Zoloft And The Auditory System: Examining The Risk Of Tinnitus

Medications are typically viewed as a positive way of treating a variety of conditions. Unfortunately, some pain medications, anti-inflammatory drugs, and even blood pressure medications can have negative side effects, like being ototoxic, or potentially harmful to the ear. Zoloft is a commonly prescribed medication to treat depressive and anxiety symptoms. This article will review whether it is ototoxic and potentially harmful to the ear, leading to hearing loss or tinnitus.

What Is Zoloft?

Zoloft (Sertraline) is used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder). It is commonly prescribed for those struggling with one of several branches of mental health conditions, typically without severe side effects. 

Zoloft is known as a selective serotonin reuptake inhibitor (SSRI). It works by helping to restore the balance of a certain natural substance (serotonin) in the brain. Because serotonin is involved in auditory filtering of stimuli, some have posited that it is possible for ringing in the ears to develop after utilizing SSRIs, like Zoloft. In one case study, a woman began taking sertraline and developed tinnitus, but the tinnitus subsided completely once sertraline use was discontinued.

What Are Other Types Of SSRI Medications?

There are many other SSRI medications available on the market to target mental health issues, as well as other conditions that have been identified as potentially viable for SSRI treatment (including, but not limited to fibromyalgia and Irritable Bowel Syndrome [IBS]). The Food and Drug Administration (FDA) has approved the following SSRIs to treat depression:

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

Because each of these SSRIs involves serotonin, which impacts the function of an auditory receptor within the ear, SSRIs as a whole have the potential to interact with auditory processing as sound travels from the ears to the brain. There is some anecdotal evidence of individuals developing tinnitus following SSRI use, but long-term studies have not proven whether SSRIs are a potential cause of tinnitus or even ototoxic. Other risk factors, like middle ear issues, ongoing exposure to loud noises, etc. may make SSRI users more likely to experience tinnitus.

Is Zoloft Used To Treat Tinnitus?

Tinnitus onset can lead to all anxiety in many aspects of an individual’s life, so many turn to SSRIs to cope. Zoloft, and other antidepressants/selective serotonin reuptake inhibitors are frequently used to help alleviate the emotional side effects of chronic tinnitus. However, they are not intended to actually treat tinnitus itself or other conditions that can cause anxiety. Because they are not used to address subjective tinnitus loudness itself, they are not considered a tinnitus treatment option.

Although the research is still unclear, there is some current literature that does suggest that in rare instances SSRIs can result in the onset of tinnitus. So, it is important to speak to your doctor or audiologist to determine what the cause of your tinnitus may be, and what treatment options are available to you. 

When it comes to taking Zoloft or other potentially ototoxic drugs to manage one’s symptoms of tinnitus, it may be better to utilize a more robust approach that includes sound therapy and counseling in the form of Tinnitus Retraining Therapy (TRT) or Cognitive Behavioral Therapy (CBT), which have been proven to help with tinnitus symptoms and provide tinnitus relief from severe tinnitus suffering.

How Are Zoloft, Selective Serotonin Reuptake Inhibitors, And Tinnitus Related?

The complex interactions of medication on the way the brain processes auditory information are thought to cause tinnitus. Many medications interfere with or alter the way that auditory pathways interpret information and relay that information to the brain, and tinnitus is also believed to be caused by a misinterpretation of auditory signals. 

Lower doses of SSRIs may not cause as intense of auditory issues as higher doses of SSRIs, and there are cases in which tinnitus discontinued shortly after eliminating SSRI intake. This suggests that the effects on the auditory system can be reversed after the medication is stopped. Not all cases of hearing loss or tinnitus are resolved this way, but it is something to consider for those who started experiencing tinnitus after starting a new medication or changing the dosage.

SSRIs do not have to be avoided for those with tinnitus. If, for instance, someone is already on an SSRI, it is not necessary to stop taking the medication. Rather, explore other ways to treat tinnitus, like TRT or CBT.

What Does Ototoxic mean?

Ototoxicity refers to damage to the auditory system caused by a medication. This means that the structures of the auditory system–specifically the cochlear structures–are harmed, resulting in permanent inner ear damage. This inner ear damage can cause disruptions to the auditory information received by auditory cortex in the brain, thereby potentially leading to tinnitus. It can also result in symptoms of hearing loss or vestibular issues.

