SSRIs and Tinnitus: Can Antidepressants Affect Your Ears?

Tinnitus can be a debilitating condition for many who experience it. Therefore, it is not uncommon for those with tinnitus to often be prescribed medications to treat depression and/or anxiety. One class of commonly prescribed medications are called selective serotonin reuptake inhibitors, or SSRIs. In this blog we will explore the possible connection between tinnitus and SSRI use.

What Are Selective Serotonin Reuptake Inhibitors?

Although the term SSRI may be common to see when discussing antidepressant drugs or therapy, SSRI refers to selective serotonin reuptake inhibitors, or a class of drugs designed to increase the amount of serotonin within the brain, thereby treating depression. SSRIs are the most commonly prescribed type of antidepressant drug, and they have been used to treat depression–from moderate to severe–for decades. By increasing the levels of serotonin in the brain, selective serotonin reuptake inhibitors are able to ease many of the symptoms associated with depression, even in situations where Cognitive Behavioral Therapy (CBT) and other therapies are not found to be useful or successful.

Serotonin is a type of neurotransmitter that plays a key role in different bodily functions, including managing mood, sleep, digestion, and more. When serotonin levels are too low, there are physical and physiological health problems that can arise–including the rise of depression and anxiety symptoms. The links between gut health and mental health are increasingly well researched and understood, and because serotonin is largely moderated by the gut, SSRIs can be extremely useful interventions for patients suffering from ongoing symptoms of moderate or severe depression.

Because selective serotonin reuptake inhibitors are among the most commonly used interventions for people with depressive disorders, there are numerous options currently available on the market. the most common ones include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil, Pexeva)
• Sertraline (Zoloft)

While this is not an exhaustive list, it is a great place to start if you are looking into SSRIs and how they may be able to help your symptoms. Note, though, that this particular class of drug is not an OTC medication, and must be prescribed by a mental health professional or medical doctor.

What Is Tinnitus?

Tinnitus is a type of hearing disorder that affects the auditory pathway. In tinnitus, many patients experience a sensation of ringing or rushing, though others have described the sound occurring within tinnitus as a buzzing or static sound. In normal hearing, the ears and brain work together to both take in sound vibrations, and subsequently interpret those vibrations. In tinnitus, auditory pathways are no longer clear or well-functioning, which results in symptoms the American Tinnitus Association identifies as ringing or “buzzing, hissing, whistling, swooshing, and clicking“.

There are different types of tinnitus, and these different types can be caused by different things, including hearing loss, cardiovascular issues, and even exposure to loud noises. To determine the most likely cause of tinnitus onset, the physician treating the patient in question will take a thorough history, perform an exam, and rule out any other conditions that might explain tinnitus. From there, a patient can consult with an audiologist, or an ENT doctor to determine the health of the ear and overall auditory system.

Why Are SSRIs Commonly Used for Tinnitus?

Acute and chronic tinnitus patients do not merely experience intermittent or constant ringing in the ears; they also frequently experience feelings of anxiety and depression when symptoms first arise and as they continue. Selective serotonin reuptake inhibitors can help relieve some of the mental health symptoms that often accompany newly onset or chronic tinnitus symptoms or a tinnitus diagnosis.

Chronic tinnitus may even result in major depression for some patients–an unfortunate development that can actually make tinnitus worse, as tinnitus patients grow increasingly anxiety-ridden about their condition. In these cases, SSRIs can be immensely helpful in easing some of those feelings and possibly even soothing some tinnitus symptoms as a result.

Anxiety and stress are common comorbidities of tinnitus, creating something of a vicious cycle; when tinnitus begins, the auditory system, limbic system, and autonomic nervous systems all respond, which can lead to feelings of danger, uncertainty, and fear, and increase feelings of anxiety and depression. When anxiety and depression increase, the risks of worsening tinnitus can also increase. Although many people still see the body as a series of separate parts, chronic tinnitus, mental health, and the autonomic nervous system are all linked, and treating depression can have the added effect of targeting tinnitus, and treating tinnitus can also address depression and anxiety.

Can SSRIs Cause Or Increase Existing Tinnitus?

