Member- Jul 7, 2022
- 148
- Tinnitus Since
- 06/2022
- Cause of Tinnitus
- Worsened with COVID-19 / Anesthesia
Antidepressants (SSRIs, SNRIs, MAOs, TCAs, TeCAs)
- Thread starter Pat
- Start date
There seems to be a general paranoia between ototoxic (hearing damage-inducing) medications and tinnitus.
Very, very, very few medications cause hearing damage and are ototoxic. A few can trigger tinnitus if existing hearing damage is present.
RELAX.
Very, very, very few medications cause hearing damage and are ototoxic. A few can trigger tinnitus if existing hearing damage is present.
RELAX.
For Pete's sake, it is not just about ototoxicity. Of course, very few medications are ototoxic. The issue is that non-ototoxic medications can induce or worsen tinnitus - like SSRIs. It is not even a debate that SSRIs can do it, and certainly should not be. Because they affect the brain, and tinnitus, or at least variants of it, originate in the brain. With an existing tinnitus, the bets are off. One should take the necessary medications, but extra caution is more than warranted, and pros/cons should be evaluated, and alternative medications considered.
Ksharky13
Member
- Mar 9, 2022
- 37
- Tinnitus Since
- 01/2022
- Cause of Tinnitus
- Suspect COVID-19 vaccine - Moderna booster in 12/2021
I totally agree. When I first went on an SSRI over two decades ago, I had no tinnitus and didn't remember any initial side effects. I tolerated it perfectly for a long time. I got off it in the summer of '22. I had mild tinnitus then, and it's moderate now. I have been going through a serious anxiety disorder for the last 1.5 years, and several providers have suggested I get back on an SSRI. But after the horror stories I've read, I don't think I could ever take one again. Hell, I won't even take a single Ibuprofen for a headache. I've become petrified of taking anything that could make my tinnitus worse. This sucks.
SSRIs can make tinnitus worse in some, improve it in some, and have no change in the rest. All I'm saying is we must challenge posters, who in a panic, go on about ototoxicity. Many patients need medication for other diseases. We must not spread fear to these people, who may stop the medications they need.
In general, TCAs are prescribed for tinnitus patients, although they are certainly not universally effective, and a percentage get worse. If that happens, stop the medication.
I'm asking for rationality. I've seen a number of people develop tinnitus or it getting worse after STOPPING a medication. If I interpret the poster above correctly, I believe it.
There are studies showing that Nortriptyline and Amitriptyline are more effective than placebo. Again, it's not a universal answer, and it can lead to tinnitus in a few.
There are some posters here describing all medications as poison. That is dangerous. After all, many are hoping other poisons like XEN1101 or these HCN2 blockers are effective.
In general, TCAs are prescribed for tinnitus patients, although they are certainly not universally effective, and a percentage get worse. If that happens, stop the medication.
I'm asking for rationality. I've seen a number of people develop tinnitus or it getting worse after STOPPING a medication. If I interpret the poster above correctly, I believe it.
There are studies showing that Nortriptyline and Amitriptyline are more effective than placebo. Again, it's not a universal answer, and it can lead to tinnitus in a few.
There are some posters here describing all medications as poison. That is dangerous. After all, many are hoping other poisons like XEN1101 or these HCN2 blockers are effective.
I take Ibuprofen for headaches, just a normal dose, and I can't say it has done anything to my ears... I guess. Your mileage may vary.
The combination of severe tinnitus and headache is just unbearable. I can't do anything about tinnitus, but at least I can fight off a headache.
I agree. But my stupid diabetes medications have made my hyperacusis worse. So it's all possible.
But haven't you been worsening? How do you know it's not from Ibuprofen?
Metformin. I went on it fine at the starter dose, but after I increased the dose a week later, my ears got worse. I stopped for a couple of weeks; my ears got a bit better, but my blood sugar got worse, so I went back on the starter dose. Then, when I upped the dose again, the ear pain returned worse. I have been a week off it and my ears have improved a little. It is depressing me a lot.
Ksharky13
Member
- Mar 9, 2022
- 37
- Tinnitus Since
- 01/2022
- Cause of Tinnitus
- Suspect COVID-19 vaccine - Moderna booster in 12/2021
I'm afraid you read my post incorrectly. I had mild tinnitus when I got off of the SSRI. It did not get worse for several months after, and continues to do so. I don't believe it had anything to do with coming off the SSRI. In fact, I don't recall any major withdrawal symptoms from getting off the SSRI.
On the surface, it doesn't make any sense to me that someone could be on an SSRI long-term with no issues with tinnitus, then get off it for a while (i.e., two years) and then get back on the same SSRI only to get tinnitus from it. The chemical reactions regarding the impact on neurotransmitters should be the same both times.
