Anxiety and Antidepressants — Tinnitus from Mirtazapine / Dysfunction of C1, C2 Vertebrae / Stress?

Hello everyone,

I've started experience tinnitus on September 7, 2021. I'm unsure if it came from either:

- Using 15mg Remeron (Mirtazapine) for 2 weeks and stopping over 6 days. I initally took Remeron for insomnia and dealing with a stressful event.
- Dysfunction of C1, C2 vertebrae from a Jiu-Jitsu move
- Persistent stress over 6 months from various stressful events in my life.

The tinnitus itself isn't so loud - barely perceptible in the day, light whooshing sound at night in my right ear mostly - just like if my internal mic's gain was too high, I'm hearing "silent" room ambience.

The bigger problem is my anxiety. Ever since I've read that an onset of tinnitus happening after discontinuing Mirtazapine might possible be 'irreversible', which scared me very much (but mind you, at the time the tinnitus was louder - it has greatly subsided since then).

A quick, responsible note about the notion of "irreversibility": It might be irreversible "only as far as science knows", and the mechanisms by which a drug can be ototoxic or not are not well understood, nor are the mechanisms by which an anti-depressant works on some people and not on others. There ARE successful treatments and coping mechanics that WORK and allow people with tinnitus to go on and lead a normal life, just like it was before getting it. So please don't be alarmed by the term "irreversible".

Yet, here I am, with light tinnitus that 'might' be healing very slowly, but dealing difficult-to-manage anxiety on the daily.

I am facing two choices:

a) Fight the good fight and try to find natural remedies, do more exercise, use relaxation techniques, meditation and physical therapy (manual therapy), but deal with bouts of anxiety that sometimes affects my mood and concentration, or

b) Take an anti-depressant so I can more easily deal with anxiety on a daily basis, but potentially suffer ototoxic effects (or none at all) over the course of my treatment.

I wish I didn't have tinnitus, but I objectively have to admit it's real and effectively affecting my mood on days when I get anxious.

My situation: I'm 46, separated with two kids 8 and 12, still wonderful ex-wife and new girlfriend of 3 years. I have a good career that I need to resume in 13 days after my extended leave. Despite being struck with tinnitus, I strongly believe I can improve my coping and resume a happy life.

In my case, tinnitus isn't so bad compared to managing the anxiety of having the condition.

Do you have any experience with being in the same situation? Did you choose to take anti-depressants to make your life easier, or did you go the "natural" way?

Thanks for your insights.

 

Hi @D5vid.

I had some severe anxiety at my onset of tinnitus. This is very common as we haven't adapted to the sound and it's still perceived as a threat. My anxiety completely hindered me from sleeping as my heart began to race when i drifted off.

To combat that, I did take one of the safer anti-anxiety drugs for a few days to calm down and get some sleep. After that, my sleep improved on its own. As the days went by I started to notice that the tinnitus remained the same through my day to day activities, and soon enough it became a very familiar aspect of my life. It no longer was perceived as a threat, and the anxiety vanished completely.

As it seems you have a milder form of tinnitus, I'm positive you'll get to that point soon enough and will be able to return to a fairly normal life.

I'd go for the above and try to deal with the anxiety without the use of anti-depressants. I think you'll be able to do it in time.

Tinnitus can happen for different reasons, but most commonly it's hearing loss. There doesn't have to be a lot of hearing loss to maintain it, and many things seem to be able to trigger it. To be on the safe side, I'd advise you to not visit very loud venues like concerts or loud bars.

Wish you well, and trust me, you'll be fine,
Stacken

 

Thank you @Stacken77.

May I ask which safer anti-anxiety drug you use? I occasionally use Ativan, but I want to stay away from it as much as possible. For now I'm using Flexeril, a muscle relaxant which seems to improve my somatosensory tinnitus experience. I can only use it for 2-3 week (I take half a dose before bedtime), but it might help me stay away from anti-depressants for now.

Otherwise — everyone around me, the mother of my kids, girlfriend, friends are advising me that taking an anti-depressant for a few months could help me cope with anxiety - which is harder to manage for me that the tinnitus itself (this solution, along with other solutions like seeing a physical therapist, psychologist on occasion, etc.).

