Huge Dilemma Over Antidepressants and Severe OCD (Zoloft and Luvox)

[juliob]

Hey all! Greetings from Brazil! (I was considering creating a introduction topic, but these doubts are bugging me so much that I decided to present more about myself later).

Does anyone here suffers from severe OCD and have tinnitus? I am worried that I need those meds for live because my OCD provides me horrible existential crisis which leads me to depression, and also makes me check tinnitus every time.

Now, there is a extremely difficult choice to make, and I would like your opinion to decide what to do regarding the meds.

I am almost sure that some days of Zoloft 50mg gave me tinnitus in the past, but not 100% sure. With that, I wondered "well, I might have suggested myself and actually I always had tinnitus, I am just more obsessed now"... so, in the end, I decided to try this 'gold standard' drug for OCD which is Zoloft. I am now 5 weeks on 50mg and 10 days on 100mg.

I had some fleeting tinnitus episodes, and some spikes while on 100mg, but always getting back to the baseline level I guess. Are the changes with dosage increase possibly permanent? Is it likely to fade away after a long withdrawal?

The major problem is that I am scared as shit to keep this medicine (fearing increase on T volume or anything like that), scared to increase dosage, scared to try other antidepressant (and remeron doesn't seem like a good option for OCD). My psych recommended Luvox, but even then, I found some scary horror stories about it.

I don't know what to do... has anyone with severe OCD here went through this? Should I stick with this dosage for a couple weeks waiting for the therapeutic period? Should I abandon ADs for life and try to get good with CBT only (I am afraid that this is not possible)? Should I play russian roullete again and try Luvox?

Oh well, I feel handcuffed and also stuck with a time bomb.

 

[sky_high]

I am almost sure that some days of Zoloft 50mg gave me tinnitus in the past, but not 100% sure.

How did this happen exactly? Was the tinnitus completely gone after you stopped the medication? And why did you take the same medicine after that?

I am also scared of taking medication, I did some research and there is this guy that says there is a connection between serotonin and tinnitus: https://news.ohsu.edu/2017/08/22/study-suggests-serotonin-may-worsen-tinnitus. Take it with a bit of salt though, there are no other studies that can confirm this.

I don't know what to do... has anyone with severe OCD here went through this? Should I stick with this dosage for a couple weeks waiting for the therapeutic period?

How long have you been on antidepressants? I don't know about OCD but I suffered with health anxiety and depression pretty much all my life, at some point it was so bad I could not get out of bed, could not go to work. I had to take medication... currently I am not taking anything and I'm ok-ish, working full time, keeping myself busy with sports and relaxing activities. It all depends if you identify the actual trigger and solve it... I did this with CBT therapy (long story though).

By the way, I also think I got tinnitus from SSRI (Lexapro) but I am not 100% sure. I guess with this thing you can never be, unless it is noise trauma. Two months after stopping all medications (Lexapro, Xanax, Imovane) my tinnitus is very slowly giving signs of improvement.

Are the changes with dosage increase possibly permanent? Is it likely to fade away after a long withdrawal?

My psychiatrist said if the tinnitus came from the drug it should go away with time, after stopping. If you do your own research, some people will say it did, other that it did not...

 

[juliob]

How did this happen exactly? Was the tinnitus completely gone after you stopped the medication? And why did you take the same medicine after that?

I was cross tapering from clomipramine to sertraline due to the side effects of the former. While doing this, there was a day that I found my PC doing a recurrent low high-pitchy sound, very annoying. After I turned it off, I confirmed it was the PC. Then I stopped to analyze the silence to check if there were another sounds around. It was when I noticed a very very mild tinnitus... I remember noticing it earlier in my life, but I didn't give attention to it thinking as a 'normal sound that everyone have, the sound of silence'. The problem is that when I noticed this sound after the PC thing, I started obsessing 'wait, is this normal?'... then I started the research and I found out that tinnitus has no cure, that antidepressants may trigger it, that I have to habituate.

