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

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

    1. Nick47

      Nick47 Member Benefactor

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      Over time yes. It's complicated as there are many serotonin receptors, so just saying increasing serotonin worsens tinnitus is not true. Maybe someone scientific can make better sense of this.

      It seems agonists of 5-HT2A, 5-HT2C + 5HT7 increase excitability.

      This paper mentions 5-HT1 agonists reduce tinnitus.

      "It may act as a 5-HT1A serotonin agonist, directly reducing tinnitus."

      155 Improvement of VIIIth Cranial Nerve Function With Cariprazine

      Implications when reviewing SSRI/SNRI medications? If you look at pharmacology (for instance on Wikipedia) of the medications, the lower the number, the higher the affinity for that receptor type. So a value of 3000 means a low affinity.
       
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    2. ZFire
      Tired

      ZFire Member Podcast Patron Benefactor Hall of Fame

      Tinnitus Since:
      2012 (mild) & 04/2021 (severe)
      Cause of Tinnitus:
      Ototoxicity (2012) Unknown-likely noise induce (2021)
      Unpopular opinion here, but I wish more people would at least give antidepressants a try. From my experience and likely others as well, there is something to the limbic system being a bit more relaxed that can go a long way in dealing with the tinnitus.

      Obviously, we all have that fear of tinnitus potentially worsening, but one must ask whether the pros from the drug outweigh the cons. For instance, if your tinnitus got a tiny bit louder from taking the antidepressant, but you became less bothered and anxious from it? Would you take it? I know I would. Obviously, if someone has extreme 10/10 tinnitus, they wouldn’t take such a chance, but if you’re somewhere in moderate to low-end severe range, there’s some space to work with, there's not a huge drawback to trying.

      And I firmly believe antidepressants aren’t ototoxic either. I don’t see how they can cause structural damage to the ear. Millions are taking antidepressants, if tinnitus was a wide spread issue, I think we would know about it by now. I was unaffected by Nortriptyline and I started at a high dose right off the bat. It’s always best to explore non-drug methods first, but antidepressants are worth looking into if all else fails.

      Please disregard this post if you feel differently.
       
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    3. Nick47

      Nick47 Member Benefactor

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      @Mike2022, I've really looked into this to understand why it may have worked for you to such a degree.

      It's the Latuda. Its pharmocology:
      • 5-HT1A Agonist (inhibitory transmitter involved in hyperacusis).
      • 5-HT2A Antagonist (excitatory in DCN).
      • 5-HT7 Antagonist (excitatory in DCN).
      • It's also an antagonist at D2/3 - We know that many drugs that increase dopamine can cause or worsen tinnitus.
      Agonist = activate.
      Antagonist = switch off.

      This is of interest to me as it hits most of the key neurotransmitters in the right way.

      16726042924655222572162974438687.jpg
      1672604346036636451170697919893.jpg
      16726044016364520497762698486136.jpg
      Screenshot_20230101-202052_Chrome.jpg
       
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    4. TLion

      TLion Member

      Tinnitus Since:
      2006
      Cause of Tinnitus:
      stress/loud concert
      Hi all,

      I experienced a pretty recent worsening in my existing tinnitus 2.5 months ago, probably from Paroxetine (Paxil) withdrawal that I had taken for 6 years. The tinnitus at first was easily maskable so it was no big deal for me that it was slightly louder.

      Afterwards I experienced panic attacks and very strange neurological issues I couldn't understand. I now know that it was the withdrawal. I went to a neurologist and asked because of my symptoms and tinnitus. He advised to get back on Paroxetine. I unfortunately did.

      The ringing got worse but I wouldn't dare to stop taking the Paroxetine now.

      It's now very, very high pitched. I can't stand the frequency. I've been back on the Paroxetine for 2.5 months, 10 mg.

      I now also read about muscle spasms caused by withdrawal. I experienced this. And some involuntary movement of the muscles in my legs.

      The withdrawal symptoms did subside partly, but the tinnitus is still worse.

      Now that I know that reintroducing Paroxetine worsened everything, I really don't know what to to. My ears feel cramped on some days. I hate the high-pitched hiss. And I don't know if I should taper the Paroxetine now rather than later. Will I experience withdrawal again after 2.5 months of taking it? Is the tinnitus going to get worse again?

      The drug seems ototoxic so I'm afraid that if I continue taking it, my hearing is going to be damaged even more. I don't know what to do. Some advice would be great.
       
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    5. Nick47

      Nick47 Member Benefactor

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      @TLion, first of all there is far too much paranoia over ototoxicity to the point it drives most of us crazy. Very few drugs damage the inner ear. The Neil Baumann character needs hanging as he's caused much distress. I would at least look at the way Dirk De Ridder goes about medications. He says SSRIs can sometimes make tinnitus worse. For those reason he does not prescribe them. There is a good presentation he made last year at the TRI. You can view it on YouTube.
       
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    6. TLion

      TLion Member

      Tinnitus Since:
      2006
      Cause of Tinnitus:
      stress/loud concert
      Ok, but even if it is not ototoxic, it made my tinnitus higher, finer, high pitched, more screeching. So yes, it is worse now.
       
    7. Nick47

      Nick47 Member Benefactor

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      @TLion, I'm validating your experience pal, truly. But ototoxicity is something different.
       
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    8. TLion

      TLion Member

      Tinnitus Since:
      2006
      Cause of Tinnitus:
      stress/loud concert
      OK. But despite that, not sure what to do. Try to taper again? Stay on it for a while?
       
