Abraham Shulman Tinnitus Protocol (Clonazepam Plus Gabapentin)

Discussion in 'Treatments' started by Chinmoku, Oct 9, 2020.

    1. momus

      momus Member

      Tinnitus Since:
      01/1998
      Cause of Tinnitus:
      antibiotics
      Klonopin and Gabapentin are, as mentioned, serious drugs. But it's all about the dosage levels. There is a lot of evidence that taking minute amounts of LSD can be beneficial to some people, and again, things are kept at a very tiny dose level. A little Bourbon is fine, drink a couple of gallons and you would probably die.

      I ride an eBike and it is very dangerous if I am not in the present moment. Two seconds of wool gathering can remove you from the planet very quickly. But I would consider this 2 dug protocol, if the dose levels were kept so low as not to affect my reaction time. I already take Gabapentin (and plan on stopping it due to long term usage worries) w/ 50-75 mg of Benadryl, which is a great sleep aid.
       
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    2. Justwaitinchilin

      Justwaitinchilin Member

      Location:
      Middle America
      Tinnitus Since:
      2022
      Cause of Tinnitus:
      NIHL
      Hey everyone,

      I had no idea of the Shulman protocol. But I recently had my psychiatrist prescribe 0.5 mg Klonopin and 300 mg Gabapentin twice a day.

      Today is the best day I’ve had in 16 months. My tinnitus is super quiet. I was out in the garage projecting and listening to music. Something I haven’t done in 16 months. I feel amazing.

      Somehow I finally stumbled onto something that works for me!
       
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    3. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      Glad to see another success story. There are a few here who find this a successful treatment.
       
    4. BrysonKingMe

      BrysonKingMe Member

      Tinnitus Since:
      2016
      Cause of Tinnitus:
      Paradoxical on Klonopin leading to a shitton of other proble
      I hope it keeps working for you, however, you must know that these medications carry extreme risk to cause much worse tinnitus and extreme hyperacusis.

      Do lots of research on these medications and don't trust just one psychiatrist's opinion.
       
    5. Justwaitinchilin

      Justwaitinchilin Member

      Location:
      Middle America
      Tinnitus Since:
      2022
      Cause of Tinnitus:
      NIHL
      I trust that not a single thing has touched my tinnitus in, well... too damn long.
       
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    6. ErikaS

      ErikaS Member Benefactor Hall of Fame

      Location:
      Pennsylvania, USA
      Tinnitus Since:
      09/2022
      Cause of Tinnitus:
      Ear infection/Ultra High Frequency SSHL in Right Ear
      Remind me, @Justwaitinchilin, is your tinnitus reactive/sound sensitive? If so, has this combo helped that?
       
      • Good Question Good Question x 1
    7. Justwaitinchilin

      Justwaitinchilin Member

      Location:
      Middle America
      Tinnitus Since:
      2022
      Cause of Tinnitus:
      NIHL
      Yes, my tinnitus was reactive. I heard it no matter the environment.

      After I started 0.5 mg Klonopin and 300 mg Gabapentin twice a day, my tinnitus is super low. I cannot hear it with any background sound going on. It is no longer in the forefront of my thinking. Sound sensitivity is gone, dishwashing and road noise sound normal again.

      I do sneak an extract Gabapentin late afternoon. This has helped me.

      I hope this stays because I’ve got my husband back. I slept last night all night with nothing on for background noise. I’ll take dementia in 20-15 years if it stays this way.
       
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    8. slc

      slc Member Benefactor

      Tinnitus Since:
      04/2011
      I used Clonazepam, at a dose of 1.5 mg taken 1 hour before bed, for several years while concurrently doing acupuncture, craniosacral therapy, hypnosis, Ayurvedic herbs, and TRT with maskers. My catastrophic hyperacusis took over a year to diminish. The catastrophic tinnitus took several years to move to severe and eventually moderate. BUT, after a year or two of moderate tinnitus, I titrated off the Clonazepam over a few months time. It was surprisingly easy. However, a few months later the tinnitus went from moderate back up to severe (with various better and worse days).

