Antidepressants (SSRIs, SNRIs, MAOs, TCAs, TeCAs)

Hi,
Thanks Golly and Marku, really appreciate the advice.

A brief history about my tinnitus . Hopefully this might help someone

I am a young sixty plus guy who operated / owned a small business till the end of march 2013. I am what u will a techno illetrate, I prefer getting info from newspapers , books, and tv. Still find it a bit difficult navigating the Internet .

In Dec 2012 I went throught a bit of anxiety and was sleeping poorly,
My doctor prescribed clonozapam 1,0mg for sleep, He assured me that this medication is not addictive ( small dosage) and I can get off the med. whenever I needed to.

I have to admit this medication gave me the best sleep I ever had in a long while.
End of jan. 2013, I disposed of the meds, thinking that I don't need anymore.

Most of u guys know of the withdrawl symptons, ie insomnia, Anxiety, total lack of energy, loss of interest in business. I had no idea what was happening to me, I thought the worst, not linking it to the clonozapam.

Then the horrid tinnitus began.

Doctor ,told me that I am not over the anxiety, put me back on clonozapam
Been to the audiologist , ent, they seem to think that it is age related hearing loss that caused the tinnitus
Presently my tinnitus is in my left ear and some evenings difficult to sleep. I am still on the clonazapam .5 mg.minus elavil.

Hopefully I can get off this benzo and get onto an alternative.

Any thoughts or help will be appreciated

Regards
Bacus

 

Hi Bacus:

First of all, Clonazepam can indeed be addictive. While not everyone builds up a tolerance, the need to increase the dose for continued efficacy is definitely a risk.

Second, there is growing evidence (clinical and anecdotal) that abrupt cessation of benzodiazapines, like Clonazepam, can lead to tinnitus. It is advisable therefore to taper slowly when trying to quit such drugs. Also, your doctor would be remiss if he didn't tell you that quitting Clonazepam cold turkey could lead to a seizure. So, make sure you reduce the dosage slowly.

When I was taking 1mg of Clonazepam daily and decided to stop, I reduced to 0.5mg for a week, then to 0.25mg for a week, then down to 0.125mg for a week, and finally stopped. As such, I experienced no adverse effects.

-Golly

 

Yes, clonazepam is addictive, like all benzodiazepines, but clonazepam is probably less addictive due to its long half-life, and doctors often switch patients to clonazepam from other benzos to wean people off benzodiazepines.

 

Mirtazapine will make you eat sugar out of the bag it came in It will also make you careless about all sorts of aspects in life. And for me it reduced tinnitus in the morning. But not to a extent where I would see it as very beneficial.

Clonazepam makes me drousy and dizzy it has little to no effect on my T. It is is also a benzo so it can cause dependence. Natural sleep should be the goal. I would only recommend it short term.

 

OK things taking a bit of a dip - don't think the Citalopram is helping me anymore had a few weeks feeling wobbly had to take sleeping pills again to help me through - hoped to get back on track - but Im now full of anxiety again and sleep issues have returned - anyone had this happen to them after doing OK on a SSRI ? Ive got an appointment to see the doc on Wednesday and Im off work again - Im no where near as bad as I was at the beginning but the anxiety is back so the T is loud and sleep is rubbish

 

Hang in there, @Cher69. Talk to your doctor---you'll figure out a course of action that's right for you. Don't forget that tapering off SSRIs is usually recommended. If sleep is an issue, find out what your doctor thinks about Mirtazapine as an alternative to SSRIs. In his post (above), Luca implied that Mirtazapine increases appetite. Studies suggest that this is the case for only about 15% of users (about the same percentage that report weight gain). I have been taking 15mg nightly since April and have been having the best sleeps of my life (and have not gained an ounce). Hope you feel better soon. -Golly

 