Tinnitus then turned out to be my new OCD focus, and I think this is one possible reason for it being louder: I read in a book that we listen loudly to the stuff that worry us, an heritage from our ancestrals. There is a lymbic system theory about it... so, sometimes I think that 'ignorance is a bliss'. Maybe if I didn't start obsessing I would have it very mild as before. One thing that bugged me by the time, is that I was starting to meditate and was practicing this exercise of 'noticing sounds without judging them'... I don't remember noticing tinnitus though, but then again, maybe by that time I was filtering the sound because I was not obsessed. Oh, I have to state that I always heard very loud music with my earphones, so... there is this other confunding variable I guess.

When I stopped the med, it didn't go away. I stood 3 months without any AD until my OCD became very severe to the point that made me severely depressed. So I started ADs again, with Prozac that I used in my 16s. But oh boy, Prozac made my anxiety skyrocket, I couldn't sleep more than 3 hours even with Ambien or other stuff, and I was restless the entire day. I guess it's not the ideal AD for someone prone to anxiety.

Then my psych wanted me to go on Effexor. I read some horror stories (regarding tinnitus) about the med and also about how hard it was to quit it. I denied and then I came with the though "well, maybe I suggested myself with my T back when I was on sertraline... maybe I should give a shot and stop imediatly if I notice anything different... it's a well evaluated AD for OCD after all". Anyway, I already had a box of Zoloft in my house and my doc said 'Ok... we can test this'. Stupid, right? But I am afraid of every option to be honest: I don't remember Paxil triggering tinnitus, but it made me fat, mentally fatigued (to the point of becoming unproductive at my job as statistician/developer), emotionally numb and with almost no sex drive... oh, withdrawing from it was hell btw.

How long have you been on antidepressants?

It's a long road. I started on Prozac at my 16s, then I changed to Paxil later. I stopped ADs for like years until I was 25 and started an uncontrolable obsession regarding my ex cheating on me. My psych put me on Paxil again. No more intrusive thoughts in the right dosage, no tinnitus (I didn't even know that this existed by the time), but the side effects I mentioned. I then tried to withdraw alone... went crazy, tried Prozac, tried Sertraline (one or two pills, what didn't caused T as I remember) but nothing could stop the paranoia and restlessness about Paxil withdrawal... then I started clomipramine in the beginning of 2017, upping the dosage and using 75mg until 03/2018, when I decided to try Zoloft due to the side effects of clomipramine. That's when the T thing I described happened.

May I ask you for how long did you took CBT and how long did it took to have very therapeutic effects?

Also, may I ask how long did you stayed on Lexapro and at which dosage before quitting? I am happy you are getting some improvement.

 

[sky_high]

@juliob I was only for 3 weeks at therapeutic dosage (10 mg) and before that 5mg for 7 weeks.

I was also on 0.5 mg Xanax and once in a while Imovane for sleep. After I got tinnitus I stopped the lexapro and Xanax in a 5 day taper and continued with the sleeping pills for one week after because it was hard to sleep.

As far as I understand your tinnitus is mild and with your OCD history it's probably not a good idea to read too many negative stories on this forum.

Regarding the CBT, I am still doing it once per week. I started in May this year and saw some results after about 10 sessions.

 

[juliob]

@sky_high I see... thank you for sharing your treatments!

I am not sure if my T is mild... it's a very high-pitch sound (I would say 14kHz) so it's hard to mask. I hear it in every silent room of my home, and I can hear between dialogues of movies or series when the scene is silent. It's such a bummer to the whole experience. I can sleep using the noise of crickets by the night. But noticing the whole time without searching for it makes me depressed.

As for the negative stories... too late I guess, I lurked this forum a lot before creating this account. But I can't dismiss the positive stories and hang on my own experience.

I just wonder if I am taking the right decision sticking to these meds. But then again... trying a new option might be risky with the noise going crazy. So hard to decide.

 

[sky_high]

I am not sure if my T is mild... it's a very high-pitch sound (I would say 14kHz) so it's hard to mask. I hear it in every silent room of my home, and I can hear between dialogues of movies or series when the scene is silent.

Mine is also around 14kHz and I got to the point where I sometimes hear it only in silent rooms, but it fluctuates a lot, I can even hear it in the park while jogging some days. The overall tendency seems to be positive though.

Unfortunately I cannot give you a wholeheartedly advice to stop or not stop medication. Probably not many on this forum can.

