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

@Nick47, how is the Mirtazapine 30 mg going for you? I am now on 15 mg of Mirtazapine. I care less about the tinnitus and sleep better. But the tinnitus is somehow more high pitched now and more reactive to some external sounds. I have been on this dose for 10 days now. Maybe I have to go up? Do you recognize this?

 

Hi @Roger79. It's hard to tell as there is no control group, just me. I went from 15 mg to 30 mg just over a year ago. No real difference noted. I was told by Dr. De Ridder it can improve the depression and anxiety but worsen the tinnitus. I didn't agree it has worsened it. I want to see a psychiatrist as I have a couple of medications I would like to try, and maybe taper the Mirtazapine down to 22.5 mg.

 

What meds are you interested in trying?

 

I'm interested in two:

1) Cyclobenzaprine: two studies backing it, plus over 50% on Tinnitus Talk have had success with it. It was suggested by Dr. De Ridder for somatic cases particularly.

2) Lurasidone: one case report + my own research on the pharmacology. It seems to target the serotonin receptors in the right way primarily. I brought it up at the consultation with Dr. De Ridder. He agreed in 'theory' it's a good choice. 20 mg is the dosage.

 

Would you want to try either or OR both at the same time? I was thinking about asking my psychiatrist about trying Cyclobenzaprine as I too have read benefits about it. I just don’t know if I could start it while on my low dose Ativan or wean off Ativan first, then go onto that.

 

I have tried many different antidepressants. I was at a tinnitus clinic in Germany and they put me on Sertraline 200 mg and Risperidone 1 mg. This helped for about 8 months until my tinnitus went crazy again. I tapered off Risperidone as I gained a lot of weight because of it. I then tried Escitalopram, Cymbalta, Cymbalta plus Sertraline, Sertraline plus Aripiprazole and landed again at Sertraline plus Risperidone. Nothing really worked. Additionally, the Aripiprazole made me very tired so I slept almost 2-3 hours during the day.

My tinnitus is killing me right now and I have a consultation with my psychiatrist on Friday. I want to taper off Risperidone again as it doesn't really help and I always gain a lot of weight.

I was thinking to ask my psychiatrist for Cyclobenzaprine or Deanxit. Has anybody got experience with Sertraline plus one of those two drugs? Is it even possible to combine them? Does anybody have any idea what substitute for Risperidone I could take that doesn't have weight gain as side effect?

 

I want to try Cyclobenzaprine on its own first. Ativan is not an issue with it. The study I think was 30 mg, however some have had success with lower doses.

 

Got it. Do you mind linking the two studies you found backing this? It would be smart to have them handy when I meet with the psychiatrist.

 

Both studies are in the Flexeril/Cyclobenzaprine thread plus you can find them online via search engine. It may be something you have to circle off every 2-3 weeks.

I'm similar to you in that I use a very small amount of Diazepam a day and would like to replace that now. I use Clonazepam once a week to good effect for a break.

I'm more interested in the Lurasidone as it can be taken longer term. That's if it's effective for me. It works on multiple receptors in the right way. Theory doesn't always translate though. Will see!

 

I’m having a bit of a dilemma on whether or not I should go back to taking meds.

I’ve been on nearly every antidepressant out there, starting a decade ago when I was 12 or 13. I’ve had a few periods of “medicine noncompliance” as my psychiatrists over the years have called it where I stopped taking my meds for a while, but for the most part I’ve been medicated regularly.

However, I haven’t been on a proper SSRI or SNRI for several months now. My therapist recently found this out and freaked out a bit and immediately emailed some psychiatrists as well as asked colleagues for recommendations on who can see me fastest. She really thinks getting back on meds will help me improve, especially given how severe my anxiety is about my tinnitus, TTTS, all of that.

The problem is I’ve poisoned my brain with a few too many horror stories and now I’m scared to take any. But given how much I have struggled with my mental health for the majority of my life, I know I should probably be medicated. Who knows, maybe it’ll really help me. Plus I’ve never had issues with tinnitus before while taking them (I haven’t been on one since my tinnitus started though). But I know they could also make it worse... I’m going to read more in this thread, but if anyone could tell me if they personally took the chance and the benefits ended up outweighing the risks for them, I’d love to hear about it.