I would say mirtazapine is a good drug, and you can take a lot of it with no troubles. Clonazapam I am not to crazy about, because you get habituated and dependent on it, so stay away. Amitryptilline is a good med, but in high doses will kill you, and is also very anti-cholinergic so I just don't like it - you brain needs acetyl choline to stay smart, so just not a good idea. Drugs are mainly to get your sleep. Lyrica is a good med, I just started it, and it stays good for long term use, supposedly. It is a newer drug, and is also used for spinal cord injury pain victims, so a major league drug. I find it is life saving (for me, anyway). Seroquel is a major league drug, which keeps you from freaking out about your tinnitus and also puts you to sleep. In high doses you get very nasty movement disorders, which does not happen with mirtazapine or Lyrica. But however Seroquel is highly useful in small doses. Seroquel will also cause you to get diabetes, which is another reason I don't like it. Cannabinoids are also anti depressant and pain killer, and would be one of my best picks, but again will do nothing to stop the tinnitus, just helps you sleep and deal with it. With cannabinoids you will gradually get habituated, so whatever you do, it is always best to rotate your drugs - one stops working, move to the next, etc. that's all i know.

 

I just read the first page, and thought I'd chime in. There are no ototoxic anti-depressants that I am aware of from any of the classes listed in the discussion subject. There have been anecdotal reports of tinnitus increase from such drugs, but nothing that has been demonstrated in a controlled, scientific setting to cause hearing loss or worsen tinnitus.

Neil Bauman's book is almost 100% misinformation. Please do not use it as a guideline for which medications you take or do not take.

 

Quite possibly Bauman's book is disinformation intended to appeal to desperate individuals who are looking for clues and answers. Because so many drugs are listed there, the book will appeal to practically everyone who has at sometime taken an allegedly ototoxic substance. As such, the sales increase.

My understanding is that while there are indeed a few drugs that are known to be ototoxic (such as aspirin in high doses), the majority of medications will not actually damage the ear. If, for a given medication, you compare tinnitus rates of people in clinical trials to baseline tinnitus rates in the general population, they are typically indistinguishable in a statistical sense.

As for antidepressants, there is anecdotal evidence that some tricyclics (e.g., Elavil) and some SSRIs (e.g., Prozac) can sometimes aggravate or induce tinnitus. This side effect is typically temporary, however, and usually subsides after cessation of the drug.

-Golly

 

Hi
Neil Bauman's and user reports over the internet have done me worse than good. I don't know who's reporting these effects chronic/persistent tinnitus as a result of SSRI. But browsing the internet and reading user reports had really damaged me to the point that I am now afraid of SSRIs and other medications.
I have been to many doctors. 1 doctor ENT, 1 professor ENT, 1 professor ENT, 1 professor neurologist, 1 professor psychiatist, 1 professor psychiatrist, 1 doctor psychiatrist.
I will now advertise ( to the benefit of you all) what they have told me.
doctor ENT : "escitalopram doesn't cause tinnitus."
professor ENT : "these medications can cause tinnitus for one in a couple of hundreds cases, espcecially when you withdrawl from them, but I don't know of any case of persistent intractable tinnitus afterwards."
professor ENT : "very rarely these medications can cause tinnitus. But in all the cases I've seen it was temporary. But I'm sure that there rare cases when it's persistent and doesn't go away"
doctor psychiatrist :" these medications don't cause tinnitus."
professor psychiatrist : "I have not seen anyone who got ringing in their ears because of escitalopram."
professor psychiatrist (asked about wellbutrin) : * picks up his computer to search in pubmed* "No.. there are no case reports of wellbutrin causing tinnitus. even better, there is a research of people with tinnitus taking SSRIs and their conditions improved."
professor neurologist : "escitalopram can very rarely cause tinnitus but in all of the cases it's only temporary." after I have showed him a paper from ATA that wellbutrin causes tinnitus : "Well I see this paper and I don't know what these results are, I treat many people with Wellbutrin and no one had come to me and told me about ringing in the ears. But I can't promise you that you will be perfectly fine."
The doctors I've been through are top-class doctors in my country and I went them privately and spent a lot of money. and yet I still afraid taking SSRI medications.. why?!
All these user reports and conspiracy, and being paranoid that the doctors are lying to me and not telling me the absolute truth, and that the internet is the truth, had really damaged my recovery process.
...
I mean, if you go and take a look in Neil Bauman's web page you can see literally HUNDREDS of user reports in his blog. and almost everyone there are saying that their tinnitus is persistent and not tempoary. It's simply terrifying to see this. Who are they? and why none of the doctors I've been through know about this?
Then there is the question if these internet user reports are real or are simply real douchbags posting them.
Lately it has even escalated (in Neil Bauman's blog) to *god forbid* comments about anti depressants which cause hearing loss.
So who's right here and who should I believe? I really feel lost and confused.

