Low-Dose Nortriptyline for Tinnitus?

[linearb]

Sorry yea, I'm just throwing stuff out from my terrible memory. I remember being at the store looking for antihistamines and having a list of 'ototoxic' medicine on my phone. My memory is telling me it was on the Merck Manuals website, but I cannot find the list anymore. It was a huge list and every antihistamine was on it, so from then on I just avoided them. Could be it only has a temporary effect. I haven't looked into it after that.

That sounds like the Neil Bauman list -- yes, it contains everything under the sun and note that the person who wrote it isn't a medical doctor.

 

[GBB]

I've only ever heard of Nortriptyline and other ADs causing serotonin-induced damage to the fusiform cells in the dorsal cochlear nucleus - not damaging the ear at all.

Serotonin modulates response properties of neurons in the dorsal cochlear nucleus of the mouse

 

[wagen]

Neither of these drugs are actually ototoxic. Benzodiazepine withdrawal can cause vestibular damage, especially if it's handled too quickly or improperly, but if there's actual damage to the hearing apparatus from simple use of benzos no one has ever been able to demonstrate it.

Antihistimines definitely do not cause vestibular damage, but, you're manipulating, minimally, acetylcholine, and additionally many of the older, common antihistamines like Benadryl, are actually not very specific and exert pretty notable serotonin reuptake inhibition (in fact, SSRIs were developed after looking at this mechanism and trying to create drugs which would exert the serotonin action without the antihistamine effect).

Drugs which mess with serotonin function are well known to, on a temporary basis, impact tinnitus perception.

People often use the word "ototoxicity" to relate to "any drug that I think might have caused me a temporary spike". This is just wrong; there are all sorts of drugs that can spike your tinnitus short to mid term without actually doing any damage to the hearing apparatus or the brain.

My tinnitus got so so so much louder after stopping Amitriptyline

Before, it was tolerable but now it's almost unmaskable.

I'm 6 months off. Do you think it could get better, at least a little bit? Since it got worse, it hasn't changed either way. Absolutely static.

 

[linearb]

My tinnitus got so so so much louder after stopping Amitriptyline

Before, it was tolerable but now it's almost unmaskable.

I'm 6 months off. Do you think it could get better, at least a little bit? Since it got worse, it hasn't changed either way. Absolutely static.

I'm sorry, I just don't know; I have no experience with TCA withdrawal, I've never been on any of those drugs for more than a couple days at a time, and like 90% of my insight into drug withdrawal syndromes relates to benzodiazepines, cannabinnoids and opioids. The mechanism of action of something like Nortriptyline is extremely complex compared to Valium or Morphine, and so I don't have the basic neurological background to understand this.

Very Generally, people often report improvement from drug withdrawals for as much as 12-24 months following the last dose, depending on the drug and how long they were on it.

Is it possible the Amitriptyline was helping with the tinnitus, which may have worsened for other reasons during the length of time you were on the drug? After 6 months off I might personally be tempted to try going back on for 1-2 weeks to see if any improvement happens.

 

[wagen]

I'm sorry, I just don't know; I have no experience with TCA withdrawal, I've never been on any of those drugs for more than a couple days at a time, and like 90% of my insight into drug withdrawal syndromes relates to benzodiazepines, cannabinnoids and opioids. The mechanism of action of something like Nortriptyline is extremely complex compared to Valium or Morphine, and so I don't have the basic neurological background to understand this.

Very Generally, people often report improvement from drug withdrawals for as much as 12-24 months following the last dose, depending on the drug and how long they were on it.

Is it possible the Amitriptyline was helping with the tinnitus, which may have worsened for other reasons during the length of time you were on the drug? After 6 months off I might personally be tempted to try going back on for 1-2 weeks to see if any improvement happens.

I've been trying to wait it out hoping that the tinnitus will improve. Unfortunately, I'm very very sleep deprived and tinnitus actually feels like it's getting worse. Probably due to sleep deprivation.

I hate that the drugs did this to me but I need to go back on something to sleep. I tried all natural options. Maximum 3 to 4 hours.

I have with me Amitriptyline, Mirtazapine, Zolpidem, Quetiapine, Hydroxyzine, Clonazepam, Lorazepam.

Which option from all these horrible drugs seems least harmful to tinnitus?

I stayed away from all this for 6 months but at this point the sleep deprivation is awful. I want to die. I have to sleep.

 

[linearb]

I've been trying to wait it out hoping that the tinnitus will improve. Unfortunately, I'm very very sleep deprived and tinnitus actually feels like it's getting worse. Probably due to sleep deprivation.