It's so frustrating since I believe I really need medications to treat my severe anxiety disorder, but I can't rely on a medication that I was on for over 20 years. That tells me that neither pharma nor the medical community actually know how these medications work. And everything I research (i.e., medications and supplements that could possibly help with anxiety also can cause or exacerbate tinnitus. And no matter how small the relative risk is, tinnitus is such a torturous affliction that it's just not worth the risk for many people.
Thanks for the response. I have chronic headaches from tight neck and shoulder muscles on the side that tinnitus is worse (right side). I assume that it's due to chronic stress from having tinnitus. If I could manage the headaches, that would help my situation a lot. It's really bad at the base of the skull, which I believe is the suboccipital muscles.
I'm glad to hear that taking a normal dose of Ibuprofen does not affect your tinnitus. Clinical data indicates that tinnitus is only a risk for those who take high doses for a long period of time. But then I see stories where people say that their tinnitus got worse from taking just one pill one time. It makes it so hard to take even one step towards helping your own situation. It's very hard to measure the risk of getting worse tinnitus from various medications or supplements, etc.
I gave in and took a leftover Mirtazapine tablet yesterday. I actually got some decent sleep for the first time in a week and my tinnitus was not loud in the morning, so no spike. That's something I guess.
RunningMan
Member
- May 8, 2023
- 612
- Tinnitus Since
- HiFrq ~2000, Increased 2022, LoFrq ~2020
- Cause of Tinnitus
- Loud noise - clubs, stereos, cycles, headphones, engines,etc
Are you not able to get a refill for Mirtazapine from your doctor? I don't think my doctor would prescribe it or TCA antidepressants (even though an NP had prescribed me a TCA called Nortriptyline in that same office when my doctor was unavailable). The doctor wouldn't even do Gabapentin.
Don't forget that during that time period, you have changed a lot. So what applied to the "you" of 20 years ago may not (and probably will not) apply to the "you" of today.
I've had tinnitus for more than three decades, and what used to work does not work now. I don't know about yours, but my tinnitus is totally unpredictable. It will amp up like crazy for no apparent reason, even though my life is exactly like it was when it was at a barely discernible level. Then, it will go down again for no apparent reason.
I usually find that when it's loud, it's due to a build of earwax. It doesn't take much! So when my tinnitus goes crazy, I will apply some drops of an OTC medication that softens the earwax, then flush them out w/ hydrogen peroxide. I leave each of those in my ears for 3 to 5 minutes. Then I do it again for three days. This usually results in the earwax getting loose, and it can be taken out carefully w/ a Q-tip. The difference in tinnitus level is very noticeable. My theory is that people w/ tinnitus build up excess earwax more frequently than before we got it, maybe because our ears are trying to protect themselves. An ear flush can often get us back to a base level.
Hi folks. I noticed Mirtazapine is an anti-depressant that does not have tinnitus listed as a side effect (tinnitus is labeled as "frequency not reported") on drugs.com.
Is Mirtazapine, therefore, widely regarded as "safe" for use by tinnitus sufferers, at least compared to other SSRI/SNRI options?
Thanks.
Is Mirtazapine, therefore, widely regarded as "safe" for use by tinnitus sufferers, at least compared to other SSRI/SNRI options?
Thanks.
You may have to try it to be sure.
I came to realize that cinnamon spiked my tinnitus after my wife made pumpkin spice cookies that were heavy on the cinnamon.
You never know what will spike it. But remember, correlation does not equal causation.
Ksharky13
Member
- Mar 9, 2022
- 37
- Tinnitus Since
- 01/2022
- Cause of Tinnitus
- Suspect COVID-19 vaccine - Moderna booster in 12/2021
Mirtazapine is a tetracyclic antidepressant that I have also researched a lot and have considered for my anxiety disorder. It is reportedly very safe for tinnitus, which is why I would even consider it. I am so afraid of taking anything that could make my tinnitus worse. It can cause weight gain and is apparently used more for depression than anxiety. Plus, like all such medicatins, it will have withdrawal symptoms if you ever want to get off of it. I don't think the risk of tinnitus is 0%, because it seems like nothing is 0% risk when it comes to tinnitus. It's an ugly and unfair beast.
By the way, I see you're only about 6 months into your experience with tinnitus and that you got it from a concert. I think you still have a chance of it resolving itself over time as long as you are careful going forward.
Are you looking for a sleep aid or something to help with anxiety?
I read some of your posts, and it looks like you are currently taking Duloxetine. Are you looking to transition from that to Mirtazapine? Be careful, as I think Duloxetine is noted for tinnitus upon withdrawal.
It looks like you have a pretty decent nightly stack of medications & supplements. Have those helped at all?
