Hyperacusis Cured/Reduced by Clomipramine

Clomipramine is a very interesting drug. While it's primarily an antidepressant, it can also be a good sleep aid, as you found out, because it enhances the way serotonin is handled in the brain. It sounds like it works best after being on a regular dosing regime for a month or more.

I'm wondering if smaller doses couldn't be used for older folks like myself whose brains don't make as much serotonin as they used to? I use Gabapentin as a sleep aid and it works pretty well. Melatonin gave me such vivid dreams that it really wasn't an option. But something that boosts serotonin is something I might try.

Don't worry about diminished sexual drive, things like Blue Chew and its variants are pretty much wonders for that. I think they work, to one extent or another, for some women as well as men.

 

I thought it was actually the antihistamine properties that allowed it to work as a sleep aid. Nortriptyline (another TCA antidepressant) is one I took for months and has those properties as well, although it never seemed to help in the slightest for my sleep or anything else, but I got the dry mouth.

Melatonin does zero for me, and I've tried different kinds and doses. Zolpidem helps.

 

Mirtazapine was pretty brilliant for my sleep - small, small dosages. 7.5 mg or half of that. It does have weight gain and increased hunger as a side effect.

 

@wiektor, @Trafalgar D and @Morgoth51, thanks for sharing your success stories!

How are you doing now? Still living a hyperacusis-free life?

@Trafalgar D, it looks like you posted an update just a few months ago in February so I assume you're still doing well (which is great!)

@wiektor, how did you go about finding a psychologist/mental health provider that specializes in tinnitus and hyperacusis? I’m trying to do the same thing and it’s tough to find someone knowledgeable in hearing disorders.

@AverageJoe12, did you ever end up trying Clomipramine? I'm curious what your experience was like if you did try it.

 

My psychiatrist had no issues prescribing Clomipramine on the basis of my anxiety and depression attributed to the hyperacusis and my prior history of health anxiety.

Unfortunately, I had to discontinue it after a few days due to insomnia and increased anxiety. That is par for the course for me with psych medications, so I just need a longer period of time to ramp up, maybe a gram scale to cut my starting dosage in half, and more time off work to adjust to the side effect profile next time.

I wouldn't let my experience discourage anyone from trying it, though. For the time being, I'm opting for Lyrica to tide me over as it is FDA-approved in the US for central sensitization, which I believe is at play here to some extent. I had a second acoustic trauma with an MRI last week, which was horrible and largely preventable, so I'm mostly going with natural healing for now. I need to regain some tolerance.

 

Hey! I'm doing very well, ear-wise!

I have an everyday life again, really. In the last 4 months, I went to over 10+ parties (with foam earplugs), took two overseas flights (12h duration each), took several shorter flights (1-3h), kept using my headphones (AirPods Max capped at 75 dB), had loads of fun in all types of bars and louder places, went to several home gatherings with friends, had vaccines... I also experienced a few accidents with plates/glasses accidentally breaking and some similar, short-lived, loud stuff.

And even so, my tinnitus did not worsen, and hyperacusis never returned. I'm now on 10 mg of Clomipramine and will stop it in about 4 weeks. Tapering is no issue; I've been doing it really slowly and have not experienced withdrawal effects (at least not yet). My tinnitus is still present, but it has no relevance in my life AT ALL.

I couldn't be happier with having my life back.

Regarding the therapist, she was an angel. She gave me all the tips (including capping the headphones at 75 dB via the iPhone settings) and has cured over 200 cases of hyperacusis. I found her by Googling "hyperacusis + [my city]," and she was the only one. My first two consultations were online because I still wore earmuffs at home. Gosh. Crazy times.

Stay positive, look for help, and take care of your ears ONLY WHEN NECESSARY. I protect my ears only above 90 dB and only with foam earplugs, which are the safest and most protective.

This journey is highly individual, so my experience may not be everyone's. Getting exposed and seeking help were the key factors that made me improve. Even if your tinnitus worsens with SAFE exposure, habituate to it, and then you'll notice the spike go down. In short, habituate to having an everyday life, and you'll start forgetting your tinnitus, even when it fluctuates. Mine used to fluctuate a LOT after some average exposures; I just started not caring because you need to live your life regardless of a friggin' noise in your head/ears.

I hope that helps.

 

Insane advice!

 

I just meant: habituate to a "normal" life - protecting against anything too loud - and you'll habituate to your tinnitus. I just couldn't stop living because one day, my tinnitus got louder, and I thought it was something stupid that caused it. I don't believe anything below 80 dB can damage your ears.

That's my experience. If I were to live life according to most of the people here, I'd be stuck in my apartment forever, not taking any "regular" pills, vaccines, etc. I stopped having setbacks when I was on Clomipramine, so I am truly grateful for my experience with that pill.

