Antidepressants (SSRIs, SNRIs, MAOs, TCAs, TeCAs, e.g. Mirtazapine (Remeron), Amitriptyline, etc.)

Discussion in 'Treatments' started by Pat, May 10, 2012.

  1. Pat

    Pat Member

    Tinnitus Since:
    10/2011
    This thread is for the discussion of antidepressants & tinnitus.

    SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), MAOs (Monoamine Oxidase Inhibitors), TCAs (Tricyclic Antidepressants), TeCAs (Tetracyclic Antidepressants), et cetera.

    Some brand names: Cymbalta, Lexapro, Effexor, Zoloft, Celexa, Prozac, Wellbutrin, Citalopram, Pristiq, Amitriptyline, Paxil, Sertraline, Remeron (Mirtazapine), Nortriptyline, Venlafaxine, Fluoxetine...

    Speak your mind, share your experiences, and ask questions.
  2. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Could anyone give me information on the anti-depressants they have tried for tinnitus?
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  3. DezDog
    Angry

    DezDog Member Benefactor

    Tinnitus Since:
    01/2009
    Fluoxetine (prozac). Unfortunately, I've heard that it might make it worse, but I think I owe a large part of my recovery (mental approach) to the prozac. I was on it before (for depression), and had come off it when I had my last and worst episode.
  4. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Thanks. Its a worry when almost all anti-depressants come up as ototoxic.
  5. erik
    Surfing

    erik Manager Staff Benefactor

    Location:
    Washington State
    Tinnitus Since:
    04/15/2012
    While this is true, there are several factors when it comes to ototoxicity. Certain medications are known to cause permanent damage to the hearing system in some people and there are very few of these. The rest are considered to be "possible" ototoxic including anti-depressants.

    Other factors are dosage, frequency and how many meds you are taken at the same time which are ototoxic (combined increased dosage). If you are taken high doses for longer periods of time, you may experience certain ototoxic effects. Many ototoxic drugs which cause hearing issues are considered to be reversible including nsaids, aspirin and anti-depressants, however the chance is minor that you will experience adverse effects in the first place. Most only 1-2%. Just because a med may potentially be ototoxic doesn't mean it will be for you.

    Symptoms of ototoxicty are tinnitus or worsening of existing tinnitus, balance problems, dizziness and vertigo. In most case, just stopping a med will cause these symptoms to improve or go away within a few days, weeks or sometimes months.
  6. jenny joyce

    jenny joyce Guest

    i find that the anti anxiety tablet is the only real tablet that helps .. it is a low dose and i have been on it for 20 years.. i dont know what else to do.. my noise is so very loud.. there is 4 noises in my head.. i have to have some quality of life...
  7. jenny joyce

    jenny joyce Guest

    am on lexapro amd lexotan 3mg and have been for many years.. they do help me cope better but thats all...
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  8. jenny joyce

    jenny joyce Guest

    louise.. you have only had tinnitus this year so maybe trying something natural would be better for you.. if you have had tinnitus for many years it is harder to treat.. you could have some great results if you start sometment now... sound therapy would be a great starting point for you.. jenny..
  9. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Thanks Jenny. The anxiety is the worst thing for me right now. Interesting that your doctor is ok with you bneing on the anti-anxiety med for so long. Can you tell that its still working for you?
  10. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Thanks Erik. I'll try not to stress about taking them then. I tried one Sertraline (Zoloft) on Friday and felt terrible. Really nauseous and the weirdest feeling of my head lifting up and floating off to the side. A very, very odd feeling. Also I got even less sleep and I think it was that.

    I need to find an Anti-D that suits me but they all seem to cause nausea and dry mouth.
  11. Markku
    Inspired

    Markku Director Staff Benefactor

    Location:
    Finland
    Tinnitus Since:
    04/2010
    As far as I know, nauseousness & dry mouth etc can be adverse effects when you first start ADs, but these symptoms generally disappear within a few days / weeks. That's what I've been told anyway and this seems to happen to quite many.

    Of course it's not pleasant, but maybe patience (yeah, easier said than done, especially with the tinnitus on the side) should be exercised and sticking to the meds for a week or so and wait if the adverse effects go away.
  12. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Yes, thats good advice Markku, I'll keep on with the Citalopram I think.
  13. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Has anyone used Amitriptyline?
  14. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Has anyone tried using this anti-depressant?
  15. DezDog
    Angry

    DezDog Member Benefactor

    Tinnitus Since:
    01/2009
    I was prescribed it to help me sleep, 10mg before bed. It was a life-saver. 10mg is very low dose, working more as a sleep aid than an AD.
  16. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    I've been trying Amitriptyline for a week to see if it helps with T (some studies suggest it does). However, I've now found a quote about how it works and it doesnt sound good. Does anyone know what this means below....

