Medications, Pills, Tinnitus Cure, SSRI, Benzodiazepines & Drugs For Tinnitus

Medications, Pills, Tinnitus Cure, SSRI, Benzodiazepines & Drugs For Tinnitus

Ben Thompson, AuD.

Hey everyone, my name is Dr. Ben Thompson. Today we have a special podcast episode with a medical doctor. What a treat, what an honor. Thank you, Dr. Jamie, for joining us, please introduce yourself.

Jamie, MD.

Hi, my name is Jamie. I am a family doctor living and working in Northern California. I’ve been in practice for almost 20 years and currently I provide full spectrum outpatient family medicine to children and adults.

Ben Thompson, AuD.

Thank you so much. And thank you for joining and volunteering your time to help us understand the difference between different anti-anxiety medications, SSRI, and benzodiazepines, as well as different herbal supplements, magnesium, turmeric, all-in-one solutions, and how that impacts someone who may be dealing with tinnitus, either acute or chronic tinnitus. I’m going to pass it to you Dr. Jamie, how do you typically counsel patients about the difference between different anxiety medications, and how does that relate to someone who has ringing in the ears?

Dr. Ben Thompson and Dr. Jamie talk about the difference between different anti-anxiety medications, SSRI, and benzodiazepines.

Jamie, MD.

Great, thank you. So since I’ve learned from you Dr. Ben, about tinnitus and really come to realize that the management of tinnitus is really about retraining our brain and our brain’s reaction. It actually has a really interesting parallel with how we think about mild anxiety and depression for a lot of people. So with the caveat that I’m a family doctor, I’m not a psychiatrist, or a neurologist, or an ear nose and throat doctor, and I’m going to be speaking really generally, and obviously would recommend that anyone speaks specifically to their own providers about their specific situation. But benzodiazepines, such as Ativan, lorazepam, Valium, clonazepam are in my opinion, honestly, really problematic medicines in America. They are sedatives that can be very effective in situations of acute anxiety or trauma because they really just sedate people and shut down their thoughts and their processing. And there are certain situations in which that can be incredibly helpful, but in my practice, I can’t really think of a situation or I can think of only very few situations where the risks of long-term benzodiazepines outweigh the benefits. And that is because benzodiazepines have qualities of dependence and tolerance, which means that over time, people need more of them to get the same effect. And also that people become physically dependent where their body depends on them to continue functioning. And because of that, they have a really narrow window of where they are helpful. They are also had very significant additive effects of sedation and respiratory depression in combination with opiates and alcohol. And so in America, they are implicated in a significant proportion of overdose deaths. So all of that being said, if we circle back to tinnitus where once we’ve evaluated for potentially underlying physical causes, most people are really going to be working to take advantage of their brain’s own innate power to kind of ignore some things and focus on other things. We really don’t want to do anything that’s going to hamper our brain’s ability to do that, and taking that to the next level, certainly people who have tinnitus may have underlying anxiety or depression, or maybe really anxious and depressed, because it’s pretty horrible to have tinnitus, especially when you first got it and are struggling with trying to find the balance of managing it. And so.

Ben Thompson, AuD.

Would you be able to share your own story with this? A little bit?

Jamie, MD.

Sure, yeah. So I actually met Ben because probably about six months to a year ago, I became aware that I had developed tinnitus and it kind of crept up on me slowly until at some point I realized that there was just this incredibly loud screaming noise in my ears. So feel really, actually… In addition to having talked about this, probably not as sensitively as I should, for the last 20 years, now having my own personal experience, I do feel really actually kind of comfortable and confident to share, to feel just a little bit more comfortable saying like, yes, this is really awful. I wish there was something we could do to turn it off. And the best advice that I have taken myself personally and also get professionally is to just really work on the, kind of… I guess what I would call kind of brain retraining type of skills that Ben talks about on his podcasts. 

And so for me, that was really a lot of, making sure that I was eating well, exercising, using kind of meditation and distraction techniques till I was really… I would say I’m at a point now where my tinnitus is still there, and a lot of the times I can just ignore it. And when I notice it, I can redirect myself again. And that actually really is an effective strategy to manage it ’cause while it’s still there, it doesn’t bother me nearly as much. 

