The Truth About Antidepressants?

[G.R.]

Dear Dr. Nagler,

Thank you for all of the helpful posts on this forum. Can you please comment on the potential for SSRIs to cause or worsen tinnitus, sometimes permanently? It seems that while many doctors will say this is rare, there are people posting in a wide array of websites and from many different countries who testify otherwise, and they seem to be in significant numbers. For some of us, even a tiny risk of worsening the tinnitus permanently is not worth it, no matter how much we are suffering with anxiety, depression, and/or panic.

If tinnitus has triggered a very severe anxiety/panic disorder in someone who was quite stable before the tinnitus, are there methods other than antidepressants that could just as effectively address these obstacles to habituation?

Thank you,
G.R.

 

[Dr. Nagler]

Thank you for all of the helpful posts on this forum.

You are welcome.

Can you please comment on the potential for SSRIs to cause or worsen tinnitus, sometimes permanently? It seems that while many doctors will say this is rare, there are people posting in a wide array of websites and from many different countries who testify otherwise, and they seem to be in significant numbers. For some of us, evan a tiny risk of worsening the tinnitus permanently is not worth it, no matter how much we are suffering with anxiety, depression, and/or panic.

Well, your premise is a real problem. When you say, "For some of us, even a tiny risk of worsening tinnitus permanently is not worth it," SSRIs are the least of your worries. There are so many things in our daily lives that present a "tiny risk" of permanently worsening tinnitus, that you might as well just stay home, never touch medications of any kind, and eat nothing but lettuce three times a day. My attitude has always been that I am not going to let my tinnitus dictate what I eat, where I go, and how I live. Instead, I am going to avoid those things (including medications) known to potentially cause permanent auditory damage, which is a readily manageable list, as opposed to those things that might present even a tiny risk of permanently worsening my tinnitus (i.e., making it permanently louder), which is an impossible task. And that, of course, goes for SSRIs, none of which are known to potentially cause auditory damage. Now I am not advocating taking SSRIs with impunity, but if you need 'em ... you need 'em. That's my attitude anyway.

If tinnitus has triggered a very severe anxiety/panic disorder in someone who was quite stable before the tinnitus, are there methods other than antidepressants that could just as effectively address these obstacles to habituation?

Chapter 6 in the (now out-of-print) book Tinnitus: A Self-Management Guide for the Ringing in Your Ears by Jane Henry and Peter Wilson contains some great ideas along those lines. I'll upload it below for your convenience.

Hope this helps.

stephen nagler