Tinnitus Worsened After Stopping Sertraline and Starting Mirtazapine

[Hammers76]

I have had tinnitus since November 2024. I first noticed ringing in my left ear on and off while I was taking Sertraline for three months. I did not taper off the medication because I wanted to stop due to harmful side effects. Three weeks after stopping, I developed tinnitus that is now constant, 24/7.

My general practitioner then offered me Mirtazapine 15 mg to help with sleep issues. They never mentioned that it could worsen tinnitus. Now I am trying to stop taking it because my tinnitus has recently changed and is keeping me awake. The tinnitus is causing anxiety and head pressure. I have not slept for four days. Mirtazapine no longer helps me, as its sedating effect has worn off.

My question is: Do you think Mirtazapine can make tinnitus worse?

 

[Badger55]

Absolutely. I took 7.5 mg of Mirtazapine each night for the year that ended on March 31, 2025. Over the course of that year, my tinnitus intensity gradually increased, so I weaned myself off the medication this month.

 

[trevl]

@Hammers76, the mitochondria, which are organelles within cells, have their own DNA (mtDNA). Liver cells play a key role in detoxifying chemicals introduced into a person's system. In the presence of excess or sustained toxins, whether naturally occurring or introduced through ingestion or intravenous means, the mitochondria can replicate. This helps the cells they reside in break down chemicals more rapidly.

As a result, sustained chemical (drug) use leads to tolerance, since more mitochondria in the liver increase the speed of detoxification. The effect of the drug at the same dose, and the duration of its effect, both diminish. This also leads to cross-tolerance. (This is covered in second-year biology.)

This is the most likely reason why your sustained Mirtazapine use, like the use of many other drugs, becomes ineffective over time.

I have used Mirtazapine to assist with sleep because my tinnitus was too loud. I have also experienced changes in my tinnitus—louder and different in character—after several weeks of sustained Mirtazapine use.

Normally, each morning as my brain exits sleep and enters wakefulness, my squealing tinnitus presents itself. It sounds like ice skates on ice or the squeal of train wheels rounding a bend on railway tracks. On two occasions, I woke to a louder sound, like the white noise from a television test pattern. It was different, and louder. I have had to reconsider my use of Mirtazapine.

There is only one published case of Mirtazapine causing tinnitus. This is not mentioned in the MSDS that accompanies the drug. I suspect there are many more anecdotal cases of tinnitus linked to Mirtazapine that do not make it into the scientific literature. Health professionals are often unaware of these, and therefore cannot inform patients about them.