Objectively speaking they're right. I would probably sleep better and feel better too, being able to go through the day without constantly having to think about managing my anxiety, doing meditation, etc.

But I'm just afraid that going to an anti-depressant again may worsen my tinnitus, and feel trapped between doing what's sounds right but worsening my tinnitus, and going the natural way with professional help, meditation, supplements and exercise. I wish there was an anti-depressant (natural or chemical) that *wasn't* ototoxic, that could work right away. I'd feel better knowing I'm not making my tinnitus worse.

What do you think?

 

Of course. I was prescribed Hydroxyzine, named Atarax or Vistaril depending on market. It's really an antihistamine with calming and sedative effects. It's also non-addictive unlike benzos, so it's generally considered to be a safer drug. I'd still advise caution, as most drugs can impact tinnitus. At one point I used took Hydoxyzine for a whole week to sleep, and that might have worsened my tinnitus and hyperacusis, but I'm not sure. Taking it for a day or two to get some sleep shouldn't be a problem though, but it's very individual how one react.

I completely understand the reasoning as I've gone though it myself. If I were you, I'd try to push through and see how it works out; you may be able to get out of this on your own, but if things become very hard, then an anti-depressant may be at place. I haven't had any experience with anti-depressants yet, so I'm not a good source of recommendation regarding that though.

Rest assured that things will get better, I'm positive of it.

Wish you well,
Stacken

 

I'm on Mirtazapine. I was up to 15 mg for a few months then recently dropped to 7.5 mg because it was making me too drowsy and hungry. I gained 25 lbs in 3 months. After the reduction, about 1-2 weeks later my baseline tinnitus spiked. It could be because my anxiety slightly increased, or because I reduced the Mirtazapine or something completely unrelated. All I can say is my baseline is higher than before the reduction. All and all I would still have taken Mirtazapine because my tinnitus is still lower than when I first got it.

I have suffered from extreme anxiety for most of my life. I believe my tinnitus is due to medication but who knows. I don't have hearing damage.

Note - Mirtazapine works for anxiety at doses higher than 15 mg. It's a weird medicine where at lower doses it makes you sleepier than higher doses.

My recommendation to you is to keep taking it. It will help. Also keep in mind usually people post horror stories online more than they do success stories. When something is working for you then you are busy living your life instead of posting online. All in all you have a better chance of it working for you then not. It's a numbers game and it depends on your risk tolerance.

Anxiety makes everything worse including tinnitus levels.

I take Mirtazapine, Buspar, and Gabapentin. 1-2 times a week I throw in a Xanax when I need. And trust me I'm all for the natural approach but I will try to reduce my meds in a year or 2 when im stable under strict doctor monitoring.

Hope this helps.

 

Hi @D5vid -- Since you asked, this is how your situation strikes me:

1st Choice: You could go the natural way in ways you describe, with the likely results. Cons: It takes time and perserverence. Pros: Literally zero chance of tinnitus worsening; significant chance it will get better.

2nd Choice: You could take some kind of antidepressant pill with the hope it's not ototoxic, and will work right away. Cons: Limited chance it will work as hoped for, and significant chance it could make your tinnitus worse, and perhaps permanent. Pros: It "might" work as hoped for.

I wondered about your hesitation when you obviously seem to know what is right for yourself. The reason for your hesitation seems to be that it would go against the advice you're getting from everyone around you. If that's the case, I would say it's a lot easier to give advice when the results could be detrimental for somebody else, but not for yourself.

D5vid, you're the one who has to live with the results of your decisions, not anybody else. I would recommend you do what you feel is right for yourself, and not let anybody's else's opinion sway you into doing something you intuitively know is not the best way to go. -- Regarding dealing with your anxiety, you may want to check out the following thread:

Three Supplements to Treat Severe Anxiety Symptoms

A final note: We live in a day and age where people are led to believe they can get immediate good results (like from popping a pill) when something has gone amiss. The reality is that the quick fix rarely works longer than short-term, and is almost always detrimental in the long-term.