The best advice I can give you is to consult another psychiatrist and explain the situation. You can decide together with your doctor if it makes sense to go off medication or try something else. When I went to mine, she admitted the tinnitus could be from the medication, but she told me it will subside after a while if I discontinue (let's hope she's right). Another decision we took was to go off medication and try only with therapy and over the counter medication and supplements. I am currently taking Valerian for sleep and Vitamin D3 and B12. That might, or might not be a viable solution for you.

As for the negative stories... too late I guess, I lurked this forum a lot before creating this account. But I can't dismiss the positive stories and hang on my own experience.

The problem is, having a tendency to obsess over your problems (I have that too), we are inclined to give more power to the worst case scenario. I guess this forum can be both a blessing and curse, it depends mostly on how you filter information.

Good luck!

 

[Lane]

I don't know what to do...

Hi @juliob


Regarding your OCD, have you considered whether it could be the result of a nutritional deficiency? The following link will take you to quite a remarkable article on the history of using inositol to successfully treat OCD (even severe OCD). -- All the Best!

LISTENING TO INOSITOL: CLINICAL NOTES

 

[juliob]

Mine is also around 14kHz and I got to the point where I sometimes hear it only in silent rooms, but it fluctuates a lot, I can even hear it in the park while jogging some days. The overall tendency seems to be positive though.

I see... Have you habituated? High frequency tinnitus sucks. Good to know that the tendecy seems positive!

When I went to mine, she admitted the tinnitus could be from the medication, but she told me it will subside after a while if I discontinue (let's hope she's right). Another decision we took was to go off medication and try only with therapy and over the counter medication and supplements. I am currently taking Valerian for sleep and Vitamin D3 and B12. That might, or might not be a viable solution for you.

So, you totally gave up on ADs? I am considering this route. My psych is good... he recognized the possibility of T from the meds and told me to tell him if the sound increases, that I am allowed to reduce the dosage. Right now, I don't know if my perception on T is higher due to the increased anxiety with the change on dosage, but I guess volumewise is the same thing: I still use the same volume of crickets to mask it (not sure if this is a good measure). But oh, I am almost abandoning antidepressants for life.

The problem is, having a tendency to obsess over your problems (I have that too), we are inclined to give more power to the worst case scenario.

Yes, I suffer a lot with worst case scenarios. Actually, mixing metaphysics + philosphy + severe OCD is really limiting me. T is a second focus of my OCD, but very bothersome too.

 

[juliob]

Hi @juliob


Regarding your OCD, have you considered whether it could be the result of a nutritional deficiency? The following link will take you to quite a remarkable article on the history of using inositol to successfully treat OCD (even severe OCD). -- All the Best!

LISTENING TO INOSITOL: CLINICAL NOTES

Hey!

Very interesting! I think I will share this with my psych. It gives me some hope... maybe I should also consider CBD oil? But thank you, never heard about inositol before!

 

[sky_high]

I see... Have you habituated? High frequency tinnitus sucks. Good to know that the tendecy seems positive!

It is high pitched but not very loud. I can hear it just because this frequency is hard to mask. I think a bit of both habituation and lower volume. Some days it does not bother me as bad when I have a cigarette on my very silent terrace. However it's still driving me crazy sometimes.

Also, yes I am on no medication since two months.

 

[juliob]

It is high pitched but not very loud. I can hear it just because this frequency is hard to mask. I think a bit of both habituation and lower volume. Some days it does not bother me as bad when I have a cigarette on my very silent terrace. However it's still driving me crazy sometimes.

Also, yes I am on no medication since two months.

I guess we are in the same boat. Does cigarettes have any effect on your T? I like to smoke once in a while so I am not sure about the overall effect of nicotine and stuff.

Two months is a very short period, and you exposed yourself to ADs in a very short time also... The chances of subsiding are in your favor. I hope your T gets better or vanishes.

Sorry for so much questions, though.

 

[sky_high]

Sorry for so much questions, though.

No worries . I also ask many questions to people on this forum that I feel have a similar situation to mine. But I think it's not that relevant as we think it is. Tinnitus seems to be unpredictable, SSRI medication the same... Just after I told you that I have a positive trend, my tinnitus got a bit worse today, probably due to work related stress.