    "The anticholinergic action leads to decreased production of endolymph and a release of inhibition in the afferent fibers at the organ of Corti and the olivocochlear bundle. The antihistaminic effect products a vasoconstriction of the cochlear artery, which decreases the cochlear potential."

    Not sure releasing inhibition and reducing blood flow to the cochlear is a good idea?
  17. joe

    joe Member

    Location:
    UK
    Tinnitus Since:
    October 2011
    I don't want to sound against your findings, and I am really pleased that Amytriptyline has anticholinergic
    Action. I have always considered this drug being ottotoxic and never tried it?
  18. mock turtle

    mock turtle Member

    Location:
    puget sound
    Tinnitus Since:
    07/26/1992...habituated after 2 years; 11/04/11 new outbreak
    joe makes a good point cause messing with endolymph is getting to the core of the hearing mechanism...this drug may help but it may hurt so id be sure and check with more than one medical professional

    anticholinergic means the drug inhibits a neurotransmitter called acetylcholineone which is one of more than around 30 brain transmitter chemicals...gaba and glutamate ore two others we talk about here a lot, you may have heard of those two )

    decreased production of endolymph means one of the two fluids in the cochlea, endolymph, is produced is lesser amounts... the endolymph is potassium rich

    the other fluid in the cochlea is called perilymph an i believe it is sodium rich

    endolymph surounds the organ of corti which is where the hearing cells are

    perilymph is on either side of the organ of corti

    endolymph is way more positive than endolymph and thats how the whole signal thing from hearing gets powered up

    so i would GUESS that if your meds change the endolymph in some way, you would notice it

    but would it help? or hurt (agravate) tinnitus...i dont know

    ask your doctor about this...im just a search engine junkie and i dont know poop without help from the internet

    good luck
    mt
  19. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Guys thanks.

    The only reason I know about Amitriptyline being implicated with tinnitus is from a phone call I made to a practioner (Cranio Sacral I think) in the early days and some google research which turned up a test in which 95% of T people in the study benefitted from it. I'll post that link at the end. its not new news is it that Amitriptyline is supposed to help?

    Joe - all the antidepressants I know of come up as ototoxic in the book I have (Ototoxic Drugs Exposed). All of them. Then some people say its only a small percentage of people who get his effect and even then its transient. When you get to the end of your tether you'll try anything and that's where I am.

    MT - You will know as well as I that normal doctors will be of no use in these very specific questions. We are talking hearing specialists for the answer to questions such as those arent we? Or even more knowledgeable ones than those. I put the question out because I'm not able to research in my current state so anything anyone can tell me from google etc etc is helpful.

    MT,, from this quote, which did you mean is moe positive? "endolymph is way more positive than endolymph and thats how the whole signal thing from hearing gets powered up" do you mean endolypmh or perilymph? Neither will mean much to me but the more info the better.

    Wasnt there something about potassium channels that has just been discovered too? I'll post that at the end as well.

    What I read sounds really scary especially the part about vasoconstriction. But, this drug has been said to help T.

    Here are the links I have read:

    http://www.ncbi.nlm.nih.gov/pubmed/11771024
    http://www.tinnitusjournal.com/detalhe_artigo.asp?id=393
    http://www2.le.ac.uk/offices/press/...lular-mechanisms-behind-the-onset-of-tinnitus
  20. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    I was wondering if anyone has had any negative experience with Mirtazapine regarding T?
  21. J. Wing

    J. Wing Member

    Tinnitus Since:
    10/1999
    Is this Lorazapam? So many I get confused
  22. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    No, Its Mirtazapine (Remeron in the US) its and anti-depressant.
  23. J. Wing

    J. Wing Member

    Tinnitus Since:
    10/1999
    DOH! on my part. Have had tinnitus since 1999 and at first was not sleeping at all. Did some reading to where the AD Amitriptyline helps with sleep. Doctor let me try it(50mg)and it worked wonders and I still take it to this day. I've heard good things about Remeron also.
  24. mick

    mick Member Benefactor

    Location:
    USA
    Tinnitus Since:
    11/2012
    Louise,

    I took Zoloft for a while and found it a very difficult medication to get used to. The first 3 or 4 weeks were terrible, but my doctor encouraged me to stick with it. The symptoms I had were agitation, sweating, and that feeling of your head floating like you described. I was taking it as anxiety not related to tinnitus at the time. I eventually got used to it, and it did get my anxiety under control, but never liked it. Stopped taking it after about 6 months. I also had difficulty sleeping while on Zoloft. I would wake up very frequently. I switched to taking it in the morning rather than at night and that helped (I woke up less frequently). Once I quit taking it, my sleep pattern went back to normal.
  25. J. Wing

    J. Wing Member

    Tinnitus Since:
    10/1999
    Been on Amitriptyline 50mg since coming down with tinnitus. It solved my issue with insomnia because of my tinnitus. Still take it. I think it's a wonder drug.
  26. Karl

    Karl Member Benefactor

    Location:
    Chicago
    Tinnitus Since:
    10/2011
    One of my doctors said that Amitripyline is one of the best for tinnitus.

