Many people who take antidepressants notice ringing in their ears or “tinnitus.” This tinnitus is usually temporary, and can be a result of changes in levels of neurotransmitters such as serotonin. In other cases, the tinnitus may emerge as a result of an ototoxic reaction that a person has to a specific antidepressant. Ototoxicity is a medical term used to characterize inner ear damage resulting from pharmacological treatments.
Ototoxic reactions are typically rare and only occur in a minority of individuals treated with antidepressants. They may occur after long-term treatment or as the result of an interaction with another medication. In any event, if you are experiencing ringing in your ear and believe that it may be a result of your antidepressant medication, it is best to seek immediate medical attention – preferably from an ENT specialist.
Additionally, it should be noted that in some cases antidepressants can cause hypersensitivity to sounds and make people more likely to notice preexisting tinnitus. It is usually difficult to pinpoint antidepressants as a specific cause of tinnitus, but if you suspect that your ears began to ring after treatment with a certain antidepressant medication, it’s always best to trust your intuition and seek help.
Can antidepressants cause tinnitus (ringing in the ears)?
Yes, they can. Not everyone will experience tinnitus or ringing in the ears while on antidepressants. In fact, only a small minority of individuals will end up with this problem. Some estimate that only approximately 1-2% of all patients treated with SSRI antidepressants could develop tinnitus as a result of treatment – others speculate that the probability is even lower. Despite the fact that antidepressant-induced tinnitus is seldom reported, this should not discount any cases in which this is the case.
Factors that influence antidepressants causing tinnitus:
It should be speculated that various factors can determine whether someone develops tinnitus as a result of antidepressant therapy. These include things like: the drug someone took, their dosage, and the individual. It should be noted that 100 people may take high dosages of the same drug and of this group maybe only 2 will develop tinnitus.
1. Individual Variation
The biggest determining factor of whether someone develops tinnitus resulting from an antidepressant medication is that of individual variation. Many people turn to antidepressants to alleviate their depression and other forms of mood disorders. However, of these individuals that use antidepressants, only a small minority will go on to develop ringing in the ears. Genetic factors and individual reaction to the medication is thought to influence whether a person will experience tinnitus.
2. The drug
Certain drugs may be more likely to cause tinnitus than others. In particular, many people have reported cases of SSRI induced tinnitus. This could be a result of SSRIs being the most widely prescribed class of antidepressants throughout the United States. There isn’t really any telling whether older drugs like MAOIs, tricyclic, and atypical antidepressants could pose equal threat to that of SSRIs and SNRIs in regards to causing tinnitus.
In most cases, the greater the dosage of the drug you are taking, the greater the ototoxic risk and/or potential for tinnitus. At lower doses, the drug is having less of an effect on your overall physiology and poses less of a risk for adverse reactions. At significantly high doses, you may be disturbing natural processes within your physiology, and the chemicals introduced into your system may result in tinnitus.
There’s no telling whether another drug you may be taking could interact with an antidepressant and cause ringing in the ears. Although usually one medication is the culprit for this condition, there’s no telling whether multiple medications may interact to contribute to causing a person’s ears to ring and/or ototoxicity.
5. Time Span
In cases of antidepressant-induced tinnitus, there tends to be individuals that experienced it after a short-term treatment, and those who developed ringing in the ears over a long-term. In both cases, the condition should be regarded as serious.
- Short-term: Some people notice their ears start to ring after just a few days or weeks after taking an antidepressant. In these cases, it is best to talk to your doctor about discontinuing and/or switching to another medication. Ringing in the ears may signify an adverse ototoxic reaction.
- Long-term: Long-term treatment with an antidepressant medication tends to result in dosage increases and a greater likelihood that the drug is having more of an impact on your body’s natural processes. If you noticed that tinnitus developed over a long-term, it could be related to increases in dosage. When you take any drug for a long-term, you are running increased risk of unwanted effects.
It is documented that during benzodiazepine withdrawal people experience tinnitus. During antidepressant withdrawal, many people report hyperacusis or hypersensitivity of visual and auditory processes. Loud noises may become amplified, vision may become temporarily blurry, and people may notice ringing in their ears. In cases of withdrawal, the tinnitus may be related to significant drops in serotonin levels upon discontinuation. Additionally during withdrawal, it may be easier to notice a preexisting “ringing” in cases which tinnitus was already present.