I hate that the drugs did this to me but I need to go back on something to sleep. I tried all natural options. Maximum 3 to 4 hours.

I have with me Amitriptyline, Mirtazapine, Zolpidem, Quetiapine, Hydroxyzine, Clonazepam, Lorazepam.

Which option from all these horrible drugs seems least harmful to tinnitus?

I stayed away from all this for 6 months but at this point the sleep deprivation is awful. I want to die. I have to sleep.

You're in an unpleasant and complex situation; all these drugs have serious risks, and I'm strongly biased because I've had positive experiences with some, negative with others, and I've been through benzo withdrawal twice so even though I continue to take Clonazepam, I don't like benzos and think use of them is generally suspect, even if it's the "best bad option" in some cases.

Our brains are different. I had a disastrous experience with Quetiapine; a friend uses it to detox from cannabis and dodge the insomnia and has no issues with it.

Nothing on that list is something you would automatically expect to cause hearing problems, and every drug on that list is something which is suspected to have caused tinnitus in some percentage of users, either from use or withdrawal.

We are deep into "chemical whack a mole" territory here, and your drug stash is pretty extensive; if you're working with a psychiatrist on this stuff, then I would ignore me and listen to them... if not, be careful.

 

[wagen]

You're in an unpleasant and complex situation; all these drugs have serious risks, and I'm strongly biased because I've had positive experiences with some, negative with others, and I've been through benzo withdrawal twice so even though I continue to take Clonazepam, I don't like benzos and think use of them is generally suspect, even if it's the "best bad option" in some cases.

Our brains are different. I had a disastrous experience with Quetiapine; a friend uses it to detox from cannabis and dodge the insomnia and has no issues with it.

Nothing on that list is something you would automatically expect to cause hearing problems, and every drug on that list is something which is suspected to have caused tinnitus in some percentage of users, either from use or withdrawal.

We are deep into "chemical whack a mole" territory here, and your drug stash is pretty extensive; if you're working with a psychiatrist on this stuff, then I would ignore me and listen to them... if not, be careful.

Thank you, linearb.

I know I'm doomed forever. There are no good options for me at this moment.

I just don't know how to move forward. My psychiatrist is useless. He doesn't believe in withdrawal and says my tinnitus is a sign of overthinking and wants me to take antipsychotics

I'm trying to figure it out alone, I have at this point zero trust in doctors.

Thank you very much for your thoughts, I truly appreciate it. Thank you.

 

[kingsfan]

Update:

I was able to get my appointment earlier, and went today. The doctor sat and listened to my entire tinnitus story, we went through my list of treatments I've heard about and wanted to try, and never once blew off anything I had to say or my condition.

I'm starting Low-Dose Nortriptyline today. Whether it will help, I will find out soon enough. It was either this or Ketamine infusion. Since I can start this today and not have to wait and possibly have to travel, I'm putting off Ketamine and trying the Low-Dose Nortriptyline.

Since they are doing a clinical trial on the Low-Dose Nortriptyline, I'm not sure if I'm allowed to talk about it or not. I didn't think to ask the doctor in the moment. I'm not part of the trial though.

 

[ajc]

I'm not sure if I'm allowed to talk about it or not. I didn't think to ask the doctor in the moment. I'm not part of the trial though.

You are allowed to talk about it if they didn't ask you to sign an NDA. And you aren't even part of the trial so there's no issue. Nortriptyline isn't even a novel drug, it's been around for ages.

 

[Lukee]

Update:

I was able to get my appointment earlier, and went today. The doctor sat and listened to my entire tinnitus story, we went through my list of treatments I've heard about and wanted to try, and never once blew off anything I had to say or my condition.

I'm starting Low-Dose Nortriptyline today. Whether it will help, I will find out soon enough. It was either this or Ketamine infusion. Since I can start this today and not have to wait and possibly have to travel, I'm putting off Ketamine and trying the Low-Dose Nortriptyline.

Since they are doing a clinical trial on the Low-Dose Nortriptyline, I'm not sure if I'm allowed to talk about it or not. I didn't think to ask the doctor in the moment. I'm not part of the trial though.

I agree with @ajc. I don't think you are tied to any secrecy. You haven't signed an NDA and you are not part of the trial!

 

[kingsfan]

I'm exactly 2 weeks into low-dose Nortriptyline (10 mg/day).

No effect on tinnitus, negatively nor positively.

As probably obvious, it has helped immensely with my depression. It has given me a bit of a jump of strength to deal with my tinnitus. It's still there. It still sucks. It's still negatively life-changing. But I can handle it a bit better.