Regardless of my advice, everyone's experience is unique. What worked for me may not work for everyone else.

Just make your choices, assume the risks, and move on with your life.

 

That used to be the case with me for over 20 years when I had "mild" tinnitus. But when severe tinnitus hit over 2 years ago, I was unhabituated, and that train left the station. My tinnitus is variable in the type of sound as well as volume, and there's no habituating to it at this point by living everyday life, which is difficult. It's impossible to forget for long and gets worse over time. Back when I had mild tinnitus, it worked just to push forward and keep tinnitus out of my mind most of the time. But the variable severe level is a different animal. And antidepressants just made things more painful for me, even after weaning off.

 

Thanks for the updates! Did you have reactive tinnitus? I saw you mentioned a reactive whistle, but did you have tinnitus that would get louder with other sounds? Do you have hearing loss? Did the Clomipramine cause a lot of weight gain or side effects like heartburn?

My tinnitus still fluctuates quite a bit, and I swing from being okay with it on quiet days to being deeply depressed.

 

Thank you for the update! It's awesome to hear you're doing so well. So you took Clomipramine for a total of how many months (I understood you're still actively taking 10 mg)? Also, would you be willing to share who your angel of a psychiatrist is? I would like to work with her, even if it's virtually.

 

I only had this whistle. My tinnitus used to get a lot louder with everyday sounds, but luckily, this is rarely the case now. I'd say it varies, but it's much more stable.

I don't have meaningful hearing loss up to 8 kHz; there are a few dips of 10 dB, and that's all.

Clomipramine gave me a few episodes of sweet teeth. But I kind of managed. I don't think I gained any significant amount of weight as I was also always working out 3-4x/week. I did not experience heartburn, but I did experience some weird constipation that slowly improved over many months.

If I remember well, I started sometime around July last year? Maybe June? I started with 25 mg, and my maximum dose was 100 mg for two months, then 75 mg extended release until I started to wean off.

My psychiatrist was reluctant to give me Clomipramine; he only did it after I showed him the anecdotes. My psychologist was the angel I mentioned before. Her name is Elke Müller-Soukoup; she has a website you can easily find on Google. She treats about 10-20 cases of hyperacusis per year, on top of being known for therapy for tinnitus in my city.

I'm very sorry to hear about your tinnitus getting worse after 20 years. It's a very difficult condition.

I hope your tinnitus stabilizes so you can try to push for a normal life again. When my tinnitus started, not even 80 dB sounds would mask it. Yet, I habituated with the help of antidepressants somehow.

The key is to turn off your emotional response to it. When I was doing my psychological therapy for hyperacusis, I'd often do exercises to stimulate my other senses. For instance, I had a few exercises where I'd have to close my eyes and touch an unknown object she would place in my hands.

I had about 10 minutes to figure it out. I never got it right, but at the end of the exercise, I was asked if I thought about tinnitus during that moment. The funny thing is that I managed to ignore it completely while touching and feeling the object.

That's when the whole "I can habituate" thing kicked in a bit. I'd normally not do such things, but getting that help (psychiatrist and psychologist) took me out of that hole. It doesn't work for everyone, but it worked for me.

Ah, also, getting out of Tinnitus Talk was somewhat harder than habituation. I lurked here every single day, and I fed my brain and body with a lot of negative emotional responses, and you only realize what kind of damage that does later on.

I think one can put tinnitus in the same mental space as an obsession in an OCD-prone brain. The more you stimulate that obsession, the worse it gets. And to me, coming here to read all the stuff was precisely that.

 

Thanks for sharing the side effects. This is all very interesting.

 

I've read that type of comment hundreds of times here. It just doesn't work for me with my tinnitus level and other issues these days.

Like I said, I dishabituated when my tinnitus went from mild (my tinnitus was mild for about 20 years; it changed to variable and severe over two years ago - plus, I have noticed additional worsening lately.)

What used to work for my mild tinnitus doesn't work for the severe variable tinnitus that I have now, which is combined with moderate hearing loss, hyperacusis, TTTS, insomnia, anxiety, and other chronic pain. There's an automatic response by the sympathetic nervous system to the loud tinnitus, even when my mind is focusing on something different.

Benzos helped a little; antidepressants didn't help at all and made things worse.

 

Yesterday I tried 25 mg of Clomipramine. It was very bad. Diarrhea, malaise, tinnitus spike, and mental confusion. Now I'm a little better, but it was terrible. I will not continue with the Clomipramine.

 

Thanks for reporting back. All of the side effects you mention sound like the usual ones people report during the first few days/week of taking antidepressants, but the tinnitus spike is a dealbreaker.

Do you think you might try a different medication?

