Tinnitus and Prozac

Do any of you directly attribute an increase in your tinnitus volume to starting Prozac or any other SSRI anti-depressants? If so, did your tinnitus return to baseline upon cessation of the drug?

Thank you.

stephen nagler

 

Hi Dr. Nagler,

My situation is more complex, so I don't know how useful this is, but I'll chime in anyway.

I developed tinnitus and "tinnitus like visual problems" at the same time in my late teens. At the time, I completely attributed to having messed with a hallucinogenic drugs a few times - but I'd been on and off SSRIs for most of my adolescence, and I've had a couple different doctors over the years finger that as a likely culprit simply because I was on SSRIs for a much longer total length of time, than the less legal and more problematic (not to mention more fun) drugs.

The other complicating factor is that I got (oral, type 1) HSV also a couple months before all these problems started, and I do wonder about that since there's a lot of data indicating it can live in the inner ear.

 

Hello Dr. Nagler,

to reply to your question: My tinnitus started 2 years ago after 5 days of taking a low dose (5mg) of an SSRI (citalopram). Even after immediate cessation I am still struggling with constant severe billateral T today. Who knows, maybe it was just a coincidence. Hard to swallow this version of the story though...

 

Thanks for your input, @linearb. I appreciate it.

I'm actually looking for individuals who first noticed onset of tinnitus within 7-10 days of starting Prozac (or another SSRII) or who noticed a distinct increase in tinnitus volume within the same time frame. Anybody?

stephen nagler

 

Thanks, Mario.

Any others who might have input?

stephen nagler

 

@Dr. Nagler
May I ask about your motivation behind this inquiry?

Best regards,

m

 

My left ear started hissing about 8 weeks into takIng Zoloft.
Soon after the faint ringing joined!

Original t is in my right ear and I had it for over 2 years with no problems in left ear when I started Zoloft.
I could be wrong but I can't help but think that Zoloft is responsible for the new development.
However, it didn't make right ear t any better or worse.

 

I was on doxepin for 3 weeks and took myself off. I noticed no change in tinnitus whilst taking the drug. I don't think I took it long enough to have an impact in my anxiet. Coming of the drug was more challenging. By the third day tinnitus volume was out of this world. However, this tapered off within the next 5 days.

 

Thats a great question @Dr. Nagler Please would it be ok to ask you to answer it as would be very interested.

 

@Dr. Nagler
Although this is no more than older anecdotal evidence about a link between SSRI and tinnitus you might want to take a look at these sources (the "dark side of the net" is full of such reports which makes even the more scepticists wonder):

https://www.lareb.nl/LarebCorporateWebsite/media/publicaties/kwb_2005_4_ssri.pdf

http://www.peoplespharmacy.com/2012...ram-lexapro-tinnitus/comment-page-1/#comments

http://www.anausa.org/smf/index.php?topic=12161.5;wap2

To get back to my previous question: What is your opinion on that matter? Do you have reason to believe that there is indeed a link between SSRI and T or do you think those reports are mostly coincidential? Do you know about any serious, independent, official publications concerning that matter?

Best regards

Mario

 

First of all, my thanks to each of you for your responses.

Now, as far as my motivation behind the inquiry goes, the question of the association between Prozac and tinnitus comes up rather frequently in clinical practice. The problem is that the SSRIs are among the most commonly used drugs in the population, and tinnitus is one of the most common conditions in the population - so it is hard to get a handle on any correlation. My thinking is that if one were to first develop tinnitus (or a clear exacerbation of previously-established tinnitus) within 7-10 days of starting Prozac (or another SSRI), while that would still be anecdotal evidence of a connection, it would at least be a bit more compelling anecdotal evidence than their mere co-existence. especially if the tinnitus (or its exacerbation) resolved within 7-10 days of cessation of the drug.

