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

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 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      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.
       
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    4. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      Thanks. It's a worry when almost all anti-depressants come up as ototoxic.
       
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    5. erik
      Breezy

      erik Member Benefactor

      Location:
      Washington State, USA
      Tinnitus Since:
      04/15/2012
      Cause of Tinnitus:
      Most likely hearing loss
      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.
       
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    6. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      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.
       
    7. Markku
      Inspired

      Markku Director Staff Benefactor Hall of Fame Advocate

      Tinnitus Since:
      04/2010
      Cause of Tinnitus:
      Syringing
      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.
       
    8. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      Yes, thats good advice Markku, I'll keep on with the Citalopram I think.
       
    9. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      Has anyone used Amitriptyline?
       
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    10. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      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?
       
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    11. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      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?

      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.

      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
       
    12. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      I was wondering if anyone has had any negative experience with Mirtazapine regarding T?
       
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    13. 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.
       
    14. 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.
       
    15. 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.
       
    16. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      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!
       
    17. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      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.
       
    18. Markku
      Inspired

      Markku Director Staff Benefactor Hall of Fame Advocate

      Tinnitus Since:
      04/2010
      Cause of Tinnitus:
      Syringing
      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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    19. James
      No Mood

      James Member Benefactor

      Location:
      California
      Tinnitus Since:
      Pulsing 03/2013
      My doctor just prescribed Amitriptyline 10 mg, probably for sleeping and my tinnitus.
      I saw that too, side effect, that it can cause tinnitus. She told me it would help it, and my sleeping.
      I have another apt soon. I'll ask her. Hate to think I'm taking something that can make it worse.
      Good to hear your results J.Wing.
       
    20. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      I doubt a doctor will know the answer to that question. Do let us know how you get on with it.
       
    21. James
      No Mood

      James Member Benefactor

      Location:
      California
      Tinnitus Since:
      Pulsing 03/2013
      All of a sudden I’m taking too many pills. I kept emailing the doctors asking about side effects of Tinnitus. Finally my regular doctor\ called me and wanted me to take the medicine. She said it takes a couple of months to work. I did sleep better last night and somehow I feel sleep is the key. I ‘m thinking my tinnitus won’t go away, but disappear into the background so I will feel as before, maybe I’m dreaming.

      I will still take it up with the doc that gave me these antidepressants. I started with Trapazode? which is a new one but it didn’t seem to help me sleep so I tried the Amitriptyline as the doc suggested. At least dezdog, karl, and jwing mentioned it was ok. I just barely started with this kind of medicine. I’m with you Louise, I want the safest possible. Which one is the one to take?
       
    22. Karl

      Karl Member Benefactor

      Location:
      Chicago
      Tinnitus Since:
      10/2011
      James -
      You are in the freak-out stage, where getting sleep is the big issue. That's the WORST time. Without sleep, your body can't recoup. You need something that doesn't agitate you, which is good for sleep.

      When my tinnitus became a problem, I was a complete mess. I couldn't sleep. My blood pressure was really high, and I was checking my BP every half hour. I remember staying home from work for a few days, but that was the worst thing for me.

      I was so desperate, I called a psychiatrist. She prescribed me an antidepressant. I remember being very apprehensive about taking an antidepressant. My psychiatrist finally just ordered me to take that pill:"Take it!" I felt as though I was about to take a cyanide capsule. Fortunately, that pill helped me sleep. I still take that pill every night.

      There are a many, many opinions that you can read about what is good and bad for tinnitus. What works for one person may not work so well for another. For me Remeron works great, with no side effects. Some people on this site don't like Remeron. I've also heard from an ENT doc that Amitriplyne (Elavol?) is one of the best for tinnitus.

      Hang in there. Take something to get sleep. After a while, you will sort out your thoughts. Tackle these issues one thing at a time. Sleep is No. 1.
       
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    23. James
      No Mood

      James Member Benefactor

      Location:
      California
      Tinnitus Since:
      Pulsing 03/2013
      Thanks Karl, that's exactly where I am. I want to sleep so bad, and wake up with no ringing. Ok, maybe that's a wish. A good night sleep is a BIG deal to me now.
       
    24. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      Hi James, I recommend Remeron for the sleep problem. It knocks you out (in a good way) and keeps you asleep all night long. It keeps on working after months of use.
       
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    25. James
      No Mood

      James Member Benefactor

      Location:
      California
      Tinnitus Since:
      Pulsing 03/2013
      Got your message Louise, thank you -- Remeron. I ask the doc about that one. I'm taking that Amitriptyline now. I'm kind of scared of these pills I'm taking. (You got some good music on those other posts, thanks).
       
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    26. arturito
      Buzzed

      arturito Member

      Tinnitus Since:
      11/2011
      I have just started today Sertraline, I will tell how I feel T and myself.
       
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    27. Louise

      Louise Member Benefactor

      Location:
      Yorkshire, UK
      Tinnitus Since:
      29/06/2012 worsened Jan 2017 & Dec 2017
      Cause of Tinnitus:
      Noise exposure
      I know its scary with the medications but what's the alternative? Might not be forever anyway, gradually we learn to live with the T and then taper off the meds.

      Remeron really is cool for sleep though, better than sleeping pills as they wear off.

      Glad you like the chill-out music ;)
       
    28. dan26
      Frustrated

      dan26 Member

      Location:
      NJ
      Tinnitus Since:
      1981
      Cause of Tinnitus:
      complete loss of hearing. motorcycle accident
      Having a tough time getting any decent sleep lately. Some meds I'm on say they cause sleeplessness. Metoprolol tartrate 25mg (trouble sleeping listed as side effect) , Tamsulosin .4mg(trouble sleeping listed as side effect) The pharmacist said he doesn't think that's the cause of me not getting sleep. Told him i have tinnitus for ages. Will have to talk to me doc and see if he can prescribe something. It would be great to get some quality sleep at least 8 hours. now I'm averaging maybe 5-6.
       
    29. Markku
      Inspired

      Markku Director Staff Benefactor Hall of Fame Advocate

      Tinnitus Since:
      04/2010
      Cause of Tinnitus:
      Syringing
      Have you tried melatonin? Doesn't help everyone, but many notice some benefit.

      Remeron, which has been much-praised here, might be another worthwhile option.

      Good amount and quality of sleep is such an important factor that hopefully you get this sorted out soon.

      Markku
       
    30. dan26
      Frustrated

      dan26 Member

      Location:
      NJ
      Tinnitus Since:
      1981
      Cause of Tinnitus:
      complete loss of hearing. motorcycle accident
      Markku: went to the doctor and he prescribed trazodone 50mg. said its helpful for sleep and depression. been on it for 2 days. i guess it takes time to get into my system. he also mentioned if i ever took steroids to help the tinnitus. I said no doctor ever mentioned trying them. will have to followup on that issue and maybe try it.
       

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