I think it's when we think in the long-term (using patience), we inject a spiritual element into our thinking. I think the best aproach to dealing with many medical issues, including tinnitus, is when we combine the physical approach with a spiritual approach. I've posted in several places on what helps me cope without resorting to potentially dangerous meds. It can all be pretty summed up in the following posts:

Post 1 -- Post 2 -- Post 3 (Note: Post 3 is a fairly long description of my first few months with tinnitus. Thankfully, I'm doing much better these days, without having to take any meds whatsoever.)

You may also want to check out the below-linked article. The following in italics is a snippet from that article. I strongly suspect they could have listed anxiety as a symptom as well.

"How many patients do you see with headaches, head pressure, neck pain, migraine, tinnitus, vertigo, POTS, brain fog, memory loss, multiple sclerosis (MS), Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and Alzheimer’s disease? In how many of those have you considered that they had a structural problem at their cranial cervical junction (CCJ) that either contributed to their condition or was the actual cause of it? What is CCJ? More on that shortly..."​

Brain fog, memory loss, neurodegenerative conditions, and more can be related to structural problems at the craniocervical junction in patients with a history of head or neck trauma.

READ: A Mystery Answer to Restoring Brain Health​

All the Best!

 

Hi @D5vid - it's a minefield. I am facing the same situation right now. I am scared of trying a new antidepressant, but I saw another therapist today who told me that I need to do so in order to aleviate the depression a bit before he can try treating me with hypnosis/EMDR/EFT.

I, personally, would suggest the following:

(a) if you suffered a clear issue/injury to C1 and C2, get them checked out, preferably by an upper cervical chiropractor ASAP. If they confirm the problem and treat it, you may well see some improvement in the near future.

(b) look for methods to aid with the anxiety. This can be CBT if you have not tried it; hypnotherapy, or counselling from an audiologist. Have you seen an ENT or audiologist yet? This could be helpful in ruling out any other issues/checking hearing.

(c) if neither of the above works or you are finding things too tough without additional support, perhaps see if you can try a low-dose benzodiazepine. For me, Valium works well and has a long half-life, so chances of tolerance/addiction are relatively low. Others on here have tried Xanax (Alprazolam) - low half-life and Clonazepam (longer half-life). At small initial doses, there should be no problems with these. It is only longer-term use followed by withdrawal where you have to be careful - and supervised.

Finally, please do NOT be led by your need to return to work. Your need to get better and to find a way to alleviate anxiety are the main priorities for you now. Explore some other avenues and look at short-term support, if required.

Whereabouts are you D5vid?

 

Do not touch benzodiazepines! I didn’t know how bad tinnitus could get until I tapered. I was only on them 6 weeks and tapered for 9 weeks. It’s hell. Not worth it. Get drunk if you need to relax.

 

Thanks for your insights and recommandations everyone. @Lane, I especially liked your objective post and links.

While the situation has been quite alarming for me when it started (and to this day still makes me a little hypervigilant and sad at times) but 6 weeks in, I find that the tinnitus has subsided remarkably and has become somewhat more tolerable. I'm also a bit less anxious.

- I no longer have tinnitus sounds at night. Or at least, barely so. The tones that were moving around and from ear to ear according to my position have subsided.

- I have slight hyperacusis in the left ear — it picks up certain high-frequencies (a pitch that occurs only when I'm in my car, or a tone coming from the fridge compressor). I'd say this is the most annoying thing.

- My tinnitus type is somatosensory. Pressing on my mastoid bones (behind the ear) removes all symptoms entirely until I let go. This leads me to believe that my tinnitus/hyperacusis might be coming from Temporo-Mandibular Dysfunction. But it occured suddenly at the same time I was ending 2 weeks of Remeron, so that's why I'm hesitating.

- I still have a feeling like my "mic gain" in the right ear is too high — just like I'm capturing room tone silence too much (I hear a silent sibilance sound like "ssssssss").

Wearing earphones during the day helps me tune out of these problems a bit and focus on getting things done. Otherwise I keep checking on my ears and trying to figure out too much if I hear tinnitus/hyperacusis or not, and all this does is keep me disappointed. It doesn't help with being patient about healing, it doesn't help with concentration or mood. So I want to stop doing that.

I want to start work again because it'll ease financial stress, and I've spoken with my manager so that I can come back doing something that motivates me more — my company is very understanding and helpful, so I'm lucky for this. It's not going to be easy — I have this like/don't like relationship with work, but I'll take things one day at a time.

I know some of you recommend that I go the natural way and try to stay away from antidepressants.

The thing is, I want to be there for my family and get over the feeling of anxiety that this event brought on. I find I'm having a hard time "feeling" things the way I did before, certainly because of the trauma brought on by the condition.

I've spoken with my doctor, pharmacist and family about the conundrum I'm in, and they understand my fears. But "fears" are what they are, and for sure I can't let the way I feel come in the way of a treatment that could help me cope with the situation better for awhile. I'm sure some people with tinnitus will read this and agree that anti-depressants didn't necessarily make their condition worse, and helped them get through the event.

I keep telling myself two things:

- Depending on several factors, it may all heal in time (tinnitus or hyperacusis are not considered chronic until you're past the 6-month mark, and even then, there's still a possibility you're healing over additional time). It's not exact knowledge at all, it depends on the tinnitus type and a host of various factors. Just keep in mind: healing happens every day. Give it time and also remember: try to heal your anxiety first, it often harms you more than the tinnitus itself.

- Depending on the effort I put into adapting, I will eventually habituate to any symptom that's left. By all means this is NOT a situation I've wanted, but the fact is, I have it. Fighting against the fact won't help me deal with it. I need to get therapy, get physical therapy, figure out what works and what doesn't.

As @Lane and others have mentioned, it's a process that can't happen overnight, and calming my "healing impatience" is the best thing I can do for myself. I need to stop wanting to remove this like I'm panic-removing tarantula cobwebs from my face, pardon the analogy.

I'm glad my tinnitus isn't worse like it can be for some others here (I sincerely respect and admire your resilience), I need to see it for what it is.

So here's what I've been telling myself.

- I'll have my anti-depressants prepared so I have them on hand, when I'm ready to start. I'd like to start with a small dose of something I feel comfortable with, even if it's just a perception.

- I'm not taking them yet, because I'm still seeing improvement, both with anxiety and tinnitus/hyperacousis. But if I find my mood doesn't improve, well:

- At the very least then, I'll need to try to see if taking 1 pill has any effect at all on my tinnitus condition. Like dipping a toe in water. I know I'm afraid of things that haven't happened yet to me, or have been reported by a few people - which might not even be linked to the pill itself. There are millions of people out there with tinnitus, most of whom are helped by anti-depressants and they're not on this forum because they're not as anxious as some of use are.

- If everything is okay, I'll go through the course of the entire treatment, which lasts several months. The best outcome is that it has no effect over my tinnitus or hyperacusis, and that I can taper off slowly and go back to a regular life when I became habituated to my phantom sound symptoms.

All in all, I hope all of you become successful in dealing with your tinnitus. I ABSOLUTELY have the utmost respect for what you're going through, I've read how some people have developed high levels of anxiety from their tinnitus situation - which might be worse than mine.

Here are some of the things I've been doing:

- Patience. Again, we want this thing to go away faster than it can. Find out what works for you, do it, and be resilient. It might require a lot of effort you didn't want or need, because it's a new condition in your life.
But once you get habituated to making these new efforts, you'll obviously be stronger also. And your tinnitus weaker.

Remember, there are NO quick ways through this. It's like growing a plant.

- Get tinnitus-masking apps are wireless buds for the day, and learn to sleep with headphones on.
I know, it's annoying. You didn't need headphones to sleep before. But you know what? Chances are you won't need them all your life. It's just for now. Listening to music, or to free hypnosis sessions on YouTube, or white noise, does WONDERS to soothe your mind and keep you away from constantly thinking about your tinnitus.

It's the most-effective, fastest-acting remedy I can share, sincerely.

- Get yourself a "Mindfulness meditation for dummies" book and read it in a hot tub. Meditation is NOT spiritual mumbo-jumbo. It's based on bio-mechanical techniques to help you relieve your body of tensions, anxiety and stress. I practice it in bed when I wake up in the morning and it helps lower morning cortisol levels.

- Another great book is "Feeling Good" by Dr. David Burns. It's Cognitive Therapy in a book, just add water (again, get in a hot tub and read). It'll help you from the first few pages, I swear.

- Less coffee, alcohol or sugars. If you can cut down, do it. It won't help tinnitus, it'll help anxiety. Remember, deal with your anxiety first and foremost.

- Therapy. Honestly, any psychological therapy than can help you cope with tinnitus can be effective.

- Reading books on "Resilience" by Boris Cyrulnik. I'm from Quebec and speak French so I've been able to view some videoconferences, but I know some of his books have been adapted to english and you can learn how to deal with the traumas brought on by tinnitus (or any other sudden, life-altering event).

- If you have suicidal thoughts or moods, do NOT act on them. They are cyclical chemical imbalances in your brain which make you believe the only way to make your tinnitus stop is to end your life. What you want is your tinnitus to stop, NOT your life! If you had no tinnitus you would not want to destroy yourself. Start by checking in your local hospital's ER social worker, there is A LOT that can be done for you.

I hope I could help you with these words. Also remember to love yourself, and give yourself a break for having this. If you don't have parents anymore, be your own parent.

You can make yourself feel better and heal faster by being caring and understanding for yourself first and foremost.

You don't know what the future is made of, so be trustful, courageous and resilient.

 

Hi everyone,

Some new information on my radar. I realized yesterday that my tinnitus might not be coming from medication or stress.

I have been practicing Brazilian Jiu-Jitsu for only a few weeks, when on a particular roll night ("rolling" means practice in BJJ), someone gave me an aggressive chokehold for a few seconds. I was proudly trying to hang on, not realizing that this could potentially cause damage (short? long-lasting? who knows) to my arteries and veins near the ear.

I had a stiff neck for a few days which felt like I had swollen lymph nodes. It eventually healed, but then my tinnitus started maybe 1-2 weeks (or so) afterwards.

I don't know if it's related, but I'd like to get this investigated. Unfortunately I feel I'm starting to get on my doctor's nerves, on my girlfriend's as well, so I'll have to find a strategy to increase my own resilience and be my first support.

My solution is to talk with a friend more if need be, and maybe get an appointment in a different clinic for a fresh view on my condition.

I also want to spare my loved ones from my incessant researching symptoms, and focus on what alleviates my anxiety and distress, so again, anti-depressants will probably help me for short a while.

I've had good reviews about Cipralex, Viibryd and Effexor.

Wish me courage

 

Hello everyone,

I'm starting Effexor XR, as prescribed by my doctor, to help me cope better with my 6-week old tinnitus condition. I've tried doing without it, and things seemed better for awhile.

However, starting medication yesterday caused a perceptible spike in my tinnitus. I've been told by the pharmacist that starting Effexor XR might cause anxiety for a few days, it should go away.

Technically, since tinnitus is exacerbated by anxiety, the latter should be the culprit in causing the spike - NOT the anti-depressant per se, which I need.

While appearing as a counterproductive situation currently, I think the anxiety brought on by the anti-depressant should recede and things will settle down once the AD starts acting.

Am I correct?

 

Hi @D5vid -- There are an almost unlimited number of extremely safe things that can be tried to reduce anxiety, and/or improve our ability to cope with tinnitus (and other difficult challenges in our lives). I think the odds of you being able to find something that works well for you is very high. I guess I don't understand why you're choosing a route that is rife with many unknowns, and many dangers. I would just encourage you again to look for safe, longer-lasting solutions. If I remember correctly, it's this type of safer approach that you said you were intuitively drawn to. -- Take care...

 

Hi @Lane,

I'm afraid I didn't make a good decision, but I'm not sure.

After trying Effexor for 5 days, I find that I've gotten very anxious daily as the initial onset of medication creates anxiety for a certain period of time. During these daily anxiety periods I get so anxious it's difficult to eat, work or require lots of efforts to take care of myself all day. I tried going to work again after 1 month sick leave as I felt better before starting the medication, but now that I've started it's making things hard again.

From starting the medication, my tinnitus seemed worse for a few days (an additional sound) before getting to a certain point where it's kinda "masked".

If I take the medication in the morning, then only after 12 hours does the medication-induced stress comes down and I'm able to relax.

I want to discontinue taking the medication but I'm afraid I won't be able to deal with the anxiety with more natural means, I don't know what to take that can has a calming effect equivalent to Ativan or an anti-depressant.

I'm stuck in a decision loop where a) I need medication to deal with anxiety but b) I'm afraid to take it as I feel it augments my tinnitus, thus augmenting my anxiety.

I can't seem to take a decision to take that medication or not, because I'm scared.

If I don't make a decision, I'm afraid I'll become a charge for my loved ones if I can't handle myself.

What keeps me from choosing the natural route is that I don't know enough about tinnitus and this medication (Effexor) to understand if it will subside within a few days or reveal itself to be worse and I won't be able to cope with anxiety.

Any insight is appreciated, I'm really worried.

 

I would comment that it sometimes takes weeks to feel the effect or certain meds. Natural way is the best. It's a numbers game. The risk of tinnitus increasing from certain meds is low. I get when you have tinnitus, even a 1% chance of it increasing is a huge risk we aren't willing to take but we should look at everything objectively with a trial and error approach.

 

Have been on Mirtazapine (30 mg.) for more than 6 years. It did not cause tinnitus for me (loud music did 4 years later). Mirtazapine is a devil to wean off from, but otherwise - probably among the least ototoxic antidepressants out there. Helps me to sleep (alongside a bit of melatonin - I take no other supplements or meds).

 

Hi everyone,

So I've had tinnitus since September 6, 2021, when I felt a fullness in my ear and it all started there, out of nowhere. It's unclear how or why it started — antidepressants for chronic insomnia? Stress? Neck problems? I don't know and it doesn't matter so much anymore.

I had been fighting with chronic insomnia for awhile, so imagine my disbelief knowing I had been struck with tinnitus additionally. It feels like a curse.

I've been going through a lot these last months since then, and it's a very difficult journey.

Recently I had to resort to taking Zoloft to help me cope, as — before Christmas — I began a series of spikes every two days. Like I have this constant "zapping laser" at the base of my neck some days, and I just doesn't let out. Nothing I do seems to make it better, except massaging the back of my neck, which seems to calm it down just a few seconds.

25 mg of Zoloft + Imovane helped on the first week it seems, as it was reported somewhere that Zoloft helped calm tinnitus at a dose of 50mg. But 15 days later, upon moving up to 50 mg, I started feeling increased unjustified anxiety. Insomnia became harder to manage, and I had daytime anxiety which required constant management or occupation to sort out. Worse even, the "eeeee" part of my tinnitus, which had previously disappeared, began again.

I was at my wits' end.

Upon talking to my GP last Thursday, we agreed to try to go back to 25 mg Zoloft and see if it had any effect on the tinnitus. So two days ago I started taking the 25 mg dose again, and play the waiting game.

Last night, I found it hard to remain asleep (my insomnia is of the sleep maintenance type), and so my night was shot to hell again. Every night is a game of adjusting earphones with white/pink/brown noise, figuring out the right pillow/body position thing, and trying every zen technique I have to relax and fall asleep again. To no avail- this insomnia's like trying to bend an iron bar with bare hands.

This morning (spike day) I was unable to hold myself from crying. Insomnia, single dad with two kids, a new house I'm struggling to like/organize/renovate, full-time job, working remotely since the pandemic started and little to no social life. At least I have great occasional support from my ex-wife and also my girlfriend, but I can't see them very often — we're all busy with work and life of course.

I tried taking L-Theanine to relax, and surprisingly it seems to be working pretty good — it's taking down the spike and anxiety several notches down. I really appreciate the more peaceful feeling in my body.

I'm struggling to come to terms with the fact that I have tinnitus and that have no control over it. But every day is different and I'm trying my best to keep on top of solutions. It's hard though. I feel everyday is a struggle for survival.

I hope everything I'm doing eventually helps me find balance.

Thank you for your kind words.

D5vid.

 

I feel your pain bro. Try Mirtazapine. It might help you sleep. Anxiety and sleep is the best solution. It won't cure tinnitus but rather help you manage it better.