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

@Rockman, @ZFire, did it affect your tinnitus negatively at all at first? I couldn't get past 20 mg because it made my tinnitus louder. The longest I was able to make it on 20 mg was 5 days and then I went back down to 10 mg where the tinnitus increase eventually subsided.

 

In the middle of the night it did seem a bit louder, but by morning it would be normal. Mine changes day to day so never can find a pattern.

Are you taking anything else with the Nortriptyline?

 

I was not taking anything else with it. I was on it from May through August last year and stopped since I couldn't get up to a therapeutic dose.

Also, I couldn't handle the extreme dry mouth any longer.

 

No discernible influence on my tinnitus as far as I know...

This happens to me every once in a while. If I wake up 3 hours after falling asleep, I notice my tinnitus has elevated in volume. When I return back to sleep and wake up in the morning, it’s back to a baseline.

 

Well I had to go off of Nortriptyline. Wasn't able to sleep with it. I must be in the small percentage that can't sleep on it.

 

It seems the tricyclic antidepressant of choice for hyperacusis and tinnitus is Mirtazapine so when I finally have my neuropsych appointment I may opt for this. I've never responded well to antidepressants but it's sadly the route that's being pushed and I have to behave for my SSDI claim.

I wanted to ask if people had any issues with weight gain on it, since that's a known side effect. My current living situation doesn't allow me to really walk much day to day and exercise spikes my tinnitus pretty badly. I am worried about potentially coming out of this with more health issues attributed to overweight and inactivity on top of my ear issues.

 

I put on about 20 pounds. But I had dropped 20 pounds from stress and anxiety of getting tinnitus and hyperacusis.

 

That's unfortunate to hear but I'm glad it at least evened out with you. My weight has been up and down but mostly because I've lost most of my muscle and gained a bunch of fat. Not looking forward to it.

I take it even with diet and exercise it doesn't counter it that much? I remember being on lithium years ago while working out 4 days a week for several hours, counting all my calories, and I would not lose a single pound. One of those "I need to work out excessively just to maintain my weight" deals. I assume it's the same. Drat.

More importantly though, did it do anything for you?

 

Honestly the first week I took it, my tinnitus and hyperacusis dropped by 50%. But I reinjured my ears from driving without earplugs. So I'm at 16 months of hyperacusis. Now recently a few things have happened; slamming doors and high frequency hearing aids have got me down. As before externalsounds would hurt my ears, now they hurt from nothing.

 

I started Nortriptyline in early August 2021 and I’ve gained 10 pounds since then. My diet has been shit the last month or so and I haven’t exercised well enough, but I believe I’ve mitigated the weight gain through 18/6 intermittent fasting. 12:30 pm-6:30 pm is my eating window. On May 15th, I’m going to return to my pre tinnitus intensive workout regimen,to see what kind of results I’m able to achieve while on Nortriptyline.

 

Good to know. I've started 20/4 up again in preparation because my diet has been shit lately as well and I gained a ridiculous amount of weight in a short time, probably because of my awful metabolism w/o exercise. Hopefully that can do something. Good to hear you'll be able to work out again and I hope it doesn't spike anything. I miss doing high impact stuff.

Did Nortriptyline work well enough for you? I'm not sure which drug I should ask for when the time comes.

Also, I'm assuming taking TCAs has to be a lifelong thing and you can't just take them for a bit, see improvements, and then stop without hyperacusis/tinnitus going back to bad levels? I hate being reliant on medication but... so be it I guess.

 

I do feel like Nortriptyline has helped a lot with my mental state, but it took a while to get there (approx. 2-3 months). It’s also possible it may have helped hyperacusis to a degree, but I’m not totally sure. I wrote about my experience with the drug a few pages back here. You can also write Nortriptyline with my name in the search engine and you’ll find some extra stuff there if you want.

My psych wants me on nortriptyline for at least a year before we consider lowering the dosage, so yeah I’m guessing you need to stay with the drug for at least a while.. It’s my first anti-depressant I’ve ever taken. I would’ve never thought I’d be taking them because of tinnitus. It is what it is though.

I hope my posts don’t come across as me advocating for you to take nortriptyline. I’m just telling you what worked for me. You should speak with your Dr when the time comes and pick the medication that you think will suit you best.

 

Hi all,

I am going through a rough time at the moment, not just tinnitus, but something else.

I think I might have to give in to the antidepressants route, as things are not improving. I have never been on antidepressants previously.

I want to view this as short term, but if I did get them prescribed, unsure how long to be on them.

A friend of mine who is on Prozac (Fluoxetine) said it helped her immensely & couldn't do without it now.

Any suggestions?

 

Hi @Nesty, sorry to hear that you are having a hard time at the moment. It is hard to suggest a particular antidepressant, though there is anecdotal evidence on here about certain ADs, as you will have seen.

In terms of length of time needed to be on them, that is also hard to say. However, most ADs will take between 4-6 weeks for the majority of people before they realise the full benefits. Side effects, on the other hand, can be noticed upon starting. If the effects are manageable, you would have to stick it out for the above period to see how effective they are for you. Some people do see positive effects a little sooner.

Taking ADs for tinnitus is a hit-and-miss game. Generally, they are thought to help tinnitus by affecting our mood so that we are less bothered by it, leading, possibly, to an impression of lower volume and a lower level of intrusiveness - but some people report a dramatic improvement in their tinnitus when taking them.