      I went back on Clonazepam. It never felt as effective. I added 500 mg of Gabapentin and eventually reduced the Clonazepam to 1 mg -- all taken before bed. About one year ago, I was exposed to a really loud alarm that spiked my tinnitus. Things are finally settling back down from severe to moderate on some days.

      My personal view is to take the drugs, especially to make sure you get sleep. Then look for a lower stress time when tinnitus symptoms are moderate before titrating off (speaking about Gabapentin and Clonazepam).

      Good luck with it,
      Stephan
       
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    9. ErikaS

      ErikaS Member Benefactor Hall of Fame

      Location:
      Pennsylvania, USA
      Tinnitus Since:
      09/2022
      Cause of Tinnitus:
      Ear infection/Ultra High Frequency SSHL in Right Ear
      I am very happy you are experiencing this relief right now. I hope it continues for you and you can stay at those doses for quite some time.
       
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    10. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      I use this combo once a week or so for 1-2 days. It seems to work better and last longer when Gabapentin and Clonazepam are taken together at the same time.
       
      • Informative Informative x 1
    11. DeanD

      DeanD Member Podcast Patron Benefactor

      Tinnitus Since:
      Mild since 1982 - then Severe Oct 2022
      Cause of Tinnitus:
      Microsuction (Oct 2022)
      It's great how you have managed to find a combination that does work for you. So much is individual, risk, trial and error.

      I took Diazepam this weekend at 5 mg (2 ml) to help get through a medical test, which I understand is meant to increase GABA the same as Clonazepam, but this seemed to send my tinnitus through the roof, so I guess the combination of Clonazepam and Gabapentin may be ineffective for me.

      Great it's worked for you though.
       
    12. BB23
      Insomnious

      BB23 Member

      Tinnitus Since:
      04/2023
      Cause of Tinnitus:
      Antibiotics and mirtazapine
      Hey. You are going to put yourself into interdose withdrawal taking it like that. You cannot take these pills like Aspirin. Do research on it if you haven't heard about it before. Most my tinnitus related problems came on because of something similar, but with antidepressants instead...
       
    13. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      Diazepam is ineffective for tinnitus.
      The problem is if I use them daily, I will become entirely dependent on them.
       
    14. Cmspgran
      Doubtful

      Cmspgran Member

      Location:
      United Kingdom
      Tinnitus Since:
      2003
      Cause of Tinnitus:
      Loud noise
      How come you don’t take Gabapentin long term, @Nick47?

      I had a Zoom appointment with Professor Bance this week and he thinks my issues (severe reactive tinnitus/sound distortions/morse code) are a retro cochlear issue, from describing my symptoms to him.

      He wants to put me on Gabapentin for 6 months as I’d explain even just 0.5 mg of Clonazepam basically shuts the reactivity down. He didn’t have an issue with a low dose of Clonazepam either, stating he understands my concerns, but reminded me people are on 3 mg of Clonazepam their entire lives for epilepsy with no issues. If the Gabapentin doesn’t work, then he advised me to try Carbamazepine.

      I’ve waited six months for improvements. I’ve seen minimal improvements.

      I’m not new to tinnitus. I suffered from it for 20 years prior, but it’s become a catastrophic set of symptoms. I’m 40 now and I’m losing out on my better years because of it.
       
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    15. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      Hi there @Cmspgran.

      Well, I had to badger my GP to prescribe any Gabapentin at all. This was after obtaining it online without a prescription and realising some benefit. My GP prescribed, reluctantly, 300 mg/d in 100 mg doses. Neither ENT at Chesterfield, Derby or Nottingham would prescribe Gabapentin or Clonazepam, so it's interesting that an ENT in the same country at a well known centre is willing to.

      What dosage of Gabapentin has he prescribed for you?

      Yes, I think Carbamazepine is a good shout too. Anything that blocks sodium channels in the nerve cells.

      I understand your thoughts.

      Do you experience a delayed effect of 18-24 hours with the Clonazepam?
       