So circling back to SSRI, SSRIs are a category of medicines that basically increase the amount of a neurotransmitter called serotonin in the synopsis in your brain. And that has a connection with anxiety and depression and has become… Those medicines have become kind of the safest, most effective medicines that we have to help people manage anxiety and depression. And my very, I would say kind of pragmatic explanation about that, is that what all of these conditions have in common is that our sympathetic nervous system has gotten kind of over-activated. And so whatever is happening in our lives, in this case, tinnitus, our sympathetic nervous system is screaming, alert, alert, danger, danger, danger, and that’s what that reaction is. And our job is to remind our brain that we’re not in danger, which then allows us to be able to put the tinnitus back in its place where we’re not having that huge emotional reaction to it. And that I think is the value of SSRIs that they’re really important and generally safe and well tolerated tool that I would say dial down that sympathetic nervous reaction for a lot of people, and then allow them to practice all the skills that they need to do. 

So the example I often give people is that your brain doesn’t know if your rent is late, or you’re having tinnitus, or you’re worried about a global pandemic, or if you’re being chased by a saber tooth tiger, the reaction is exactly the same. And sometimes in that state, people cannot eat well, meditate, talk to a therapist enough to dial that down. And what the medicines do, is help dial down that reaction so that your body is then I think in a more receptive place to be able to learn all of those skills and strategies. Benzo, oh I’m sorry, SSRIs do not have the qualities of dependence and tolerance. And they do not alter a brain in the way I think that gets away… They do not alter our brain in a way that negatively affects developing those skills that I talked about, the way that I think benzodiazepines do. Sometimes you’ll hear people talk about pills not skills, meaning we want to teach people skills, not just give them pills. And that really refers to benzodiazepines. I think that SSRIs are really pills that help us develop those skills. And some people take them for a short time and some people take them for an extended period of time.

Ben Thompson, AuD.

And how about the common names of the SSRI? What are they?

Jamie, MD.

So common SSRIs are things like sertraline or Zoloft, fluoxetine or Prozac, escitalopram or Lexapro, citalopram or Celexa. Those medicines have some pretty common side effects. Some people gain weight, some people have sexual dysfunction, some people have specific reactions to them, dizziness, sedation, fatigue, but a lot of times with appropriate counseling from your practitioner and understanding of what to expect most people in my experience tolerate them really, really well and find them to be incredibly helpful if they give them a try.

Ben Thompson, AuD.

Thank you, Dr. Jamie, that’s very helpful. And how about for sleep? Because what we’ve learned through working with patients, our focus groups for tinnitus and creating our services and offerings is that there’s this urgent care phase of tinnitus when for some people it can become so intense, develop insomnia, anxiety, stress, loss of appetite, weight loss, typically within the first few weeks up to two or three months. We see that some of our patients are prescribed benzodiazepines to help regulate sleep as well as other sleep medications. So how does that all come together in your eyes?

Jamie, MD.

So again, I think that it’s always really important to think about acute things and chronic things. And there are times where people just really need to sleep. Because the loss of sleep in itself is messing up their ability to process things. And again, benzodiazepines are honestly never my favorite, there’s other medications, particularly there’s a medication called Trazodone that we feel is safer and can be effective in the short term. But yes, in the short term, sometimes people just do need support to reset their sleep cycle, and it may be that they need something. And the important thing I think is to recognize that there is no evidence that long-term use of medicines helps chronic insomnia. Really the evidence supports that chronic insomnia is best treated by cognitive behavioral strategies geared toward insomnia, it’s called CBT insomnia. So that doesn’t mean that in the short term, a medication might not be helpful while you are again, practicing those skills and learning. And honestly, I wish like chronic insomnia is a really challenging, problematic things. For which I wish we had an easier solution. 

So again, I think, if people can understand what short-term means, be really safe with their use of medicines and have a clear plan for what they’re going to do to get off those medicines. Then I think that may be the best option when people really need that.

Ben Thompson, AuD.

I’m finding this incredibly insightful and helpful. And for anyone who’s listening to this recording on YouTube, please write in the comments right now, helpful, if this is helpful to you, please write helpful in the comments because I’m learning so much. And I don’t often get to have these conversations with medical doctors, with physicians. 