You might want to consider your need to try these out. How long have you had tinnitus? Are you having a spike now/has it worsened? If so, do you think you can adjust through the spike or to the current level? Might other matters get better soon? If things are very hard for you right now and you are struggling to cope and to see a possibility of brighter days soon, it might be the best option if you cannot make other lifestyle changes (job, personal life) to help with the current levels of stress.

If you go down that route, try to see a psychiatrist to discuss.

I am originally from round about your way. I have the name of a good private psychiatrist should you want details.

Best of luck and wishing you well.

 

Hi @ZFire -- I'm also into intermittent fasting, and average about 18 hours/day. I've read several times there are advantages to working out after the fasting, and before eating. I was wondering what your schedule is, and whether you also work out before eating. BTW, I think intermittent fasting is very important my my physical and mental/emotional health and well being.

 

I would say that a general SSRI is a good starting point. They are very safe and been around for a long time. Some doctors prescribe benzos alongside because the first few weeks could be rough. Try to avoid benzos if you can. With SSRIs, it can be 2-3 weeks where you actually feel worse. Try to pull through. Do not take too low a dose either. A higher dose will make sure that you get a good effect.

 

Same situation for me, tinnitus plus something else.

I talked to a friend who said being put on SSRI really helped her in like 2 weeks.

I had never used an antidepressant before but just started Fluoxetine 2 days ago. I was told that the usual course is to take it ~10 months to hopefully establish long term changes. The psychiatrist also said that Fluoxetine doesn't have to be tapered as it has a super long half life.

 

Fasting is crucial for me as well.

I still need to figure out how my body will respond but the plan is to work out while fasting. Once the workout is complete, my fast ends. My eating window is from 12:30 pm to 6:30pm, so I’ll be working out 1-2 hours before that. Fasted training supposedly boosts more fat burning/mobilization especially fasted cardio, but it is extremely difficult when starting. You’ll likely fatigue very quickly, but once you make it a habit, the body will get used to it. Basing this off my experience.

 

I’m on Flupentixol 0.5mg and Doxepin 10 mg - 10 mg - 25 mg since August last year, it’s the best period for me since tinnitus onset in 2015.

 

I'm not sure about that @AfroSnowman. I thought that weaning off an AD was not so much about removing it from your system as it was about general mood, rebound anxiety/depression and adjusting to altered biochemistry in the brain.

I have never heard that it is a good idea to stop ADs cold turkey if you have been on them for any prolonged period of time.

 

Well he was suggesting that if I wanted, I could stop cold turkey as Fluoxetine stays in your system for some crazy amount of time, like 3 or 4 weeks, so it was self tapering so to speak. He also suggested either to drop it in about 8 weeks if/when my current environmental situation with some crazy problems comes to an end or to go for a 10-12 month course to hopefully establish long term good vibes.

Well, as I’ve been on this earth for a little while and this is the first time I’ve tried an AD, it is a whole new world for me. I’ll be sure to do more research before stopping cold turkey but he point blank told me I could.

 

Hi guys! Can anyone here please tell me if ADs can help calm down the cranial nerves when they became overactive due to prolonged inflammation?

For example, chronic inflammation in the middle ear and ear canal can affect facial and trigeminal nerves.

I know ADs can mess with your serotonin levels and make your tinnitus worse. I'm so confused!

 

I've read that Nortriptyline, Amitriptyline and Cymbalta can help with nerve pain. Plus some anticonvulsants can possibly help too.

 

I have no nerve pain. But crazy fizzing sizzling tinnitus in the head, caused by that inflammation. Cranial nerves go in the middle ear and ear canal. I never thought medications could help, but maybe there are some that could help with overactive brain nerves? I have always been afraid to try any medications. I already take 0.5 mg Rivotril (Clonazepam) for sleeping and am worried about it.

In the beginning it would put my head noise down. Not anymore. I'm probably in tolerance. But to get better, I would need to keep increasing the dosage? You don't always hit tolerance with benzos?

 

I don't have experience with benzos. I do know Nortriptyline really helped with my headaches. But I couldn't sleep with it.

 

I went back on Nortriptyline a few days ago since my depression has been building back up, but I've been having horrible premature ventricular and atrial contractions since starting. I didn't have this problem last time I was on it, but I did have a fast heart-rate. I've had issues with PVCs and PACs in the past - had to wear a Holter monitor for a month to get a diagnosis. They last for hours and I get out of breath, dizzy, and tired.

I'm going to stop and see if they stop happening. It could all be coincidence, after all. I am under a huge amount of stress at the moment.

 

There's a good chance it is. Some nights it would wake me up. I'd almost feel like a panic attack was brewing. Sweaty, arms felt like I just got done lifting weights. Not fun.

 

@Rockman and @kingsfan, did the Nortriptyline reduce tinnitus volume for you at all?

My doctor offered to prescribe it to help me with sleep but I've stayed away from it so far. The first thing I was given was Trazodone, but I got a bad spike that I think was related, so now I just take an occasional Ambien as needed.

 

Didn't raise or lower it.

 

It raised mine, which is why I could never get to even a moderate dose. It went back down after discontinuing. I have seen someone post that it did lower their tinnitus though, so it's just something you have to try to find out.