Ototoxicity can vary in terms of intensity and likelihood. Some people may be more predisposed to ototoxic reactions to medications, while others may not experience the same effect. For many medications, the degree of ototoxicity is expected to vary with the dosage of the medication (i.e., higher doses are likely to result in more cochlear damage). This is why it can be valuable to keep in contact with your health professional each time a new medication is introduced, to make sure that any new symptoms you experience are logged and evaluated.

Additionally, you will want to stay connected to your audiologist as you work with your prescribing physicians to manage these effects, as your audiologist is the healthcare provider most qualified to connect you to solutions addressing auditory problems such as hearing loss and tinnitus. Pain medications, certain types of chemotherapy drugs, some antibiotics, anti inflammatory drugs, and blood pressure medications have all been implicated as possible ototoxic medications.

Tinnitus Treatment Options

Tinnitus treatment often address the mental health issues that arise as a result of tinnitus. Some of the best ways to address tinnitus include:

• Tinnitus Retraining Therapy (TRT). In this form of therapy, patients are essentially “retrained” in their responses to tinnitus. Retraining can help limit anxiety and depressive responses, while also developing an ability to essentially “tune out” the sound of ringing in the ears through the use of sound therapy and counseling. Although a person’s tinnitus perception may not change significantly, usually people’s tinnitus annoyance levels significantly decrease. In addition, many people who have disabling tinnitus learn strategies that help them significantly using this approach.
• Cognitive Behavioral Therapy (CBT). Cognitive therapy is another useful intervention that focuses on the interaction between how we feel, think, and behave in response to a stressor. There are many studies in which treatment of tinnitus is accomplished successfully using CBT strategies. Many people with severe tinnitus benefit from this strategy because it teaches people how to employ coping strategies and problem solving skills during the moments when tinnitus can be most bothersome or intrusive.
• Sound Therapy. Sound therapy involves using external sounds to mask the sounds of tinnitus, or give the brain another source of auditory stimuli on which to focus. This sound can be delivered in a variety of ways, including through on-ear devices such as a hearing aid or tinnitus sound generator that provides consistent access to sound. It can also involve non-custom earbuds, headphones, or other speakers.
• Medication Changes. If an ototoxic drug has been identified as a likely cause of one’s tinnitus, as has been the case with some antidepressants, stopping use or changing to a different medication may be considered. If removing the drug altogether is not an option, some tinnitus patients may take a low dose, instead.
• Lifestyle Changes. Reducing exposure to loud noises, improving sleep, exercising, and living a healthy lifestyle cannot necessarily reverse tinnitus, but can support greater physical and mental health. Having fewer lifestyle stressors is viewed as a positive factor when someone has bothersome tinnitus. Stress reduction is commonly recommended because most people who experience stressors find that their perceived tinnitus loudness increases when under high levels of stress.
• Hearing Aids. Hearing aids are frequently recommended as an intervention for tinnitus, because they can help administer sound therapy and reduce the effort that a person is expending to compensate for their hearing loss. Additionally, 90% of those with tinnitus have some degree of hearing loss. Treating hearing loss in many cases can improve the overall perception of tinnitus.

The Verdict: Does Zoloft Cause Tinnitus?

While there is no research to directly prove that Zoloft causes tinnitus or worsens tinnitus, there is a great body of research to support that ototoxic medications can damage the inner ear structures, which can result in the perception of tinnitus. Some side effect lists of SSRIs include ringing in the ears, so it can be said that Zoloft may lead to tinnitus or hearing loss in some individuals.

Ultimately, tinnitus is a rare side effect of sertraline (Zoloft), meaning that those who take Zoloft are not at a particularly high risk for developing tinnitus as a result of taking the drug. In other words, there is not a consistent and direct connection between Zoloft and tinnitus. Zoloft should not be avoided outright for those with tinnitus, but it is a good idea for those taking Zoloft for depressive disorders or anxiety disorders to be aware of any changes to their hearing or to tinnitus. 

Managing Tinnitus With Treble Health

At Treble Health, we specialize in helping individuals navigate the complexities of tinnitus. We understand how tinnitus can impact your quality of life, and our team is here to provide the guidance and support you need.

Take the first step towards relief by scheduling a complimentary telehealth consultation with our experienced audiologists. In this 20-minute Zoom session, we will delve into your unique situation, providing answers to your questions and personalized strategies to manage and alleviate your tinnitus symptoms. We are committed to helping you regain control over your auditory world, guiding you towards a life of tranquility and well-being. Don’t wait; schedule your free consultation today and begin your journey to a quieter, more peaceful life.