I hope this clarifies more than confuses.

stephen nagler

 

Hello Dr. Nagler,

I understand that you are still sceptical on that matter. So if I may, I would like to add a hypothetical
question:

Although I understand that you are not a psychiatrist... With all your knowledge and clinical experience on tinnitus, would you advise SSRI treatment to a patient who suffers from T-induced anxiety and recurrent episodes of depression despite the fact that the same patient claims onset of his condition upon starting SSRI treatment?
(like I said, purely hypothetical. I obviously do not expect you to make a diagnosis here )

thank you in advance, your input is much appreciated!

best regards

m

 

The first thing I'd recommend for such a patient would be TRT.

Tinnitus-induced anxiety is a reaction to tinnitus. TRT is ideally suited to addressing that sort of thing. And the depression associated with tinnitus typically comes from loss, specifically the loss of control and the loss of silence. Once again TRT can be incredibly effective in that regard.

In my experience, the overwhelming majority of tinnitus sufferers who are seriously considering starting SSRIs and/or benzodiazepines because of tinnitus-associated anxiety and/or tinnitus-associated depression are found to no longer be interested in starting the drugs by the time of their six-week follow-up session. So I encourage all of them to hold off.

The realization that there is legitimate hope for meaningful lasting relief along with the initiation of a predictably effective strategy for achieving that relief can very often do wonders for anxiety and depression.

If your hypothetical patient still felt the need to start an SSRI after six weeks of TRT, then I would recommend an SSRI other than the one that he or she believes is the culprit. SSRIs very often differ from one another in side-effects even though they belong to the same family.

stephen nagler

 

If i remember correctly, dr., you said that the influence of those meds should always subsides once one stops taking them.

 

Right. But @MarioT's hypothetical patient believes otherwise. So why cause him or her unnecessary worry when it is just as easy to prescribe another SSRI!

Also, there is such a thing as an idiosyncratic reaction to a drug, which is very rare and is felt to be an immune-mediated toxicity rather than a pharmacological effect.

stephen nagler

 

Sorry I am a bit late to the party Dr Nagler, but if it is of any help to you I was on Prozac for three years (2011-2014) on doses between 20mg and 60mg but I didn't notice it having any effect on my tinnitus whatsoever.

 

Thanks for your input. Appreciate it.

 

Dr Nagler,

I had T from noise exposure and after taking Citalopram I started to experience a high pitched hiss from the back of my head on the left side. If you are at all interested.

RGDS
ML

 

I have been on fluoxetine for 21 days today and I have been noticing a temporary increase in tinnitus (which was almost non existent prior to medication)... Usually within minutes after popping the pill. A bit scary I must say. I usually do so in the evening. However, the morning after the tinnitus becomes unnoticeable again.

 

I started fluoxetine 20mg (1 a day) 3 weeks ago and this week i have noticed a massive increase in the volume of my tinnitus, which was livable. Now it is unbearable and I don't know what to do.

 

I have been on an SSRI for years (Paxil to be exact). My tinnitus started during an ear infection, so this is the most likely culprit, but I had read about the link between the two, so I stopped taking it for 2 months after the T set in. I felt worse in every way as people who try to get of SSRI's do after stopping Paxil, except the Tinnitus didn't get worse. It didn't get BETTER, but it didn't get worse. At this point I am uncertain as to what role, if any, Paxil has played in my "contraction" of T.

 

I only just stumbled across this terrific website, and immediately noticed this older thread. I hope my input is still useful. Although I can only offer circumstantial evidence, my experience does seem to point to new-onset tinnitus associated with my starting a newer, anti-depressant named Brintellix (Vortioxetine).

I started taking it in December of 2014- first 5mg for a week, then 10mg. This was after an extremely difficult few years in my life, and my psychiatrist had prescribed three other SSRI's previously. All were ultimately discontinued for ineffectiveness and typical side effects. I had been clear of other SSRI's for a few months before trying Brintellix, without persistent ill-effect.