 

@ColoredRed;

I know exactly how you feel. Obviously, you are apprehensive about the possibility of making an existing problem worse. I can assure you that I did my due diligence before trying any drug (and I have tried a few).

For what it's worth, let let me tell you what my doctor told me when I voiced my concern about the possibility that Lexapro would aggravate my tinnitus. Based on his experience, his belief was that tinnitus resulting from SSRIs or SNRIs is an extremely rare event (I recall that he estimated the probability at one in a thousand). He has prescribed Lexapro and similar drugs for years, and rarely, if ever, has he heard about someone developing tinnitus as a consequence.

Of course, do your own due diligence and make a choice that fits your risk tolerance. While I never ended up trying Lexapro (for unrelated reasons), I have tried various benzodiazepines as well as Mirtazapine and Gabapentin. None of these has had a negative effect upon my tinnitus.

-Golly

 

Please, need some other replies against my post

 

I hear what you are saying, ColoredRed. While tinnitus patients need to know there are drugs they should avoid, the Bauman list can make you think that just about any pill you put in your mouth will make your ears start ringing. For example, my own blood pressure medication, Enalapril, is on it. Should I stop taking it? But when I pulled the documents based on FDA advserse incident reports, about .05 percent of the hundreds of thousands of people who take this drug have had this side effect.

Also: We need to remember that those reports from patients claiming a medication caused their tinnitus are very subjective -- particularly because, in many cases, its so dang hard to figure out what caused T to start in that patient. Was it the Enalapril they were taking? Or a severe sinus infection that somehow sparked T while they were taking Enalapril? Also, we all know there is a connection between anxiety and tinnitus. So was it the anxiety drug you took that caused your tinnitus? Or the anxiety itself?

The Internet can be a godsend and a demon. I was TERRIFIED to take Xanax, between reports of it (yes, Xanax too) causing tinnitus and/or turning me into miserable addict. Ultimately, I felt the medication was necessary at this particular time. And you know what? My doc started me on very, very low doses, we have kept it there and I feel SO much better.

So, in a nutshell: I agree with Golly and 5htp. Do your research but consider the sources.

 

the thing is, I've asked a psychiatrist whether or not clonazepam can cause eye floaters, and he told me "no". This kind of event have occurred in this topic at the third page. he was a PROFESSOR. The same "no" he said on clonazepam, can be the same "no" they say for permanent tinnitus induced by SSRI. I've asked many doctors. and they all said "no" except one professor ENT specializing in tinnitus, who said "I don't know about such a case myself, But I'm sure (without checking the evidence) that there are rare cases where the tinnitus resulted from SSRI is permanent"
What I mean is, at first, they say "no", but as I dig up more and more the doctors admit that there is such "rare possibility" which they are not sure of. they say "I can't promise you that everything will be fine". one PROFESSOR neurologist I've been to said to me "You have more chances to win the lottery than receiving permanent tinnitus from SSRI"
For now I'm taking saint john's wort, the same medication Neil bauman is recommending on, but the regular dosage did not affect positively ONE BIT. even worse, I think this medication makes me restless and I can't stand it. I've started with double dosage, but I'm losing my patience and I'm having hard time to cope - not with the tinnitus cause my tinnitus is mild, but with my whole life situation. I cant even work the recent days and I've lost enjoyment in it.

