SSRI Induced Tinnitus — I Think I Know Why

My tinnitus began a bit more than 3 years ago while I was taking Sertraline (50mg per day). I found this alarming and since it wasn't working for me anyway (calmed racing thoughts but sapped motivation, which was my real problem) I tapered off. T wasn't the only complication I had and it's not the only complication I still face. I also have digestive issues and my baseline mood is very low. I also find that the "fight or flight" response kicks in when faced with situations that I could easily handle before I ever took an SSRI. I've had more days off work in each successive winter since I took Sertraline than I had in the first 6 years of my working life.

By now, I am habituated to the T and in fact it has never been my most bothersome symptom. I'm sure I am lucky in a sense because reading some of the descriptions, it is clear I don't suffer as much as others. It is constant and unrelenting but the pitch and volume has remained fairly consistent and while I have spikes, they aren't anything too severe.

Onto the mechanics... it has been quite a frustrating search for information because SSRIs are sometimes used in the treatment of tinnitus and those are the results that Google spits out. It seems insane to me that a neurotoxic, ototoxic medication with no guarantee of working and a significant (underappreciated by the medical community) downside risk would be prescribed for tinnitus.

I believe I have cracked it, as a result of piecing together various tidbits that I have come across. SSRIs work by increasing the extracellular amount of Serotonin in the brain. This is done by blocking the re-uptake of Serotonin released from the synapse which is another way of saying that Serotonin is recycled. This has the effect of reducing symptoms of depression in some people. After a period of time, the body becomes accustomed to this increased level of Serotonin and doesn't produce as much. In the normal course of events, when discontinuing an anti-depressant, the body will re-adapt to the absence of the drug and produce Serotonin at a normal level.

Unfortunately, this doesn't happen with everybody and I believe it's an underappreciated phenomenon. Mainstream medicine doesn't recognise a protracted withdrawal syndrome so symptoms will be chalked up as a re-emergence of the symptoms for which the SSRI was prescribed in the first place. In the protracted withdrawal syndrome, the body takes much longer to adapt to the absence of the SSRI and doesn't produce enough Serotonin. This has a bunch of knock on effects. Serotonin can be described as a neuromodulator which means that it has an affect on levels of other neurotransmitters. Most pertinent seems to be the regulation of GABA/Glutamate levels. The two are intrinsically linked. Glutamate is an excitatory neurotransmitter and plays a role in learning/memory and general alertness. GABA is an inhibitory neurotransmitter which reduces stress. GABA is actually produced from Glutamate and Serotonin modulates this activity. In survival situations, Glutamate levels will naturally be higher due to the increased need to be alert. When environmental factors allow us to switch off, GABA levels will be higher, which has a calming effect. The problems associated with increased stress are well understood so this process is important.

In the protracted SSRI withdrawal syndrome, Glutamate levels are elevated beyond what is normal. I believe that this increased excitatory action is the cause of tinnitus as well as a host of other symptoms. The good news is that people do return to a normal baseline even if it takes years in some cases. The bad news is that when Glutamate is elevated for a prolonged period, a process called excitotoxicity occurs. I have read a few accounts where people become much better but the tinnitus remains. Ability to deal with the tinnitus improves, though. Glutamate rebound activity and excitotoxicity is implicated in T induced by Benzo withdrawal, too. It's just a different way of getting to the same problem.

I started to take Benzos in May last year, before I knew any of this. If I had a second chance, I would never have taken the SSRI and I probably wouldn't have taken the Benzo. To be honest, I dived into the Benzo thing with a heavy bias because of the huge relief they provided. Now that tolerance has set in and I am well and truly dependent, it's clear to me that I don't have much choice but to stick with them, because all hell will break loose even with the smallest reduction in dose. I am stable at 15mg Diazepam per day which isn't a monster dose. It's nowhere near as effective as the honeymoon period (about 2 months) but I believe keeps a lid on things somewhat. The biggest reason I stay on them, though, is what will happen if I stop. I am hoping that in time I will get some indication that the time is right to taper them down. That's not now, though.

One implication for people in the same boat is that tinnitus might not be such a big cause of stress by itself. It doesn't help - that's clear - but the mechanism by which the tinnitus was induced is implicated in elevated levels of stress. People may find that they can improve their quality of life by not subjecting themselves to stressful situations unless completely necessary.

 

You've thought that yourself? What's your occupation? I've just started this drug and these stories making it worse permanently scare me

 

@sickofants I’m in the same boat with the tinnitus being caused by SSRI. Can you please give me some advice and maybe how I can reverse this! It happened only two months ago.