    16. Cmspgran
      Doubtful

      Cmspgran Member

      Location:
      United Kingdom
      Tinnitus Since:
      2003
      Cause of Tinnitus:
      Loud noise
      He hasn’t actually done the prescribing in this case, he was willing to, but instead he wrote my GP a letter telling him to. I’m actually lucky with my GP in that he’s really accommodating with experimenting with drugs if you present a case why.

      My condition has morphed and developed somewhat over the last 6 months. Initially the reactive tinnitus felt like an electrical cacophony going off in my left ear. It’s still terrible and the right has joined in a bit too but it’s not as reactive as the first two months. Still completely life destroying in terms of quality of life. Clonazepam was literally a miracle drug initially, I’d take 0.5 mg and it’d just shut the left ear off. Similar to you, I’d try to use it sparingly. It doesn’t seem as pronounced the last few times I’ve taken it. I’ve taken about 20 pills over 5 months. The improvement would last most the day and maybe get a little bit of benefit the next day, the first six hours on it were the best though.

      He’s started me on 300 mg of Gabapentin a day for one week, then up to 600 mg the following and if that doesn’t work, up to 900 mg. He stated 900 mg is still a small dose. I note that study went up towards 1800 mg a day for tinnitus. If I feel it’s working but need to up the dose, I may see if he’ll negotiate but let’s see if it works first.

      Mate, it might be worth the £220 consultation fee with him, just to get the letter stating all this, as how can your GP argue with one of Europe’s leading experts. From what I’ve read, your symptoms sound very similar to me, although I didn’t get SSHL.
       
    17. DeanD

      DeanD Member Podcast Patron Benefactor

      Tinnitus Since:
      Mild since 1982 - then Severe Oct 2022
      Cause of Tinnitus:
      Microsuction (Oct 2022)
      I went to see Dr. Bance this year with a private consultation with severe reactive tinnitus but was only given an all clear on myoclonus, a pat on the back and told not much else could be done. No mention of any medication - so if anyone decides to do this, they may need to push a little for the medication request.
       
    18. Cmspgran
      Doubtful

      Cmspgran Member

      Location:
      United Kingdom
      Tinnitus Since:
      2003
      Cause of Tinnitus:
      Loud noise
      Sorry to hear that @DeanD. I’ve followed your story and realise how much you’re suffering. I can relate to the symptoms. One of the things that pricked Professor Bance’s ears up for the medication was me explaining the 0.5 mg of Clonazepam shut my reactivity off, maybe that was the difference?
       
    19. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      I paid £78 for a consultation with Dr. Dirk De Ridder. He prescribed, and the GP refused.
       
    20. Cmspgran
      Doubtful

      Cmspgran Member

      Location:
      United Kingdom
      Tinnitus Since:
      2003
      Cause of Tinnitus:
      Loud noise
      Rubbish mate, what a bargain Dr. De Ridder is compared to UK private rip-off prices.

      I’ll let you know how the Gabapentin goes, I’m going to throw the Clonazepam in here and there as well to see what the score is.
       
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    21. DeanD

      DeanD Member Podcast Patron Benefactor

      Tinnitus Since:
      Mild since 1982 - then Severe Oct 2022
      Cause of Tinnitus:
      Microsuction (Oct 2022)
      Do you think you could take it to a private GP (at a cost of about £100) with Dr. Dirk De Ridder's prescription to get a UK one, rather than your own GP?
       
      • Helpful Helpful x 1
    22. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      Did he provide any rationale about Carbamazepine? Has he had success with certain types of tinnitus patients?

      There are some studies showing that those who respond to Lidocaine have a 50% chance of responding to Carbamazepine. I have read about quite a few who find it efficacious. Oxcarbazepine less so.
       
    23. Cmspgran
      Doubtful

      Cmspgran Member

      Location:
      United Kingdom
      Tinnitus Since:
      2003
      Cause of Tinnitus:
      Loud noise
      Yes, in his letter he states "the drug that is most effective for neuralic ectactic conduction is Carbamazepine but it has more side effects, should Gabapentin not work, you may wish to try this and consult with your GP."