 

tinnitus is a common(%1-%10) side effect of sertraline which is an ssri.. i think the doctors ignore the side effects of antidepressants because these drugs simplify their job and they spend less effort as you see neurologists also have authorization to prescribe these drugs without psychotherapy.

 

I can just talk about my experience. I took escitalopram for 9 months, years before to have tinnitus, and I had no problem, it was very helpful.

 

Lady Di.,
I started on Xanex several years ago when the T got to the point I had to do something..I helped me get to sleep but seemed to have a short effect..My Dr. switched me to Knopolin due to its less addictive nature..I was taking as high as 4 mg daily of Knopolin with a prescribed dose of up to 6 mg a day..A very high dosage I know now..

I asked to come of the Knopolin because it seemed to be not working..I reduced the doseage gradually over a period of several months and everything seemed to be going OK..But all hell broke loose when I quit completely . I started having full blown panic attacks about every 2 to 3 days. These lasted 2 to 3 hours and were hell. Sometimes I would sweat or chill with the attacks. These subsided after about 2 to 3 months..Afterwards I got floaters in one of my eyes and did not connect this with anything at the time but know now that is one symptom of withdrawl from benzos.

Luckly the panic attacks and floaters have cleared up. I now think all of this was from my prolonged useage of the benzos..

I now take REMERON as a antidepressant..It was only one of 2 antidepressants that I found that was not ototoxic and after a year or so of usage seems to still have a good effect on me..It helps me sleep but wants to make you eat all the time.

Just the past week I started on a anxiety med called VENLAFAXINE..My T spiked a couple days ago and was so bad I did not get out of bed for 2 days..I do not know if it was this new drug but the T has not been this bad in a very long time..I have stopped taking the new drug.

Sorry for the long post but I feel it was needed to show how the benzos affected me and I have heard of many similar cases so beware of them. I am very drug tolerant so taking 4 to 6 mg daily of a benzo for me was not even enough but would have put most people in dream land all the time with that dosage.

The bottom line is what works for one does not work for the other..I know people who have taken low dosages of benzos for years and most likely will continue the rest of their lives. If they had worked for me I would still be taking them. I really am not concerned at my age with addiction.

Thank God for the web and forums like these where people can share their experiences both good and bad.

 

Thank you for sharing your story, Relic Hunter. I don't mean to imply take warnings about benzos or anti-Ds lightly. I also give added weight to testimonies from people on this board, as I have found them to be thoughtful, supportive and better educated about tinnitus. I do listen to what folks say here and have made decisions based on their recommendations.

Sounds like you were on a high dose of Xanax. I have been able to maintain using 1 to 1.75 mg daily. But I still don't consider it a permanent solution. Have been on it three months. We have agreed I will start a taper at six months and if it doesn't work, switch to something like klonopin.

And I agree with ColoredRed that docs, including professors, do tend to say no when asked about toxic response when asked about some drugs. But that may be there isnt a big body reliable evidence that encourages them to say yes.

 

FYI: Venlafaxine is an SNRI antidepressant. It is sometimes taken in conjunction with Remeron to treat severe depression. The admixture is called "California Rocket Fuel."

 

Basically, the professor neurologist I've been to said : "Don't trust what you read on the internet. You don't know who these people are and what are their motives. The internet is the biggest problem today for the hypochondriacs."
one professor psychiatrist I've been to said (about some other permanent SSRI disability, which is not permanent tinnitus that people are complaining about) : "On the internet there are a lot of reports. Perhaps these are individuals who are uniting together to sue the pharmaceutical companies". when I confronted him about this symptom (which is not permanent tinnitus) he said "There have been one or two times when a patient came to me and complained about that". so I asked "is that around one in 10,000 patients"? he said "quite possibly".

 

I also want to say that most of the doctors/professors I've been to are considered TOP class in my country, I either got referred to them by someone who received very good treatment from them, or they have plenty of knowledge about tinnitus, or they are considered top-expertise in their field, for an example a hospitals manager. these are not general practitioners, or any generic ENTs.