RunningMan
Member
- May 8, 2023
- 612
- Tinnitus Since
- HiFrq ~2000, Increased 2022, LoFrq ~2020
- Cause of Tinnitus
- Loud noise - clubs, stereos, cycles, headphones, engines,etc
From what I've read, Mirtazapine (Remeron) is less likely to cause/worsen tinnitus than SSRI/SNRI, but I wouldn't call it safe by a long shot. There's quite a bit of previous feedback on Tinnitus Talk. Recent discussion:
https://www.tinnitustalk.com/posts/702851
Hi @Ksharky13 - thanks so much for your detailed reply. I'm after both a sleep aid and something to help with anxiety - although probably more the latter than the former (they go hand in hand to some degree!).
I am not on Duloxetine at the moment - I was on it shortly after my tinnitus first started in October 2023, but I got off it after about three months. I'm not sure if it caused some new tinnitus that came upon me at about the 3-month mark and while I was on Duloxetine (i.e., prior to withdrawal) or if the "new" tinnitus at month 3 was just the random natural progression of tinnitus during its early stages. My original tinnitus was due to a loud concert.
So, at the moment, I am taking nothing other than NAC when I fly or am doing something moderately loud (like going to a restaurant even with earplugs, etc). I might take Klonopin like once every few weeks if I've had a really tough night/day with shrieking tinnitus.
Yes, it's this sort of situation that really scares me - so despite Mirtazapine being widely regarded as at the lowest end of the risk spectrum, there are still people out there who are convinced it has either caused or exacerbated their tinnitus.
RunningMan
Member
- May 8, 2023
- 612
- Tinnitus Since
- HiFrq ~2000, Increased 2022, LoFrq ~2020
- Cause of Tinnitus
- Loud noise - clubs, stereos, cycles, headphones, engines,etc
Well, those other things that people mentioned in those references such as "destroying their life" and other chronic conditions mentioned in regard to Mirtazapine are pretty scary as well, so it's not just about exacerbating tinnitus.
My bigger problem after taking SSRIs was actually stomach pain, which continued after weaning off, rather than the worsening tinnitus, that usually gets mentioned on Tinnitus Talk.
- Jul 7, 2022
- 148
- Tinnitus Since
- 06/2022
- Cause of Tinnitus
- Worsened with COVID-19 / Anesthesia
Ksharky13
Member
- Mar 9, 2022
- 37
- Tinnitus Since
- 01/2022
- Cause of Tinnitus
- Suspect COVID-19 vaccine - Moderna booster in 12/2021
Unfortunately, I am in the group of people who have gone down that rabbit hole and doom-scrolled my way into being petrified of trying anything that could help either my tinnitus or severe anxiety. I was on Sertraline for over two decades with no issues; I have been off it for two years and now won't even give it a chance due to all of the people who say they've gotten debilitating tinnitus from Sertraline or any number of other SSRI medications.
I have various different providers strongly suggesting I need to be on an antidepressant medication, but I simply can't pull the trigger due to fear. I won't even try CBD oil because so many people said it spiked their tinnitus. Heck, I won't even take one Ibuprofen for a chronic headache. I've really put myself in a bad place, and I keep getting worse on both the anxiety and tinnitus/MEM fronts.
I welcome any suggestions from people who have been where I'm at and were able to get past it and get better. Thanks.
Ksharky13
Member
- Mar 9, 2022
- 37
- Tinnitus Since
- 01/2022
- Cause of Tinnitus
- Suspect COVID-19 vaccine - Moderna booster in 12/2021
Thanks. Yes, I am certainly aware that tinnitus from SSRIs is reported as being "rare," but even a very slim chance is too much for me to risk with my current mental state. Of course, I've found a handful of reports from people on here who had been on an SSRI (including Sertraline), had been off for a while, then tried the same one again with horrendous results.
I wish I had never gone down the rabbit hole of constant "Google University" research and doom-scrolling and just listened to my doctors. At least I would have had a chance at getting better. Now, my mental health is deteriorating and has caused (I assume) my recent hyperacusis/phonophobia and MEM/TTTS situation. I'm trying many of the recommended treatments, like CBT, deep breathing, mindfulness, journaling, etc., but my anxiety is so severe it just laughs at that stuff. My auditory issues combined with my mental health situation make every day a challenge to get through, and I don't see any "light at the end of the tunnel" but rather a complete mental breakdown.
Sertraline caused my intermittent tinnitus. I did not have it before I took Sertraline. Medications can definitely cause tinnitus and other ear issues.
Just because a medication hasn't caused or increased your tinnitus, it doesn't mean everyone will be as lucky.
I can't understand why discussion is still going on about this.
It is completely random whether serotonergic or gabaergic drugs will give you tinnitus or not. This also includes hardcore drugs like LSD or even weed. It has to do with receptor downregulation or excitotoxicity. It doesn't happen to everyone, but it happens to some.
You don't need to suffer ototoxicity; neurotoxicity itself gives you tinnitus, and these drugs can cause that.