After roughly two weeks I noticed an odd, new, sound in my head. By three weeks, it was extremely loud and uncomfortable and certain external sounds (crockery!) were excruciatingly loud. (Hyperacusis, I later learned.) I had never experienced anything similar to this before, nor had had other noticeable hearing problems. There were no other medication changes or any exposure to loud noises during that time.

On my prescriber's advice, I tapered off Brintellix, with my final dose about 1 month after the first. The tinnitus remained. It was bilateral, but slightly "louder" in my left ear- roughly a 60/40 balance and very intrusive. It was (and still is), actually difficult to hear "over" it at times.

I'd never even heard the term "ototoxic" before, so I think I misjudged the urgency of my situation. I was ultimately seen and tested by an ENT roughly 6 weeks after stopping Brintellix. Audiometry confirmed some bilateral hearing loss. The ENT prescribed a course of oral Prednisone (80mg, two-week taper). He emphatically told me I needed to start it that day, and to pick up the Rx immediately, which I did.

And this is where it gets mildly interesting. Or at least useful, I hope.

By the end of the Prednisone course, the tinnitus had almost completely resolved- but only in my right ear! Repeat audiometry showed improved hearing in that ear. But the tinnitus in my left ear was still extremely loud, with persistent relative hearing loss of up to 25dB in a range around 4000-7500Hz. It has remained that miserable way ever since. But the fact that the Prednisone apparently "healed" my right ear almost entirely strikes me as a compelling clue that this particular medication may be the source of my new-onset tinnitus. And that I should have sought out an ENT much, much sooner.

Recently, I was examined at a leading hearing institute, where more sophisticated audiometry confirmed the now-asymmetric hearing loss. That made them request an MRI of my head to rule out a neuroma. Contrary to the longstanding beliefs of my wife and family, my head was normal. Unfortunately, they could offer no magic cures, and I try to cope with the usual masking/sleep/distraction approaches that most of us here seem to be stuck with.

So I hope this account is helpful to you Doctor, and to others. And for anyone who arrived at this thread via a search for SSRI or Brintellix and tinnitus or otoxicity:

Get to an ENT. It could make all the difference.

 

@Dr. Nagler
I started taking zoloft three days after the onset of my T. At the beginning I didn't had a clear "baseline", although most days were moderate to loud. Three days after taking the pill, 100 mg, the T increased and even had bouts of pulsatile T, but it could be explained also by my panic state. I've been on zoloft for 28 months and withdrew several months ago. During this time, T has been easing a bit with occasional spikes.

Now I'm going thru a depression, don't really know if benzo withdrawal induced or whatever, and I'm considering starting on zoloft again, but I'm beyond scared. I would not be able to tolerate a t louder than currently is, and SSRIs are a risk. I've been on/off zoloft for years, since I was a teenager, and everytime I started the drug I had different feelings (restless legs, akathysia, increased anxiety). It looks like my brain is used to sertraline but I don't really know what to do, probably will wait till the end of the withdrawal and the spring and see if the depression lifts off.

 

Sorry but Dr. Nagler is no longer on this forum.
It may be possible for you to send this to @Dr. Ancill instead who is on this forum and answering questions or to any of the other doctors in doctors corner such as @Dr. Gans or @Dr. Hubbard.
Hope this helps.....

 

Didn't know that, thank you.

 

Any thoughts on taking Prozac?

Will it make tinnitus worse?

I'm depressed because I have tinnitus so I don't want to make it louder.

Thanks!

 

@jeannie . Hi. I have tried Prozac it didn't effect my tinnitus. But I could not get on well with this antidepressant it made me feel like a zombie. So the doctor prescribed me with Amitriptyline which I'm happy to be on now. Antidepressants don't suite everyone having said that you might be fine on Prozac.

 

What mg was you on Richard?

 

@jeannie 50 mg a day. Amitriptyline is not just a depressant it's also Drug for nerve pain it's also used widely by doctors to help tinnitus it certainly brings my tinnitus down so l can get to sleep more easily.

 

Ok thank you!