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357564/
How antidepressants may cause tinnitus…
Below are a few ways in which antidepressants are thought to cause tinnitus. Some speculate that the antidepressants may make people more relaxed and less sensitive to the effects of loud noise, thus resulting in unprotected exposure to elevated decibel levels. Others believe that certain dosages of the drugs could have ototoxic effects, while others hypothesize that changes in neurotransmitter levels (e.g. serotonin) may result in temporary ringing in the ears.
- Desensitization to loud sounds: Antidepressants may make some individuals more relaxed and reduce their level of arousal. As a result of lower arousal, a person may not be as sensitive to loud music or sounds as they should be. This may result in them listening to music at abnormally high decibel levels through headphones, in their car, and/or around the house. Additionally, people may not take as many precautions as they should at concerts and loud sporting events – leading to increased susceptibility of noise-induced hearing loss.
- Ototoxicity: Pharmacological drugs can cause hearing loss as a result of damage to the inner ear. Although antidepressants are not classified as “ototoxic,” it doesn’t mean that they can’t have ototoxic effects in some people. This is why certain individuals end up with hearing issues and/or ringing in the ears long after discontinuing antidepressant medications.
- Neurotransmitter changes: Antidepressants change neurotransmitter levels, particularly that of serotonin. There’s no telling how a specific person will react to a particular antidepressant until they take it. Since everyone has different responses to antidepressant drugs based on their genetics and physiology, the neurotransmitter changes that a drug makes may lead to temporary tinnitus.
Antidepressants likely to cause tinnitus
Some would speculate that older antidepressants such as MAOIs and tricyclic antidepressants would be more likely to cause tinnitus than newer SSRIs and SNRIs. However, based on reports of vertigo, a symptom closely related to changes in hearing and tinnitus, older drugs are less likely to cause vertigo. This may suggest that older medications are actually less likely to cause tinnitus, despite carrying more overall side effects than newer medications.
With that said, it should be noted that reports of tinnitus from older antidepressants are less likely these days simply because they are seldom prescribed. Most doctors will use other classes of medications for depression instead of prescribing an MAOI or tricyclic drug. It is believed that since more people are taking newer medications, there is a greater chance that tinnitus will be reported by those who are on an SSRI or SNRI.
This isn’t to say that older medications cannot cause ringing in the ears, because they likely can. However, since ringing in the ears is only reported by 1-2% of patients that take antidepressants, and very few people are still taking MAOIs or tricyclic medications, tinnitus is seldom reported with older drugs.
- SSRIs / SNRIs: Many people have reported cases of SSRI-induced tinnitus – there are threads across the internet dedicated to this particular topic. Even tinnitus as a result of SSRI and SNRI usage is pretty rare. Those who develop ringing in the ears after taking a selective-serotonin reuptake inhibitor are in the minority.
- Atypical antidepressants: Some atypical antidepressants like Viibryd are considered newer, while others like Remeron are older. Each of these drugs tends to have unique properties, so it cannot be generalized that all atypical antidepressants cause tinnitus.
- Tricyclic antidepressants: These drugs are essentially precursors to SSRIs. They tend to affect the reuptake of serotonin and in some cases norepinephrine. These are no more or less likely than other classes to cause tinnitus.
- MAOIs: The Monoamine Oxidase Inhibitors are an old class of medications that tend to react with foods containing tyramine. Since people can have potentially fatal reactions to eating tyramine-containing foods, these drugs are seldom prescribed. These drugs are no more likely than any other class to cause ringing in the ears.
It would be interesting for someone to conduct a study and determine which class of antidepressant medications and/or psychotropic medications are most likely to cause tinnitus. It would also be interesting to determine whether the tinnitus is permanent and caused by ototoxicity or whether it is temporary and caused by changes in neurotransmission. Many would be interesting in also getting more specific and doing a direct comparison of drugs within classes such as the likelihood of Paxil to cause tinnitus vs. Lexapro. It may also be beneficial to understand whether there is a correlation between drug dosage and tinnitus and/or whether length of time taking a medication can influence development of tinnitus.