 

I have my appointment this coming Monday and all my notes to discuss these two. I’m also going to bring up the post COVID-19 tinnitus study using 1 mg Pimozide, I know results aren’t out yet but I want my psychiatrist to keep this on his radar.

I read through Flexeril threads and how it did decrease tinnitus for some, but I didn’t see anyone comment specifically about reactivity. Did you read anywhere about Flexeril calming reactivity?

 

I think you are doing all the right things. Ideally no medication, but if the severity of the condition (hyperacusis, tinnitus or both) are causing a disability, then a medication strategy may have more benefits than side effects.

You have selected medications that give some benefit/have some evidence to back them up. From here it's trial and error as to whether that benefit applies to you.

It may be that if Cyclobenzaprine gives a benefit, it has to be cycled on and off.

It may be that others can be taken daily. This is where the medical professional comes in.

Checking for any interactions between medications, which, from the ones you've selected, seem to be free of, is also the responsibility of the MD.

Like most people, I think Pimozide is a wild card. Similar medications some people have success with are Aripiprazole/Flupentixol/Lurasidone. All are antipsychotic medications but at low doses do not have the usual side effects. Side effects are still possible though. Proceed confidently, but sensibly, and come up with a testing plan before deciding which ones are useful, if any.

And lastly of course report back your findings for an extra 20 points.

 

Thank you much, @Nick47! Yeah, I'm in month 7 of reactive multi-tone tinnitus and the depression is only getting worse, and I am growing more intolerable of my tinnitus. Especially my super high-pitched, electric, reactive crap that makes me feel and sound like I have some type of power source on in my ears/head at all times, so something needs a change.

The daily small dose Ativan also has to go - it brought me relief for quite some time, and still does at times, but cannot be a long term thing and I don't believe it is helping the depression at all, probably worsening it as it dies off every day.

I will absolutely report back on what my doctor and I decide to do.

 

So after discussion with my psychiatrist, who I have to say seems very knowledgeable, has tinnitus himself, and did a deeper rabbit hole dive on studies and such, he is recommending Lamotrigine (Lamictal), Zoloft, or would consider Propranolol. He is not against trying Cyclobenzaprine (Flexeril), but due to it being a muscle relaxer, he cannot prescribe it (ugh!). I discussed Latuda with him, and he shared that there are side effects with that, and with how that works on the brain, there are other similar meds that would be considered before that.

So, that is that, and I am not sure what to do. I don't know if I am going to put a call into my ENT or GP office to see if I could get them to prescribe the Flexeril. A part of me would like to try that first before I alter brain chemicals with an anticonvulsant or SSRI.

 

I take Zoloft right now. When my tinnitus started, it was increased from 50 mg to 75 mg. Zoloft will help you address the anxiety and depression in the long run so that you can habituate and have less distress. I would take the Zoloft. Good luck!

 

That's a good start. I have heard of someone who got improvement with Lamictal. Cyclobenzaprine acts on the brainstem and works as an antagonist at 5-HT2A/C which may be important.

Yes, Lurasidone can cause side effects. There is someone who had great success with this a couple of months back and reported it on this thread. Aripiprazole is similar.

I see Propranolol discussed sometimes and I have no idea why.

 

I just started Cyclobenzaprine yesterday. 10 mg a night. After a few days, I am going to increase it. My psych said I need to cut back 25 mg of Amitriptyline per 10 mg dose of Cyclobenzaprine. I will post back if I have any improvement.

 

Interesting, my ENT, who is knowledgeable in this field, prescribed Inderal (Propranolol) along with Betaserc and Vit B1 but I haven't taken them yet. I told him I had tried Betaserc before but he said Betaserc with Inderal is effective. I don't know if he prescribed them for tinnitus, hyperacusis or both!

 

Amitriptyline and Cyclobenzaprine are both in the tricyclic class so it's a good, but expected spot by your MD. Are you still on 1.5 mg Clonazepam/day?

Please do post back in the Cyclobenzaprine thread either way.

