Antidepressants and Tinnitus: What to Know

Antidepressants and tinnitus are linked in two opposite directions. A small number of people notice new or louder ringing after starting, changing or stopping an antidepressant, although for most of these medicines it is listed as an uncommon side effect. At the same time, depression, anxiety and poor sleep make tinnitus much harder to live with, and treating them can make the ringing feel less overwhelming, even if the sound itself stays.

Three ways antidepressants and ringing ears connect

It helps to sort out which situation you are in, because each one leads to a different conversation with your doctor.

1. A possible side effect. Ringing appears or gets louder within days or weeks of starting a new antidepressant or raising the dose.
2. A stopping (discontinuation) effect. Ringing shows up along with dizziness, "brain zaps," trouble sleeping or flu-like feelings after a dose was missed, lowered or stopped.
3. A mood and coping effect. Tinnitus came first, and depression, anxiety or sleep loss followed. Here, treating the mood problem may be one of the most useful things you can do.

Ringing as a side effect

Tinnitus has been reported with many types of antidepressants. For most, it is described as uncommon or rare in drug information. Because tinnitus is so common in everyone, some of these reports will be coincidence, and it is hard to know from reports alone how often the medicine is truly the cause.

Why might an antidepressant affect ringing in some people? The brain chemicals these drugs act on, such as serotonin and norepinephrine, are also involved in how the brain processes sound and how alert you feel. Some antidepressants can also cause side effects that influence tinnitus indirectly, such as:

• Restlessness or jitteriness in the first weeks
• Changes in sleep, either drowsiness or insomnia
• Teeth clenching or grinding, which can affect somatic tinnitus
• Higher blood pressure with some medicines, especially at higher doses
• Dry mouth and dizziness with some older medicines

Early side effects often ease after the first few weeks as your body adjusts. That is one reason prescribers usually suggest giving a new medicine time, unless a side effect is severe.

Timing is the most useful clue. Ringing that began years before the medicine, or right after a loud event, a cold or an ear infection, is less likely to be a side effect. Ringing that started within days of a new prescription or a dose increase, or that rises and falls with your dose schedule, is worth raising with your prescriber sooner.

Ringing when stopping or lowering a dose

When an antidepressant is stopped suddenly or lowered too fast, some people develop discontinuation symptoms. These can include dizziness, a feeling of electric shocks in the head ("brain zaps"), nausea, irritability, vivid dreams, trouble sleeping and, in some reports, ringing or other odd sounds. These symptoms are more likely with medicines that leave the body quickly.

Federal health information is clear that you need time to come off these medicines safely and that your provider can tell you the safest way to do it. If you are thinking about stopping, or you have run out, contact your prescriber or pharmacist rather than stopping on your own.

Common antidepressant groups at a glance

This table is general information, not a ranking. Your prescriber chooses a medicine based on your symptoms, other conditions, other medicines and past experience, and the right choice for you may be very different from someone else's.

When tinnitus affects your mood

For many people, the hardest part of tinnitus is not the sound itself but how it makes them feel: worried, trapped, short-tempered, unable to rest. Depression and anxiety are common among people with bothersome tinnitus, and they feed each other. Poor sleep makes the ringing seem louder, the ringing makes sleep harder, and the cycle goes on.

Signs that tinnitus is affecting your mental health include:

• Feeling down, hopeless or numb most days for two weeks or more
• Losing interest in things you used to enjoy
• Avoiding quiet places, people or activities because of the ringing
• Constant worry about the sound getting worse
• Trouble falling or staying asleep most nights

If this sounds like you, tell your doctor. Treating depression or anxiety, with therapy, medicine or both, is worthwhile on its own and can make tinnitus easier to cope with.

Support that does not depend on medicine

Whether or not you take an antidepressant, several approaches can lower the distress tinnitus causes:

• Tinnitus-focused CBT. A therapist helps you change the thoughts and reactions that make the ringing feel threatening. Some programs are offered online or by phone.
• