Mechanisms of Antidepressant-Induced Tinnitus

Hello,

I would like to start a discussion and ask if anyone knows the exact mechanisms behind non-traditional ototoxic medicine-induced tinnitus, compared to say, acoustic trauma tinnitus. I say non-traditional because many doctors do not consider SSRIs, TCAs, etc. to be truly ototoxic in the sense that they cause hearing damage. Even the renowned Dr. Nadler on this very website claims that SSRIs are not ototoxic and do not cause auditory damage. However, I, like many on this website and around the world, have severe tinnitus after taking an antidepressant for a short time (in my case Lexapro).

Can these medications actually cause damage to the hair cells in the cochlea? Or is it a matter of damaged/hyperactive nerves in the auditory cortex? Or some other mechanism? Any insight is appreciated as I need some hope that this can someday be healed or at least mitigated.

Thank you.

 

Read this article:

Study suggests serotonin may worsen tinnitus

 

There are also certain antidepressants that people report improved tinnitus in studies, so it doesn’t seem conclusive one way or another.

 

When I was young and first got tinnitus at 14 I got put on Fluvoxamine and it actually lowered my tinnitus. Years later I took that same drug and it actually worsened my tinnitus. So yeah this shit really makes no sense hahaha.

 

I've seen this before. Doesn't really get into the details behind what causes or worsens tinnitus. In my case, the SSRI gave me tinnitus (I didn't have it before then). I am mainly curious if these drugs can actually damage the hair cells (such as the case in acoustic trauma), or if it involves damage to the neurons in the auditory cortex, etc.

 

Any new findings on this? I am also trying to learn about the mechanisms and wondering if any of the upcoming treatments will help with SSRI induced tinnitus if it's associated with damage in the neurons in the auditory cortex.

 

I saw on the Internet two cases where people got relief from tinnitus after taking Mirtazapine, when the tinnitus was caused by an SSRI. What do you think about this?

 

Improved tinnitus, or improved ability to cope with tinnitus?

My tinnitus was caused by Zoloft.

Development of Tinnitus at a Low Dose of Sertraline: Clinical Course and Proposed Mechanisms

"Discussion. Tinnitus is a rare side effect of sertraline and may be related to particular distribution of serotonin receptor subtypes within the auditory system, and serotonergic agents may reinforce or desensitize the activity of different receptors. Also, there may be a priming effect of salicylate agents on the auditory system, predisposing particular patients to be more sensitive to how auditory stimuli are processed."

 

Licorice root tea might have spiked my antidepressant-induced tinnitus. I only had one cup.

Any theoretical reason to justify this besides the raise in blood pressure?

I am almost sure that it's neurological with neurons misfiring due to who knows what interactions serotonin could cause.

 

In several articles, I read ototoxic induced tinnitus was caused by eighth cranial nerve impulse transmission. That masking was being studied. None of the articles discussed masking details?

 

Spot on. My understanding is that SSRIs are indeed not ototoxic but can trigger chronic tinnitus through the mechanism described in this post. There is a wealth of research now evidencing this mechanism. Excess serotonin in the dorsal cochlear nucleus causes the fusiform cells that are first-line brain processing for auditory and somatic input from multiple cranial nerves to become hyperactive and malfunction. Salicylates can induce a similar dysfunction in the fusiform cells (hence tinnitus spikes from aspirin, naproxen, etc) but the changes are typically temporary rather than permanent.

For serotonin to trigger permanent tinnitus though, as @Greg Sacramento points out, most people typically have some pre-existing damage to the auditory system (8th cranial nerve) and/or inflammation in the somatic cranial nerves involved (e.g. neck, TMJ problems).

So while the SSRIs aren’t ototoxic per say, and not a root “cause” of tinnitus, they can indeed trigger permanent tinnitus through a neurological mechanism.

 

Is there something natural that can be done to mitigate or slowly heal what Serotonin did? Can something that boosts neurogenesis or exercises to boost BDNF help somehow?

 

I really like your explanation here. I still have a long way to go in discovering the cause of my own tinnitus, but I think this is one possible explanation. If that IS the case for me, I didn't get the serotonin trigger from an SSRI, but maybe from Delta-8 gummies (which are known to alter and increase the serotonin activity in the brain). Or maybe not? I don't have hearing loss at 8 kHz, but I don't know about the higher frequencies. I also have some somatic characteristics.

If you're correct, we need to find something that calms or "reboots" the DCN. This paper is beyond my technical knowledge, perhaps someone can spell it out for us.

Decreasing dorsal cochlear nucleus activity ameliorates noise-induced tinnitus perception in mice - PMC (nih.gov)

 

They basically used some designer drugs to modify the muscarinic M4 receptors in the DCN. These receptors must be key to tinnitus maintenance, at least in rats.

 

That would be of my interest too.

And do I understand correctly that the Dr. Susan Shore device should target the SSRI induced misfire in the DCN?

My tinnitus is so much worsened by an SSRI (Paxil) that I can’t cope any more. Is this nerve damage? Would stem cells help? What could I do to help my condition? I have also bad ear pain and hyperacusis.