 

I agree. There are limits to habituation. Pain makes it impossible, just like you can't habituate to toothache.

What antidepressants made it worse?

 

Nortriptyline (a tricyclic antidepressant like Clomipramine) didn't seem to have any effect on my tinnitus but caused other side effects, and it was questionable whether I really ever received any relief from anxiety or depression:

https://www.tinnitustalk.com/posts/686402/

Sertraline and Lexapro (both SSRI antidepressants) did seem to have a negative effect on my tinnitus, but they had even worse side effects and no benefit after using them combined for eight weeks before weaning off:

https://www.tinnitustalk.com/posts/706445/

 

Nortriptyline spiked my tinnitus and caused me to have nasty dry mouth and a bit of constipation.

 

What do you know, another Belgian with hyperacusis. Do you have noxacusis?

 

Heya guys!

Just an update about Clomipramine. I had successfully tapered it and eventually stopped taking it. But I had a major setback in late January, worsened by either COVID-19 or the flu. Burning pain in both ears, to the point I remembered what I read somewhere on the Internet about having melting lava poured into the ears... yeah, it did feel like that.

I was reluctant to start Clomipramine again, as stopping it was hard (headaches, fatigue, brain zaps, mood changes), but the burning pain was too much, and I decided to give it a (new) try.

I started at 10 mg a day, then increased to 20 mg, 30 mg, 40 mg. After a month, I reached 100 mg a day, and I've stayed there since. The pain is gone by 80-90% and during bad days, it's mostly a tingling; definitely uncomfortable but not that painful.

The side effects are mostly dry mouth, heavy sweating, constipation, urinary retention, and being often sleepy. On the other hand, there was no tinnitus spike, which is quite appreciable.

As far as I'm concerned, Clomipramine still proves to be the most efficient medication for neuropathic pain (burning type), and I wish ENTs were more aware of it. I did talk about the pain when I first went to one right after the trauma, and he said (and did) nothing to help me with the pain.

 

Which was worse, Sertraline or Lexapro? When you say negative effect, do you mean an increase in tinnitus or something else? It was interesting to see a study on Sertraline vs Melatonin on tinnitus.

 

When I said "negative effect on tinnitus," I was referring to the new intermittent chirping ringing sound mentioned in the post I linked to, as it was more obvious when something new started. It was harder to say if my existing variable tinnitus was any worse. The new sound started shortly after starting Sertraline and continued with Lexapro. Neither that nor the stomach discomfort improved moving from Sertraline to Lexapro, so I couldn't say either was worse. I recall reading quite a few posts in the past from people reporting that their tinnitus started or increased after taking those and other SSRI antidepressants.

Some people sleep better when taking Melatonin, so they might report better scores because of that. I've tried it often in various doses, from about 1 mg to 5 mg, and it doesn't seem to have any effect on my sleep or tinnitus.

 

What do you think of Cymbalta?

 

I haven't tried it. Cymbalta (Duloxetine) is an SNRI, and I've only tried the TCA and SSRI antidepressants, unsuccessfully, so it's still on my list of possibilities. I have read some positive feedback about Cymbalta from people on Tinnitus Talk, who also had nerve pain, and I think I'm having some of that as well. I've read that it's more difficult to wean off of than SRRIs and that being late with a single dose can cause side effects.

My doctor leans towards Effexor (Venlafaxine) within the SNRI class, so I'm not sure he would let me try Cymbalta. For now, I'm avoiding starting anything else new while looking into the stomach pain issue and trying a new insomnia drug (so far, not so good).

 

What's the insomnia drug?

 

Quviviq (Daridorexant). It has been available for about two years and is the newest medication in the dual orexin receptor antagonist (DORA) class, which includes the drugs Belsomra (Suvorexant) and Dayvigo (Lemborexant).

 

I was thinking of Cymbalta since it's used for central sensitization disorders, and hyperacusis supposedly falls into that category. I didn't realize Effexor was also an SNRI, but one of those might work. I don't blame you for wanting to take a break. And that's great news about the insomnia drug!

 

Yeah, Effexor is an SNRI, but it acts as an SSRI at lower doses (<150 mg).

I can't say it's great news on the insomnia drug at this point. It doesn't seem to be helping yet, but I'm moving from 25 mg to 50 mg (the max dose) in a couple of days and will see if that helps in the nights that follow.

 

Ah okay! I'm taking it some nights. My sleep doctor said 50 mg; giving it two weeks is an adequate trial. Have you ever had a sleep study done? Most these days are at home with a little ring on your finger, or you can get a more accurate in-lab one done.

On nights when I get more deep sleep (confirmed by my Apple Watch), my tinnitus is reduced the following morning and day. Quviviq seems to help with that. But so does Gabapentin/Mirtazapine.