I have been smoking regularly for more than 10 years. Nasty vice... unfortunately I feel I can't give it up during this period. I can't tell you if it makes it better or worse since I am smoking an average of 15 cigarettes per day, so I can't really tell you how it is without smoking for me. In the days where I am smoking more or less than usual I don't notice any difference though.

For me it's been very random so far and it's hard to find a pattern. Sometimes alcohol takes the edge off and makes it better, sometimes it makes it worse... sometimes running in the park makes it better, sometimes I get a temporary spike.

Two months is a very short period, and you exposed yourself to ADs in a very short time also... The chances of subsiding are in your favor. I hope your T gets better or vanishes.

I tend to believe the serotonin induced tinnitus theory, hopefully the brain manages to reach homeostasis again.

 

[juliob]

I tend to believe the serotonin induced tinnitus theory, hopefully the brain manages to reach homeostasis again.

I also believe this.

Thank you for all the answers!

 

[juliob]

Ok, little update here:

Today I completed 2 weeks using 100mg of Zoloft. T, volumewise, seems the same, and I feel it's kind of helping me to stop seeking the noise. It is really helping with my anxiety so I think I will keep the treatment. I mean... I think I already passed through the risky period.

Tomorrow I am going to talk to my psych to know about the next steps. But I guess switching to Luvox would be a shot in the dark: I med that I never used, ototoxic as any SSRI, could change something regarding my T. Better stay away from the unkown since I didn't find many experiences on Luvox on this forum.

 

[Tamara]

juliob,
Onde você mora no Brasil?
Tamara

 

[Paulmanlike]

@juliob OCD and having an intolerance for uncertainty go hand in hand.

Most AD's are safe to take and withdraw from under supervision from a doctor. The SSRIs and Mirtazapine etc.

However the sheer number of people around the world taking AD's that they necessarily don't need and the common incidence of tinnitus is going to create a sense of tinnitus is caused by this AD which in turns exacerbates your OCD fear of taking them.

There is also something called prolonged sexual dysfunction that remains once the drug that is withdrawn, that you can find many reports on the internet, however, again, the sheer number of millions of people that take them does not mean it will happen to you.

@Nanny chocolate is convinced her tinnitus escalated from Zoloft, that may or may not be true, and she isn't the first person I've seen report this on the internet.

 

[juliob]

juliob,
Onde você mora no Brasil?
Tamara

Oi, Tamara. Eu sou de São Paulo, e você? Sabe se tem outros usuários brasileiros por aqui também?

 

[juliob]

@juliob OCD and having an intolerance for uncertainty go hand in hand.

Most AD's are safe to take and withdraw from under supervision from a doctor. The SSRIs and Mirtazapine etc.

However the sheer number of people around the world taking AD's that they necessarily don't need and the common incidence of tinnitus is going to create a sense of tinnitus is caused by this AD which in turns exacerbates your OCD fear of taking them.

There is also something called prolonged sexual dysfunction that remains once the drug that is withdrawn, that you can find many reports on the internet, however, again, the sheer number of millions of people that take them does not mean it will happen to you.

@Nanny chocolate is convinced her tinnitus escalated from Zoloft, that may or may not be true, and she isn't the first person I've seen report this on the internet.

Hey! I like to believe that ADs are safe, and that with a long enough withdrawal, the brain reaches homeostasis. TBH, I am not even sure if it was indeed Zoloft the trigger of my T, but I am determined to NOT increase the dosage as my OCD is pretty manageable now, keeping the residual symptoms to CBT and mindfulness meditation, lowering the dosage after my improvement through therapy.

Regarding stuff like 'prolonged sexual dysfunction', I try to not obsess with this kind of stuff: my libido seems kinda OK now and I can't drop the meds now that I am going to start a new job and I need to gain more stability with therapy before abandoning the drugs. But, I believe that these reactions are pretty rare, and I also believe that belief itself is something very strong: once you are 'infected' with the suggestion of such an effect, you might manifest the symptoms on yourself due to your negative thoughts. I guess the placebo effect is the more direct evidence of the power of our own minds.

I saw Nanny's report. It's one of the anecdotal reports that I considered a lot, mainly when I was going to up my dosage. My T seems at the same level as it was before, I guess I am lucky with this. But I can find anecdotal negative reports on any AD, even Remeron... so I decided that Zoloft is the last AD drug I will try. If things go bad, my plan B will be to try Inositol or CBD oil, this if CBT itself doesn't control the symptoms.