Limited research suggests that there may be a link between the onset of tinnitus or an exacerbation of tinnitus symptoms when SSRIs are utilized, but the research is limited, and it is not certain whether it is likely to see tinnitus occur following depression treatment with SSRIs like Zoloft. Some studies have determined that there are possible ototoxic effects of long-term SSRI use. Ototoxicity in medicine means that the delicate structures of the inner ear may be harmed, which can lead to both hearing loss and therefore, tinnitus. Although a large portion of patients have not reported tinnitus worsened with SSRI use, it is possible to see hearing loss and tinnitus occur while trying to treat depression or anxiety with selective serotonin reuptake inhibitors.

Knowing exactly what has made tinnitus occur can be difficult; after all hearing loss and associated issues can be rooted in numerous different causes, many of those causes diverse and unrelated to one another. While not everyone who utilizes SSRIs to treat anxiety or address depression will experience hearing loss, hearing damage, or chronic pain related to either, there are instances in which severe tinnitus can develop following the use of certain medications. SSRIs falling under this class is understandably difficult, as it is often used in conjunction with other forms of tinnitus treatment, to address some of the mental health aspects that can arise when tinnitus occurs.

I Have Tinnitus After Taking SSRIs, Now What?

If you suspect that tinnitus occurs following SSRI use, or that symptoms of tinnitus and hearing loss increase during SSRI treatment, talk to your doctor about possibly changing medication or dosages of your medication. There are different options for treating depression and anxiety, including tricyclic antidepressants, though these come with their own set of challenges and potential hazards. A physician can more thoroughly identify the best medication regimen for your unique needs, and all concerns should be promptly discussed with your doctor.

Tinnitus treatments are also available to those with chronic tinnitus and severe tinnitus, with or without hearing loss, infection or injury. We will go into greater detail about potential ways to treat tinnitus below.

Tinnitus Treatment Options

Treating tinnitus is a multi-pronged endeavor, just as the roots of tinnitus tend to have more than one root cause. Some of the more common methods to treat tinnitus include:

• Hearing aids. A hearing aid is typically associated with hearing loss, but can also be used to target the symptoms of tinnitus. A hearing aid is a useful intervention, because it not only amplifies sound; it also has the potential to provide sound therapy and other therapeutic interventions for tinnitus.
• Tinnitus Retraining Therapy (TRT). A combination of both sound therapy, and mental health interventions like cognitive behavioral therapy, TRT does precisely what its name suggests: it retrains tinnitus patients’ response to symptoms, and helps essentially treat anxiety and depression associated with tinnitus–or, at the very least, lessen its effects.
• Cognitive Behavioral Therapy (CBT). Cognitive behavioral therapy is a useful treatment to address hearing loss and tinnitus, because it helps treat anxiety while addressing many of the fears and concerns surrounding the onset of hearing disorders. Tinnitus occurs with a host of other conditions in many cases, so being able to treat anxiety and depression while targeting tinnitus can be immensely helpful for many patients.
• Sound therapy. While sound therapy does not treat anxiety and tinnitus exactly, it can be used to lessen some of the anxieties and discomforts associated with symptom onset and deliver a beneficial effect for patients with tinnitus. Sound therapy can help establish a background noise baseline that makes it more difficult to discern tinnitus ringing or buzzing, and research suggests that this is a useful means of lessening the discomfort and frustration of tinnitus onset.

Each of these interventions can be implemented and supervised by an audiologist, to make sure that the hearing aid and therapies in question are being utilized to the best of their ability. Many patients experience significant relief from symptoms when using a multi-pronged approach, and research suggests that addressing all avenues of potential treatment is the most likely to yield consistent results. Treating tinnitus can also have a hand in maintaining mood balance, as existing scientific literature suggests that patients reported both anxiety and depression alongside symptoms of tinnitus and hearing loss.

Whether tinnitus has developed as a result of damage to the hair cells within the inner ear, or symptoms are related to breaks in the auditory system and neurological function, people with tinnitus are far more likely to experience some mental health issues than the general population, and antidepressants, like SSRIs, and therapies are frequently employed to ease the distress associated with symptoms.