    9. ajc

      ajc Member

      Tinnitus Since:
      11/2002; spike 2009; worse 2017-18
      Cause of Tinnitus:
      Loud music - noise damage
      Seriously, how do you expect anyone to tell you what to do? You can get worse by withdrawing, you can get worse by staying on it. Nobody can tell you what to do, not even a qualified doctor. You try your luck and see what happens.

      Overall though, the less drugs you are on, the better. Some research suggests that you should taper Paroxetine over a longer period of time than other antidepressants, because Paroxetine has a half-life of around 1 day, which is shorter than many other antidepressants.

      Go speak with a doctor about how to taper it safely.
       
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    10. Nick47

      Nick47 Member Benefactor

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      @TLion, or read my posts in the thread. Non-SSRI medications seem the way to go, like Aripiprazole, Latuda, LDN, Cariprazine, Mirtazapine or Deanxit.
       
    11. andronici

      andronici Member

      Location:
      U.S.
      Tinnitus Since:
      02/2022
      Cause of Tinnitus:
      Antidepressant, Acoustic trauma
      If I were you, I would create an account at Surviving Antidepressants and ask for advice there. It looks like they are open for new registrations again on January 27th. I wouldn't make any sudden changes with your Paroxetine dosage. If you ultimately decide to taper again, it would probably be best to do so very slowly.
       
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    12. juliob
      Confused

      juliob Member

      Location:
      Brazil
      Tinnitus Since:
      03/2018
      Cause of Tinnitus:
      Antidepressants / Loud Sound Exposure
      Considering this and given what you know, do you think adding NAC when you are on antidepressants could be unsafe tinnituswise?

      I found this:
      N-acetylcysteine blocks serotonin 1B agonist-induced OCD-related behavior in mice

      I am trying to find out something to help me deal with OCD and my benzo tapering but I am afraid everything interacts with Serotonin receptors.
       
    13. Nick47

      Nick47 Member Benefactor

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      I know only the basics from what I've read. I watched Dr. De Ridder's video on 'medication for tinnitus' that he gave as part of the TRI Academy series last year. In fact, I watched it about 30 times and then sought out the papers he cited. I then looked at studies on neurotransmitters in the DCN and how they change in tinnitus. I also looked at what people here had success with.

      Yes, 5-HT1B IS involved, especially in hyperacusis (Elgoyhen); see attachment. In fact, most of the 5-HT1 neurons are. The question is then how to proceed pragmatically? Not all medication cross the blood brain barrier or reach the areas you want. The pharmacology is something I'm learning still. Do you go for an agonist or antagonist?

      The image is side effect profile to make it more confusing and it seems the longer the line, the more causative. Sertraline has a short line so less likely to cause side effects, for example.

      Screenshot_20221218-095134_YouTube.jpg

      I would appreciate any input from other members. The take home message I got is monotherapy where the GP just updoses the SSRI you are on is not the way, however, multiple medications in low doses might be.
       
    14. Lane

      Lane Member Hall of Fame

      Tinnitus Since:
      02/2018
      Cause of Tinnitus:
      Single 25 mg dose of (anticholinergic) drug Promethazine
      Hi @juliob -- I highly recommend the following (pretty amazing) article on how it originally became clear a simple B vitamin could successfully treat OCD. Best of luck to you getting your OCD under control. I feel confident you can do it!

      LISTENING TO INOSITOL: CLINICAL NOTES
       
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    15. Tomas80

      Tomas80 Member Benefactor

      Tinnitus Since:
      10/2018
      Cause of Tinnitus:
      Unknow. Maybe stress?
      But Latuda is a very interesting medicine. It is quite new. And it works on DCN! I will ask the doctor to try it.

      Latuda has the active ingredient Lurasidone. But the drug Reagila (trade name in Slovakia) has the active substance Cariprazine. Cariprazine is mentioned in the materials. Should I ask the doctor about the medicine Latuda - Lurasidone, or Reagila - Cariprazine. Thank you very much!
       
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    16. Nick47

      Nick47 Member Benefactor

      Location:
      UK
      Tinnitus Since:
      2015
      Cause of Tinnitus:
      Viral/noise
      @Tomas80, this is all a theory with ONLY case reports to back it up. There are 2 things with any medication that bother me:

      1) How much of it crosses the blood-brain barrier? It's different for all medicines.
      2) How much gets to the DCN or brainstem in the first place.

      Then of course it's a question of if there are any side effects...

      If you have a cooperative doctor, then give one of them a go for a few weeks.

      Yes, I noticed Latuda has only been on the market since around 2010, so relatively unknown and untested for tinnitus/hyperacusis.
       
    17. juliob
      Confused

      juliob Member

      Location:
      Brazil
      Tinnitus Since:
      03/2018
      Cause of Tinnitus:
      Antidepressants / Loud Sound Exposure
      This clinical reports are interesting! Thank you for sharing them. Before this I just saw the two papers on Inositol of the same author saying that associating with a SSRI wasn't effective. But this reports give hope.

      The thing I am over the fence is something that is mentioned on the post:

      "Drug Interactions: As already mentioned, inositol can boost the effects of SSRIs. When adding inositol to an SSRI, be aware that SSRI side effects can emerge, similar to what happens when starting or increasing an SSRI.".

      I now wonder if this association is safe tinnitus wise as Inositol also somehow works on serotonin. I don't know if I should add Inositol or if I updose Luvox. I wish I was med free to try Inositol monotherapy.

      My OCD is being very hard these days with one episode of racing thoughts that made me have a peak of stress that made my tinnitus spike. I decided that I will try anything more than ERP (Exposure and Response Prevention) alone because tapering Diazepam is sending my OCD to another level.

      Is there anyone in the thread that started Inositol while on SSRI to share the experience?
       
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