I have the option of going up to 20 mg/day now. I'm trying to decide whether to wait another week and see. The literature on this drug says it take 3-4 weeks for full effect so I may wait another week.

 

[GBB]

I'm exactly 2 weeks into low-dose Nortriptyline (10 mg/day).

No effect on tinnitus, negatively nor positively.

As probably obvious, it has helped immensely with my depression. It has given me a bit of a jump of strength to deal with my tinnitus. It's still there. It still sucks. It's still negatively life-changing. But I can handle it a bit better.

I have the option of going up to 20 mg/day now. I'm trying to decide whether to wait another week and see. The literature on this drug says it take 3-4 weeks for full effect so I may wait another week.

That's great to hear! I think anything under 25 mg is typically the dose used for sleep/nerve pain, and over that is getting into dedicated AD territory.

EDIT: for clarity, I have been on 25 mg for about 8 months - I'm surprised it would be in a trial since it's not like a new drug or a new approach at this dose.

 

[Lukee]

I'm exactly 2 weeks into low-dose Nortriptyline (10 mg/day).

No effect on tinnitus, negatively nor positively.

As probably obvious, it has helped immensely with my depression. It has given me a bit of a jump of strength to deal with my tinnitus. It's still there. It still sucks. It's still negatively life-changing. But I can handle it a bit better.

I have the option of going up to 20 mg/day now. I'm trying to decide whether to wait another week and see. The literature on this drug says it take 3-4 weeks for full effect so I may wait another week.

Great to hear at least you are getting some positive effect out of it.

Would you say you have more energy now as well? Nortriptyline is known as a stimulant while Amitriptyline is a depressant but for some people, they will get sluggish on Nortriptyline as well.

Have you noticed any benefit on an inflammation perspective?

 

[Matchbox]

Nortriptyline is the metabolic product of Amitriptyline, so people taking the latter get both! They do bind to receptors with different strengths though.

 

[h-p]

One thing about low-dose Nortriptyline (but usually Amitriptyline among tricyclics) is that it might cause tinnitus. I was taking Nortriptyline 25 mg for 2.5 weeks for heartburn/GI issues when all of a sudden I developed high-pitched tinnitus (80% balance to right ear). But I don't know the cause for sure - I was also on a PPI so maybe that caused it or perhaps it arose from side effects from older cervical spine issues? Tests couldn't find any cause but the ENT suspected the tricyclic.

I'm trying to stay off drugs at the moment to see if the tinnitus abates at all. I had tried to get off Nortriptyline before but I do poorly with acid reducers if I don't also take it. It also helps my mood a bit.

 

[kingsfan]

That's great to hear! I think anything under 25 mg is typically the dose used for sleep/nerve pain, and over that is getting into dedicated AD territory.

EDIT: for clarity, I have been on 25 mg for about 8 months - I'm surprised it would be in a trial since it's not like a new drug or a new approach at this dose.

Yea, I'm not sure exactly what they are doing differently with it to be using it in a trial, but I wanted in on it to find out. I've also had depression for years and never any motivation to do anything about it so thought I should start there. The doctor told me to increase by 10 mg/day every two weeks for 6 weeks if I didn't have any negative reaction to it, so that doesn't seem low-dose anymore. I'll be at 30 mg/day doing that.

Great to hear at least you are getting some positive effect out of it.

Would you say you have more energy now as well? Nortriptyline is known as a stimulant while Amitriptyline is a depressant but for some people, they will get sluggish on Nortriptyline as well.

Have you noticed any benefit on an inflammation perspective?

I haven't noticed any new energy, but I also started intermittent fasting this week as I now have motivation to lose weight.

One thing about low-dose Nortriptyline (but usually Amitriptyline among tricyclics) is that it might cause tinnitus. I was taking Nortriptyline 25 mg for 2.5 weeks for heartburn/GI issues when all of a sudden I developed high-pitched tinnitus (80% balance to right ear). But I don't know the cause for sure - I was also on a PPI so maybe that caused it or perhaps it arose from side effects from older cervical spine issues? Tests couldn't find any cause but the ENT suspected the tricyclic.

I'm trying to stay off drugs at the moment to see if the tinnitus abates at all. I had tried to get off Nortriptyline before but I do poorly with acid reducers if I don't also take it. It also helps my mood a bit.

I've seen people report tinnitus with this drug, so I'm trying to take it slow. The moment I notice something awry with my tinnitus I'll be stopping or tapering down. Hopefully I'll be in the clear.

