In February 2023, after a night out at a club, I developed unilateral hyperacusis in my right ear. Over time, my tinnitus would fade, but the hyperacusis has persisted. I experience mild burning and occasional stabbing sensations if I am exposed to excessive noise. Otherwise, it is mostly loudness hyperacusis. In July 2023, my hyperacusis worsened after taking three doses of Auvelity (one pill), a compound drug containing Wellbutrin. In August 2023, I started taking Mirtazapine and Fluvoxamine. These medications helped with sleep, but my brain tinnitus returned and has been severe since starting that combination.
I discontinued Fluvoxamine but continued taking a low dose of 7.5 mg Mirtazapine for sleep, along with 100-200 mg of Gabapentin as needed until May 2024.
In June 2024, I stopped taking Mirtazapine and started on Nortriptyline, beginning at 60 mg and increasing to 75 mg. The side effects were not too bad, starting at 60 mg, but included some sexual side effects. I also increased my Gabapentin to 900 mg in divided doses. I am not sure if I am feeling any benefits for my tinnitus and hyperacusis. I thought I might have experienced some improvement in my hyperacusis, but good days are rare. My tinnitus is still severe, and my hyperacusis is very apparent most days. My mood has deteriorated because I have become a hermit due to the hyperacusis.
I am considering trying Topiramate, as recommended by Dr. Djalilian, instead of Gabapentin, although I know it is a difficult drug to tolerate. Lyrica and Lamictal were also options provided to me, in addition to Gabapentin and Topiramate. I may stop taking Nortriptyline if the sexual side effects do not ease up and if I do not see any real benefit for my hyperacusis and reactive tinnitus. However, I might need to go higher than the recommended 75 mg to realize any benefit. Clomipramine works for hyperacusis for some people at high dosages, and the same logic might apply to Nortriptyline.