 

My ENT prescribed Propranolol (Inderal) and Betaserc and told me they are effective once taken together. I haven't taken them as I am afraid of any side effects.

 

I am hoping I can get my GP to agree to Cyclobenzaprine. I feel like I may have a chance to that helping if I get relief from Ativan which also works as a CNS depressant.

 

I agree with your psychiatrist -- personally I would be VERY wary of antipsychotics. Definitely not a first-line treatment. Even low dose can cause unwanted side effects like weight gain. Longer term use or higher doses can cause potentially permanent extrapyramidal symptoms.

Lamictal and Zoloft, like all psych drugs, are a bit of a gamble. Effect on tinnitus could be positive, negative, or neutral. You could also get a temporary spike or fluctuations that then settle as your body adjusts to the med. I don't know your specific situation, but if you are dealing with anxiety and depression, it could definitely help you cope with the tinnitus, even if it might not reduce the volume. Try them one at a time at a low dose to see how your body reacts, and it can take a few weeks to adjust. I would try Zoloft before Lamictal -- SSRIs are lower risk meds. (I'm assuming your doctor knows to start you on the lowest dose for Lamictal and stop if you develop a rash.)

Best of luck!

 

That's strange that your psych won't prescribe Flexeril. Maybe they have a personal policy against prescribing meds they deem "out of his realm."

I would try to find someone to prescribe the Flexeril. It's very reasonable to try and has shown some potential benefit. I know SSRIs help some people to cope but I've read so many stories of tinnitus starting/worsening after SSRIs that I wouldn't pick Zoloft as a first option.

Was the Propranolol offered just as a treatment for tinnitus-induced anxiety? Propranolol has shown to have potential ototoxicity. I used to take it here and there for when I had really huge oral presentations but won't anymore after I found out about that. But interesting to see that someone above was prescribed Propranolol and Betaserc. It seems like no one has any idea what to do lol.

 

Girl, tell me about it. You’d think a condition that knocks so many normal functioning, healthy people to their knees and disabled overnight would trigger someone (other than Dr. Shore) to want to figure out something. I’m convinced either not enough “elite” people have been plagued with this to really bring awareness and push funding, or they just get behind the curtain treatments that aren’t available to the rest of us yet in exchange for $$$, but I digress.

I emailed my GP about the Flexeril earlier today, waiting to hear back. Really going to push her to let me try it, especially because I did get some relief from Ativan, and as I feel the same way you do about the other meds.

 

Yes, still on 1.5 mg Clonazepam/day.

 

Yeah, the doctor said Betaserc with Propranolol work. Propranolol is a beta blocker and Betaserc helps with blood flow in the inner ear. I told him that I had tried Betaserc but he answered Betaserc is effective with Propranolol!

The ENT is knowledgeable in this field but he said I have no hearing problem based on extended audiometry and ABR. Maybe that's the reason he prescribed Propranolol!

I read here that someone's hyperacusis was improved with Propranolol and Betaserc.

I am totally confused but will let you all know if I decide to try them!

 

What’s the best antidepressant for a panic disorder that doesn’t affect tinnitus? I’m using Mirtazapine now but every two weeks I have to go to a higher dose.

 

I concur with this.

 

@Nick47, @yeezysqueezy, I just picked up my Flexeril script that my PCP was very willing to write for me. She has me starting on 10-15 mg day and working up from there if well tolerated and if needed.

I will communicate further with questions and how I do with this in the Cyclobenzaprine/Flexeril thread. Crossing all fingers and praying this will bring me relief and allow me to get off the daily microdose Ativan and to avoid SSRIs.

 

I saw a psychiatrist today and she prescribed Zoloft. I’ve been on Zoloft in the past (before my tinnitus started) and didn’t have an issue with it.

I’m very anxious that it will worsen my tinnitus now that I have it, though. But from my understanding, Zoloft is usually one of the more easily tolerated meds when it comes to tinnitus. I know some people have had problems with it, but I need to remind myself that everyone is different, and just because it was an issue for one person doesn’t mean it’ll be an issue for me. Plus I really need to be medicated. So I guess I’ll probably give it a shot. Wish me luck