 

Thought it was time to update my progress on AD's on this thread - So I've been on Citalopram since the early days and after 3-4 week found it helped me greatly - sleep patterns improved although never back to normal I wasn't worried and scared about going to bed and failing in my mission to sleep !

I remember how horrible those first weeks and months are and without doubt citalopram picked me up and put me on the right road. But after a few dips, and hic-ups I found myself knocked in confidence, and not able to cope with a few life experiences and my sleep suffered. After a few Doc visits and some more Zopiclone to try and restore the sleep pattern and get me back on track - I was getting back to where I was - but not quite.......

I told myself I could cope on 4-5 hours disturbed sleep and kept plodding on - I looked tired a lot of the time, make up hid the dark circles, I tried to keep focused and going but everynight still only getting a few hours.

My usual Doc was away and the one I saw advised to try acupuncture, maybe CBT was the next line of action he wasn't prepared to increase my AD or suggest alternative just told me ' NO more sleeping tablets'

So I'm trying acupuncture and chinese herbs from the same clinic - still sitting on the fence on both of these options - I've said to the 'practitioners' help me sleep and I can deal with the T !

Robbed of any sleep this last week I found myself calling into work sick again., and I made an appointment back at the doctors to see my regular GP. He is understanding, supportive and GOSH tells me I'm normal, he see's these things and anxiety problems all the time - I'm not alone and he has lots of things to help me!!!

Now I am the kind of person who likes medical DRUGS - I've done the natural stuff and maybe I will keep doing that long term - but the doc has given me trazodone hydrochloride to help with sleep only a low dose on an evening and so far ......... and I hope I don't jinx myself but so far so good and I have managed to get some good sleep.

So fingers crossed I'm back on the right road - I need sleep and want sleep so anything to help me sleep and I can deal with T - feeling positive and happy to take AD's if they get you through then there is no shame only benefits and hopefully not toooooo many side effects which I know for some people can be troublesome.

Give it a go - get a Doctor you trust and can talk too on board and don't be afraid to say your struggling if you are - Cher xx

 

Has anyone taken celexa for for depression/anxiety? If so, did it help stabilize the mood? Or were there worse side effects?

 

ColorRed:

I agree. Even on this website, now and then I've noticed suspicious postings, wondering if the poster has a hidden agenda to sell something.

Cher69:

I'm like you, I have no problems taking medicine. I take medicine for high cholesterol, acid reflux, allergies and Remeron for sleep. However, I know people who have a big aversion to taking any pills...even aspirin. It has always amazed me when some people prefer a "natural" remedy to prescription drugs. Snake venom is "natural".

Markku:

I think there is a lot of confusion about the word "ototoxic". I have always consider "ototoxic" to mean a drug that literally ruins your cochlear hair cells. Certain antibiotics can do that. My tinnitus started when I was given several drugs at a hospital. But I can't say for certain which drug caused me to have tinnitus.

I think our brains can be temporarily excited by certain chemicals which can make our tinnitus louder. For some people, caffeine maginifies their tinnitus. We all seem to react differently. There's a saying: "That's why there is chocolate and vanilla."

 

Anyone tried an anxiety drug called BuSpar.

 

Yes, I have tried and currently take buspar. It had no affect on my tinnitus whatsoever. I'm not convinced it's that great of an anti-anxiety drug though, as it did not seem to touch my panic attacks. It is a non-benzodiazepine drug though, which makes it desirable in that you will not become addicted to it, or suffer withdrawals much when you discontinue it.

 

Speaking to the "levels" of toxicity of a drug. Do we know how that is calculated? It was once told to me that the FDA will label a drug ototoxic if even one person develops T after taking a drug. They must report any side effect. So that could be 1 person in 75,000 that took a medication that developed T. That's not bad, I'd risk it. But if 50,000 in 75,000 developed T, I'd be out. How exactly do they figure the ototoxicity? By people in a controlled study group or by side effects reported, how many rats had T? Does anyone really know?