The Irony: Antidepressants are used to treat tinnitus
If you review the profile for a number of antidepressant medications, many are used off-label for treating tinnitus and/or the anxiety that tends to accompany it. Upon closer examination, you may see that the medication being prescribed for tinnitus, can actually cause tinnitus in an unknown percentage of users. Typically the amount of people who benefit from an antidepressant to help cope with tinnitus significantly outweighs the number of individuals who experience antidepressant-induced tinnitus.
Most doctors are not aware of the fact that these medications can and do cause tinnitus in certain individuals. Whether this tinnitus is a cause for concern in every individual is debatable. Some people may experience the tinnitus as a result of neurochemical changes from the antidepressant treatment. Others may experience tinnitus as a result of ototoxicity from taking a certain antidepressant medication at a high dose for an extended period of time.
It is nearly impossible to pinpoint the number of cases of tinnitus resulting from antidepressant usage. Additionally, it should be speculated that many people may begin experiencing tinnitus and not even think that their antidepressant medication may have contributed to its development. Therefore it can be assumed that a significant number of cases of antidepressant-induced tinnitus may go unreported.
The problem: The antidepressant may not always help people with tinnitus or ringing in the ears and if it does work, it may not work forever. Additionally, many people are unable to tolerate antidepressant side effects such as sexual dysfunction and weight gain from these medications. In many cases, other anti anxiety medications may be a better fit for those with tinnitus.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/22972065
How antidepressants treat tinnitus
There are a couple of ways that antidepressants can actually treat tinnitus. The first being desensitization by raising serotonin levels. Many people become desensitized to various types of anxiety when their serotonin levels increase. This results in less preoccupation and dwelling on ringing in the ears.
- Desensitization: The increase in serotonin resulting from various antidepressants is thought to improve tinnitus. People can become hypersensitive to the ringing in the ears and/or panic when they first notice it. This increases a person’s arousal and can cause them to become highly sensitized to the noise. Every time there is silence and the ringing becomes noticeable, it may trigger further panic. Antidepressants help by desensitizing a person to the sound that they are hearing.
- Reduces anxiety: The biggest benefit of taking antidepressants is that they reduce a person’s anxiety. Someone with tinnitus may fear that they are losing their hearing completely and the tone may drive them crazy. A person may feel anxious or trapped because there is currently no good treatment or cure for this condition. Antidepressants help reduce a person’s anxiety and panic that many people experience with tinnitus. This allows people to function without constantly thinking about and/or dreading the ringing.
- Serotonin: The neurotransmitter serotonin has been specifically linked to ringing in the ears. Although increasing it won’t help every case of tinnitus, for many people, it does help fade or drown out the sound. Differences in serotonin blood levels have been observed between those with tinnitus and those without it.
What to do if antidepressants caused tinnitus (ringing in the ears)?
If you notice that your ears start to ring after taking an antidepressant medication, do some self-analysis and make sure that the ringing isn’t caused by wax and wasn’t caused by exposure to loud noise. Assuming that you are sure the antidepressant drug is the cause of your tinnitus, the first thing you should do is book an appointment with an ENT specialist.
1. Book an appointment with an ENT specialist: An ENT (Ear, Nose, Throat) specialist will be able to conduct a hearing test, check for blockages in the ear canal (such as wax), and rule out other causes for your ear ringing. Additionally, it is important to discuss the potential that your antidepressant could have caused an ototoxic reaction. If you suspect ototoxicity from your medication, it may be recommended to immediately discontinue treatment.
2. Take your hearing very serious: If you experience tinnitus, it should be taken serious as this may be a sign of a larger issue such as hearing loss. If you ignore the ringing in the ears and don’t do anything about it, it may become permanent. Unfortunately most people are not aware that any hearing concerns and/or tinnitus must be taken seriously.
3. Consider all possible medications: In addition to the antidepressant that you are taking, are you on any other drugs? Could the ringing in your ears have been caused by another drug and/or an interaction between medications? Assuming you are only on an antidepressant and no other medications, you can rule out other causes. If you are on other medications though, these may be equally (or more) liable for causing tinnitus.