Just because some studies showed success in treating tinnitus with an SSRI, it doesn't mean that it won't cause tinnitus in some other people; everybody's brain is different.
Also, @Travis Henry isn't the only one who got hit by benzos on Tinnitus Talk. Remember @Brian P. [RIP]? @BrysonKingMe also had a similar reaction.
Before making absolute comments, do research on adverse reactions, paradoxical reactions, the kindling phenomenon, interdose withdrawals, and tolerance states. All these can cause tinnitus, regardless of ototoxicity. They also cause other issues, which will make tinnitus the least of your problems.
Again, it doesn't happen to everyone, but it does happen to some. It's like how one drug ends up helping someone and not doing anything for someone else. It's up to you to risk it.
It is completely random whether serotonergic or gabaergic drugs will give you tinnitus or not. This also includes hardcore drugs like LSD or even weed. It has to do with receptor downregulation or excitotoxicity. It doesn't happen to everyone, but it happens to some.
You don't need to suffer ototoxicity; neurotoxicity itself gives you tinnitus, and these drugs can cause that.
Just because some studies showed success in treating tinnitus with an SSRI, it doesn't mean that it won't cause tinnitus in some other people; everybody's brain is different.
Also, @Travis Henry isn't the only one who got hit by benzos on Tinnitus Talk. Remember @Brian P. [RIP]? @BrysonKingMe also had a similar reaction.
Before making absolute comments, do research on adverse reactions, paradoxical reactions, the kindling phenomenon, interdose withdrawals, and tolerance states. All these can cause tinnitus, regardless of ototoxicity. They also cause other issues, which will make tinnitus the least of your problems.
Again, it doesn't happen to everyone, but it does happen to some. It's like how one drug ends up helping someone and not doing anything for someone else. It's up to you to risk it.
I took Amitriptyline for two weeks: 10 mg in the first week, then 20 mg in the second. The first week was fine, but my tinnitus worsened in the second week. It went back to normal after I stopped taking it.
I wonder if I should try keeping it at a smaller dose. The first week was interesting, with some quieter moments and some new sounds, though it could have just been a placebo.
Has anybody else experienced something similar and got a good result on a smaller dose?
I would try some other antidepressant, but my country only has Amitriptyline from the tricyclic class.
I wonder if I should try keeping it at a smaller dose. The first week was interesting, with some quieter moments and some new sounds, though it could have just been a placebo.
Has anybody else experienced something similar and got a good result on a smaller dose?
I would try some other antidepressant, but my country only has Amitriptyline from the tricyclic class.
I don't intend to upset anyone. If you take a medicine and develop tinnitus within days or a week, report it here and with regulatory authority.
I learned on Tinnitus Talk that many had Wellbutrin-induced tinnitus, so reports are very useful.
All I wanted to say is that ototoxicity (hearing damage) is caused only by a handful of medications that are well-known here. I think promoting rationality and calm is important here. There are people who may greatly benefit from some medications but are now terrified to try them. That's a shame and surely not our aim.
For example, @Mentos found the combo of Doxepin + Flupentixol reduced his tinnitus.
@Carlos1, @linearb and @Dakota all do well on Gabapentin and Clonazepam.
@grate_biff has had success with Baclofen, Flupentixol + others.
@glynis has done well on Nortriptyline.
And there are others...
Possibly a low-dose combo of some of the above?
10 mg of Amitriptyline is normally the dose for chronic neuropathic pain.
This hints at a combination of medications with CBT. It mentions bimodal study and a medication being tested in animals.
I learned on Tinnitus Talk that many had Wellbutrin-induced tinnitus, so reports are very useful.
All I wanted to say is that ototoxicity (hearing damage) is caused only by a handful of medications that are well-known here. I think promoting rationality and calm is important here. There are people who may greatly benefit from some medications but are now terrified to try them. That's a shame and surely not our aim.
For example, @Mentos found the combo of Doxepin + Flupentixol reduced his tinnitus.
@Carlos1, @linearb and @Dakota all do well on Gabapentin and Clonazepam.
@grate_biff has had success with Baclofen, Flupentixol + others.
@glynis has done well on Nortriptyline.
And there are others...
There was a Lancet review in 2021. It had Amitriptyline top for likely to be effective:
→ Efficacy of pharmacologic treatment in tinnitus patients without specific or treatable origin: A network meta-analysis of randomised controlled trials
Possibly a low-dose combo of some of the above?
10 mg of Amitriptyline is normally the dose for chronic neuropathic pain.
This hints at a combination of medications with CBT. It mentions bimodal study and a medication being tested in animals.
- Nov 1, 2022
- 185
- Tinnitus Since
- 09/2022
- Cause of Tinnitus
- being a caregiver for an elderly lady who is hard of hearing
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.
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.