 

[MBH]

I was given Nortriptyline in the beginning. They said it would take a while to work and it was for sleep. Well, I didn't wait that long due to I didn't sleep and I was a mess. So when I went off of it I was even more of a mess.

 

[Matchbox]

Some people have their tinnitus resolve with antidepressants. But it's pretty rare. I seemed to be getting better taking one, but honestly couldn't be sure as I was also finally sleeping 8 hours using it.

 

[kingsfan]

So I upped the dose last night to 20 mg, per doctor's instructions, and I had a terrible time with my tinnitus. I'm not sure if it was because I was tired or not. I did stay up pretty late, about 1 or 2am. I had a lot of ringing in my right ear, which I don't normally have... usually I have head hissing/ringing, but now I had super loud ringing in my left ear, and just loud static in my right. I woke up a few times during the night and it was still unbearable. This morning things were calmed down, but I'm not sure if it's going to pick up during the day.

On the fence about what to do tonight when I have to take another dose.

 

[Psych]

I take Nortriptyline 50 mg.

It stopped my head tinnitus and I sleep really well on it.
No side effects. Only a little bit of tiredness when I started it.

It's been the best thing for me.

Love glynis

Great that it worked for you! But what is "head tinnitus," if you don't mind my asking?

 

[kingsfan]

But what is "head tinnitus," if you don't mind my asking?

Sounds like it's coming from the middle of my head and not my ears.

 

[Psych]

Sounds like it's coming from the middle of my head and not my ears.

Mine's kind of like that. Also, pressure-y, which makes it worse.

Hope we all get some relief soon!

 

[vttbx]

I have an appointment with Dr Djalilian at the end of July. If anything eventful comes from it, I'll let everyone know.

I was accepted into the study based on a preliminary phone call. Dr. Djalilian was booking into August already.

Did you say you are going to participate in the trial to get a July appointment?

 

[kingsfan]

I was accepted into the study based on a preliminary phone call. Dr. Djalilian was booking into August already.

Did you say you are going to participate in the trial to get a July appointment?

I just called and booked a regular appointment with him. My appointment is at the end of July. At the time I booked the appointment I also booked an appointment with a nurse practitioner there because I was having ear pain and just wanted to get evaluated as soon as possible. When I went for that appointment someone had messed something up and I wasn't on the schedule for that day, so instead they ended up getting me in with Dr. Harrison later that same day. I took the opportunity to talk with him about my tinnitus.

I am not participating in the trial.

 

[kingsfan]

3-week update

So I've had been on 10 mg of Nortriptyline for 3 weeks last Friday. I tried upping to 20 mg again. I did okay over the weekend. My tinnitus actually had an increase on Friday before I even upped the dose, but it didn't seem to get any worse during the weekend.

Last night and this morning it has ramped up a lot. There's two possibilities, it's the Nortriptyline or it was the motorcycle, squeaking car breaks, and loud car stereo I was subjected to yesterday while wearing 13 dB NRR earplugs. I had my car window down at an intersection for a brief moment and experienced these things all within that brief moment. City life is crazy like that...

Anyways I'm going back to 10mg for at least the next 4 days and I'll see what happens.

So far it seems 10 mg has been great for my ability to cope, but anything more seems to make things worse.

Final note. Dry mouth is extreme with this stuff. I'm chewing gum constantly to combat it.

 

[wagen]

Some people have their tinnitus resolve with antidepressants. But it's pretty rare. I seemed to be getting better taking one, but honestly couldn't be sure as I was also finally sleeping 8 hours using it.

Matchbox, what antidepressant gives you 8 hours of sleep? I haven't had 8 hours of sleep in more than 7 months

I hate drugs but at this point I'm ready to take anything that gives me a break.

Glad it works for you!

 

[Matchbox]

Matchbox, what antidepressant gives you 8 hours of sleep? I haven't had 8 hours of sleep in more than 7 months

As needed, very low dose of Amitriptyline. It might be making me worse though.

 

[Wrfortiscue]

Man, I haven't touched any drugs but Prednisone once, and I feel I'm slowly getting worse wtf.

 

[Wrfortiscue]

I really really hope so.

My dentist drill went away!

With that being said, my right ear permanently spiked and developed a reactive tone, and left ear permanently rings now compared to being intermittent previously.

Lol.

 

[wagen]

As needed, very low dose of Amitriptyline. It might be making me worse though.

I'm glad Amitriptyline helps you a bit at least! How do you think it makes you worse?

Amitriptyline is what gave me this horrible head drilling. I swore I would never get back to it but here I'm thinking about it again. It's this or life, I just don't know how to cope anymore. I don't sleep at all.