      Well, he’d recently prescribed me a box at my request, so I have it in the draw. I took a whole 1 mg of Clonazepam tonight, it’s definitely losing its effectiveness compared to initially; worked for a couple of hours, then just made me super groggy and unsteady on my feet.

      Going to give the Gabapentin a solid go, will throw the odd Clonazepam in for an experiment and if no better in 3 months, try a bit of Dr. Dirk De Ridder's poly pharmacy and throw a Carbamazepine in too.
       
    24. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      It's not easy. Ideally I would not take any medication, however this situation is not ideal.

      I find the Clonazepam needs to be judged after 24 hours. For me (and many others) there is a delayed effect. First couple of hours a reduction in anxiety but not tinnitus. Somewhere between 12-24 hours later the volume seems to drop and this may be maintained for 24 hours after.

      It seems Carbamazepine is more effective than Oxcarbazepine, the newer medication with less side effects.

      With Gabapentin on its own, I have minimal success that's unpredictable and uncertain, although I take ~300 mg/day. I did seem to have better success at 600 mg/d. The bioavailability of Gabapentin is increased at lower doses so above 1200 mg/d is unlikely to give better effect.

      Dr. Dirk De Ridder's standard cocktail at low doses is:
      • 0.5 mg Clonazepam
      • 1 mg Deanxit
      • 2 mg Aripiprazole
      • Optionally add on Cyclobenzaprine or LDN for somatic components.
      The Deanxit has a relaxing effect and it seems to push the tinnitus to the background. At times the tinnitus seems lower. I don't use it regularly.
       
    25. Cmspgran
      Doubtful

      Cmspgran Member

      Location:
      United Kingdom
      Tinnitus Since:
      2003
      Cause of Tinnitus:
      Loud noise
      Yep, same, if you’d have told me a year ago I’d be on a tinnitus forum discussing the best way to take benzodiazepines and other hardcore drugs because of a simple MRI scan, I’d have said you’re crazy. I still can’t believe the situation I find myself in at times.

      Interesting cocktail by Dr. Dirk De Ridder. I notice Deanxit is banned in the UK.

      Just slightly off topic, but do you have hope that the passage of time might lead to some improvements in your condition, through a combo of neuroplasticity and part habituation?
       
    26. AfroSnowman
      Balanced

      AfroSnowman Member Hall of Fame

      Tinnitus Since:
      04/2019
      Cause of Tinnitus:
      Nonnatural energy source
      I’ve found the same with Clonazepam. Doesn’t help until I sleep/the next morning. It settles down things a little when it gets very hyperactive. I probably average about 1 dose a week.

      I’ve also noticed that taking more than 0.5 mg doesn’t have any increased benefit.
       
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    27. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      No, just acceptance.
       
    28. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      Me neither. Deanxit isn't banned, just not licensed. It can be mimicked by 10 mg Nortriptyline and 0.5 mg of Flupentixol.

      If you don't get much benefit from Gabapentin, you could try Oxcarbazepine, instead of Carbamazepine, which is less likely to causes side effects. Dosage is normally around 600 mg/day.
       
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    29. Nick47

      Nick47 Member Benefactor Hall of Fame

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      How are you getting on with the Gabapentin/Clonazepam thing? I'm in discussion with my doctor's surgery to trial Carbamazepine or something similar.
       
    30. Cmspgran
      Doubtful

      Cmspgran Member

      Location:
      United Kingdom
      Tinnitus Since:
      2003
      Cause of Tinnitus:
      Loud noise
      I did the Gabapentin for two weeks and felt like it was making the electrical reactive tinnitus element worse so I quit and moved straight onto Carbamazepine. Initially I thought it was working miracles on the Morse code element but I think it must’ve been more of a placebo effect as it went right down for a few days but has come back. I’m continuing on with it for a few more weeks but it has come with side effects including tiredness, bad stomach and unsteadiness.

      Wish I had more positive news to share. My issues aren’t the steady tone tinnitus, it’s the hissing, spitting and feedback my ears are doing, on top of Morse code tones that also overlap white noise. If it was just steady tone tinnitus, even ridiculously loud, I feel like I’d be able to cope a whole lot more.
       
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