilian and Dirk De Ridder.

I've seen others on here take e.g., Deanxit and Clonazepam & Carbamazepine and Keppra. People refer to it as a stack.

I take daily 22.5 mg of Mirtazapine and 300-600 mg of Gabapentin + 600 mg of Alpha-Lipoic Acid. On days when my tinnitus is very severe, I take Clonazepam, Deanxit Gabapentin, and Betahistine in a small cocktail. This is maybe once a week.

That's interesting. A multi-pronged attack on it, but yet no permanent changes? Or are there any success stories?

I am not sure what caused mine; I was given a few treatments all at once by a dodgy old medical doctor who specialized in "naturopathy." I feel it was a combination of far too many substances being pumped into my body at high dosages/a direct injection into a nerve that is close to the ear/ten Prolotherapy injections which seemed to dramatically tighten the ligaments of the skull, neck, chest, back, etc., including leaving me with Eustachian Tube Dysfunction. I'm not sure if this is 'somatic' tinnitus.

I have Magnesium and B2 (did you mean B12?). I also have 30x 100 mg Fluvoxamine, Propranolol, Xanax, and a few others.

I've considered if Fluvoxamine can be ototoxic, but the damage is reversible when stopping the drug, so maybe taking that for a while might help. I'd even considered taking it with the Amitriptyline.

My next plan is to try to reverse the ligament tightness in the hopes it will stop the tinnitus - I will use Somatotropin and anabolic steroids with weight training, considering also getting Botox near the ears or using Cyclobenzaprine.

Like us all, I'm desperate.

 

[Nick47]

. A multi-pronged attack on it, but yet no permanent changes? Or are there any success stories?

I first noticed people who were not suffering all the time and only pop on here now and again are on stacks/cocktails.

Prof. Dirk De Ridder's lectures demonstrate many of the neurotransmitters involved in generating tinnitus. He also has his own cocktails.

Also, more recently, Dr. Hamid Djalilian has had a Phase 4 trial, which has shown some success; he also uses a cocktail of medications and nutraceuticals.

 

[BB23]

Prof. Dirk De Ridder's lectures demonstrate many of the neurotransmitters involved in generating tinnitus.

I have seen many of his videos but have never found one in which he mentions specific neurotransmitters. Can you link me to related videos?

 

[Nick47]

I have seen many of his videos but have never found one in which he mentions specific neurotransmitters. Can you link me to related videos?

Go to YouTube and search for "Medication for tinnitus disorder." It's on the TRI Academy channel.

 

[BB23]

I take Deanxit for a couple of days, with Clonazepam and Gabapentin. I don't take it on its own. I use this cocktail on a low-maintenance dose, so if I'm struggling, I take the medications for a couple of days and then stop. I do this a few times a month.

Do you get permanent improvements at all with any of these cocktails, and how much relief do they bring you? Like out of ten, what are the before and after scores?

By the way, I just watched Dr. Dirk De Ridder's video. It is very depressing to realize that a real cure is not coming.