 

[juliob]

Some news: I switched to Luvox (I am on 100 mg) and it didn't seem to change my tinnitus.

BUT, when I tried to updose to 125 mg with my doctor, my tinnitus got more intrusive and I gave up and got back to 100 mg.

I am sure that Sertraline caused my tinnitus, as I tried 150 mg before this swap and a second tone appeared on the third day and it's still there.

Given that and the paper relating serotonin to tinnitus, I find myself in a very tricky position: I need something effective for OCD, it might be dangerous to try Inositol together as it also influences serotonin and increasing the SSRI might worsen my tinnitus, but I still need a effective med for OCD.

Decisions... again.

 

[juliob]

BUT, when I tried to updose to 125 mg with my doctor, my tinnitus got more intrusive and I gave up and got back to 100 mg.

My OCD is so brutal these days that I am starting to consider that the updosing route is not that bad.

Is there anyone with severe OCD that can give hints or opinions? I am not interpreting anything here as professional medical advice.

 

[ECP]

Have you ever considered taking N-acetylcysteine (NAC)? Some research shows that NAC is good for the ears, and coincidentally it is also good for anxiety and OCD.

If you search this message board for posts about NAC, you'll find a lot of people here who recommend it.

If you decide to try NAC, it's easily available at Amazon, no prescription required. You'll just have to talk it over with your doctor and decide if it's worth a try.

 

[juliob]

Have you ever considered taking N-acetylcysteine (NAC)? Some research shows that NAC is good for the ears, and coincidentally it is also good for anxiety and OCD.

If you search this message board for posts about NAC, you'll find a lot of people here who recommend it.

If you decide to try NAC, it's easily available at Amazon, no prescription required. You'll just have to talk it over with your doctor and decide if it's worth a try.

Yes, I did consider NAC! As I am tapering Diazepam, I bought a bottle (actually it's not my first one) of NAC and it seems to help.

Maybe I should use higher doses such as 1800 mg or 2400 mg. My only concern is if it can cause cancer or anything serious if used daily in the long term.

 

[ZFire]

My OCD is so brutal these days that I am starting to consider that the updosing route is not that bad.

Is there anyone with severe OCD that can give hints or opinions? I am not interpreting anything here as professional medical advice.

I know someone who had a debilitating case of harm OCD. They went on Fluoxetine and it helped tremendously. Updosing all the way to 80 mg eliminated their obsessive thoughts as far as I know. Granted, it was their first time ever using a anti-depressant (they're still on Fluoxetine 4 years later).

Also some counseling (with a psychologist) seemed to provide some added benefit as well.

 

[juliob]

I know someone who had a debilitating case of harm OCD. They went on Fluoxetine and it helped tremendously. Updosing all the way to 80 mg eliminated their obsessive thoughts as far as I know. Granted, it was their first time ever using a anti-depressant (they're still on Fluoxetine 4 years later).

Also some counseling (with a psychologist) seemed to provide some added benefit as well.

Thank you for sharing this. The major issue is that my tinnitus was induced by SSRIs (Sertraline) and now I wonder if I should max the dose out. Everytime I tried updosing Luvox, I got a spike long enough to make me go back to the previous dose for it to subside.

I wonder if this person you mentioned have SSRI induced tinnitus as well. But I am still considering updosing...

 

[Nick47]

Thank you for sharing this. The major issue is that my tinnitus was induced by SSRIs (Sertraline) and now I wonder if I should max the dose out. Everytime I tried updosing Luvox, I got a spike long enough to make me go back to the previous dose for it to subside.

I wonder if this person you mentioned have SSRI induced tinnitus as well. But I am still considering updosing...

It's not as simple as more serotonin increases tinnitus, unfortunately. There are around a dozen or so identified serotonin types in different parts of the body. I posted some information on the antidepressant thread.

 

[ZFire]

I wonder if this person you mentioned have SSRI induced tinnitus as well. But I am still considering updosing...

This person is a very close relative of mine. They have never brought up any issues related to SSRIs/tinnitus to me. They don't experience tinnitus as a matter of fact.