4. Consider withdrawal: If you are sure that your antidepressant is the cause of your ear ringing, you should probably withdraw from it. If it is having an ototoxic effect on your ears, it’s best to discontinue as soon as possible to avoid further damage. It is never recommended to suddenly discontinue antidepressant treatment, but if it is causing any sort of hearing issues, this may be your best bet.
5. Take vitamins: You may want to consider taking vitamins to help with any tinnitus. Some people take multivitamins and specific vitamin formulas. There is some evidence that the combination of Vitamins A, C, and E plus magnesium can help protect hearing – but more research is necessary. You may want to conduct some research and determine whether supplementation of various vitamins may help with your tinnitus.
6. Realize that the tinnitus may subside: In some cases, antidepressant-induced tinnitus can be permanent or long-lasting. For other individuals, this condition will last several days, weeks, or months before it finally clears up. The inner ear and neurotransmitter levels may take awhile before they regain proper functioning and the ringing subsides. In the meantime, do your best to hope that your hearing stays protected.
7. Consider other causes of tinnitus
Before assuming that your ear-ringing was caused by an antidepressant, it is important to consider some other possibilities. There are plenty of other causes for tinnitus besides a medication – these causes should always be considered.
- Noise-induced hearing loss: In people that have lost their hearing from loud-noise exposure (such as attending too many rock concerts or operating loud machinery without hearing protection), tinnitus is common. If you listen to music at high levels without protection, your hearing will deteriorate over time. Hearing loss is often accompanied by ringing in the ears.
- Ear wax buildup: If you have considerable build-up of earwax, it may impair your ability to properly hear. When the ear canal is clogged with wax, it prevents accurate sound perception and may contribute to ringing in the ears.
- Viral infection: If you had some sort of viral infection, it can cause temporary tinnitus and/or permanent changes in hearing. In most cases, viruses may temporarily change our ability to perceive sounds, but as our body fights off the virus, the ringing subsides.
- Allergies: Do you currently have bad allergies such as a runny nose or congestion? If you have bad allergies, temporary changes in sinus pressure, and fluid shifts between the inner ear and sinuses may contribute to temporary tinnitus.
- Neurological damage: People with neurological damage such as that from multiple sclerosis can develop tinnitus. If you have any form of neurological damage, it is important to consider that as a cause of the ringing in your ears.
- Oxidative stress: Free radicals can essentially cause damage to your ear and lead you to experience tinnitus. If your body is not producing an adequate antioxidative response to free radicals, oxidative stress can lead to tinnitus.
- Emotional stress: There have been reports of emotional stress causing tinnitus. Usually emotional stress can make us hyperaroused or hypersensitive to noises and more likely to tune into preexisting cases of tinnitus. Emotional stress is known to cause changes in neurotransmission and brain activity – leading to ringing in the ears.
8. Corticosteroid treatment: If you suspect that your medication was ototoxic, a doctor may suggest temporary corticosteroid treatment in attempt to help heal the inner ear. This treatment may be highly uncomfortable, but is thought to protect and help repair some damage that a medication may have caused to your ears.
Final thoughts on antidepressants causing tinnitus…
For most people, antidepressants are not associated with any major tinnitus or ringing in the ears. However, just because they don’t cause tinnitus in some people does not mean that they can’t in others. Although it is rare for an antidepressant medication to cause tinnitus, it should not be dismissed or ignored as a possible culprit for this condition in certain individuals.
Antidepressants are not regarded by the medical community as being universally ototoxic, but some speculate that they may have ototoxic reactions in certain individuals. Factors for influencing potential ototoxic reactions include: the drug, your dosage, duration for which you took it, and other individual factor such as whether you are on other medications. Some hypothesize that taking high dosages for extended periods of time (i.e. years) may result in ototoxicity – which could cause tinnitus.
It is estimated that only 1-2% of individuals taking antidepressants will experience tinnitus as a side effect. If this is experienced, it may be recommended to discontinue the drug as this could signify ototoxicity and lead to hearing loss. If you begin experiencing tinnitus while using an antidepressant, immediately contact a professional and express concern for your hearing and well-being.
Have you experienced ringing in your ears following usage of an antidepressant? Did your ringing eventually subside or has it been an ongoing problem? Do you really think it was caused by the medication that you took? If so, feel free to share your experience in the comments section below – it may help someone else who is dealing with a similar situation.