Here’s a question that patients ask me, “Dr. Ben, I’m taking” what they ask our providers as well. “Dr. Ben I’m taking benzodiazepines for tinnitus, or I’m taking certain medications for tinnitus and I don’t want to be on it long-term, but I need to develop better sleeping patterns. At what point can I start tapering off of it?” I know this is individual and there’s many factors that go into this, but what are some guidelines for how much time of getting good sleep on a medication would be enough generally to say, okay, now that you’ve developed this consistency, we can consider tapering off.

Jamie, MD.

That’s a really good question. I don’t know that I have a great answer. I think that somewhere in the two to four week mark, seems reasonable for someone to be working and developing other skills. I mean, there’s just a lot of fear and anxiety about insomnia that is probably worth exploring a little bit other than… There’s just a lot of like I can’t sleep and that immediately starts this huge reaction. So doing a little bit of like, what’s the worst thing can happen? Do I need to change my schedule a little bit? Can I really commit to a good sleep hygiene program? 

There’s an amazing book called “Why We Sleep” by Dr. Matthew Walker. And there are a lot of things that people can do that really help their sleep. It’s a little overwhelming if you really commit to it, but people have to really recognize that there are a lot of strategies. They’re just going to have to do them. Which I think can be hard. And the longer you’ve been on benzodiazepines, the slower and more carefully, you need to taper off them. And that’s something that people really need to do with a trained professionals supporting them, ’cause it can be very dangerous to stop taking those medicines suddenly. 

I think sometimes one of the most important things is just to tell your doctor, I do want to go off of these. Let’s make a plan. And acknowledge that you’re ready to do the work and maybe have a little bit of discomfort while you’re making that transition.

Ben Thompson, AuD.

Absolutely.

Jamie, MD.

And then I also really encourage people. There’s a website called sleep well, there’s some very specific training and people who provide cognitive behavioral therapy for insomnia, which is really great evidence-based, nonpharmacologic strategies to support good sleep.

Ben Thompson, AuD.

That’s excellent. I’ll be learning that and educating our team of providers on that invaluable, thank you. Now, when those transition into herbal supplements, and in your opinion, how this relates to someone’s overall health, who’s going through a period of either acute or chronic tinnitus. So some common herbal supplements that may have some merit scientifically for other conditions. And I would love to hear your opinion on this magnesium, turmeric, and then all-in-one tinnitus solutions, where different companies are selling unregulated pill bottles full of natural vitamins, natural foods, putting them into a small pill and calling them pills for tinnitus. What’s your opinion on all that?

Jamie, MD.

Okay, so number one, I don’t have any specific training in naturopathic, complementary medicine, holistic medicine, or vitamins. But so much of what I’ve learned has been from my patients who are taking things and then me researching them. 

I would say overall in general, whether we’re talking about over the counter cough and cold medicine, or vitamins, I tend to recommend people focus on single ingredients rather than combinations ’cause when you get combinations, you don’t really know what’s in it and often you get suboptimal doses of lots of things. And then you also are not going to know which of those things is the thing that benefits you. So that generally is my bias. 

In terms of overall health, most people who have resources financially and otherwise to eat a well balanced diet. I am not generally someone that recommends a multivitamin. I much prefer that people get their nutrients from food. And so I actually am a big fan of magnesium. I think it’s a wonderful mineral that unless you are on medications or have a condition that your doctor says you shouldn’t take it, is generally something I think that is well tolerated and has a whole host of benefits. So magnesium is actually really helpful for people who are constipated. It can be really helpful for people who are anxious and have trouble sleeping. It can be incredibly helpful for people who have general muscle pain and especially leg cramps. And that type of nighttime Charley horse, leg cramps. And so I do recommend magnesium in that context. 

Magnesium comes bound with different things and those things seem to, in my experience, regulate a lot of the gastrointestinal side effects. So magnesium citrate is a laxative which may be helpful for you and chelated magnesium, or magnesium glycinate, I think it seems to be the… Have the least side effects. 

Our understanding of tinnitus, I think to date, is that it’s not like there is a specific mineral, or vitamin, or enzyme, or chemical, that needs to replete to make it better