    I have to agree with Dez Dog's statement:
    The problem with tinnitus is our reaction. If these drugs can reduce the tension and anxiety, then we reduce our negative reactions.
  27. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    Thanks for the info. Did Amitriptyline reduce the T noise at all? Its the one that is supposed to help with that. I got some but didnt take it when I saw T was actually listed as a side-effect!
  28. Louise

    Louise Member Benefactor

    Location:
    Yorkshire, UK
    Tinnitus Since:
    29/06/2012
    I've been told that Amitriptyline can lower T volume. J Wing, do you get a volume reduction? Unfortunately the Patient Informatino Leaflet lists tinnitus as a side-effect (other meds dont, so its not like its on everything) so I wouldnt take it.
  29. terry123

    terry123 Member

    Location:
    Everett WA
    Tinnitus Since:
    12/2012
    Has any one eperienced relief by using the above-mentioned drugs. I would like to hear any positive or negative results
  30. Markku
    Inspired

    Markku Director Staff Benefactor

    Location:
    Finland
    Tinnitus Since:
    04/2010
    I don't have enough personal experience, but I want to offer some information.

    Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management

    Antidepressants
    Baldo and colleagues performed a meta-analysis in 2006 on tricyclic antidepressants (TCAs) and SSRIs, which questioned substantially their efficacy in the treatment of tinnitus, although most evidence may have been invalidated by methodological bias or the reliance on single case reports.47 In 2007, an analysis of four RCTs by Robinson found that higher doses of SSRIs and TCAs appear to work for tinnitus patients who also exhibit depression and anxiety48 or insomnia,49 both of which are frequent comorbidities among chronic otolaryngic patients.50 What appears to be irreversible disability of otologic origin may, in part, be a reversible disability of psychiatric origin when treated51,52 with drugs proven to be effective antidepressants such as nortriptyline.53
    Some TCAs have proven not to be effective for tinnitus,54,55 or were even less effective than placebo56 (or possibly being associated with tinnitus onset with high doses of clomipramine).57
    A possible dose effect may exist as lower doses have sometimes been related to tinnitus onset,58,59 even when the same agents were reported as being effective60 (as in non-TCA heterocyclic antidepressants such as trazodone61 and mianserin).62

    Sertraline was found to be more effective than placebo for severe refractory tinnitus cases63 although its discontinuation was associated with tinnitus onset.64 Other SSRIs (eg, paroxetine) provided no significant improvement for nondepressed patients65 or even exacerbated tinnitus (eg, fluoxetine).66
    While newer antidepressants have not been investigated as thoroughly as SSRIs and TCAs, little data on their role in the treatment of tinnitus has been reported and which has sometimes led to inhomogeneous evidence.
    Serotonin norepinephrine reuptake inhibitors (SNRIs) withdrawal has seldom been associated with tinnitus (both for venlafaxine67,68 and duloxetine69), while the norepinephrine dopamine reuptake inhibitor (NDRI) bupropion may mimic a transient ischemic attack that may induce tinnitus,70,71 that is most likely due to DA-ergic enhancment.



    Antidepressants for patients with tinnitus

    Main results: Six trials involving 610 patients were included. Trial quality was generally low. Four of the trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. One study investigated trazodone, an atypical antidepressant, versus placebo. Only the trial using the SSRI drug reached the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop‐out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. In the trial investigating trazodone, the results showed an improvement in tinnitus intensity and in quality of life after treatment, but in neither case reached statistical significance. Reports of side effects including sedation, sexual dysfunction and dry mouth were common.
    Authors' conclusions: There is as yet insufficient evidence to say that antidepressant drug therapy improves tinnitus.



    Louise might chip in with her ototoxic drugs book with information about how ototoxic Celexa or Cymbalta are classified as.

    But, I wouldn't expect miracles taking ADs. They might help you if you are depressed/anxious, thus they might indirectly ease the perception of tinnitus, too.
    Worth remembering that some antidepressants have caused tinnitus or made it worse, so proceed with caution.

    Remeron is a good one and praised here for its sleep-inducing properties. Its chances of causing hearing loss/tinnitus is somewhere between 0,1% - 1%.

    You could also try natural alternatives, such as melatonin (for sleep). It's also a good antioxidant and might protect your hearing.

    Now, let's hear from others!
    Markku
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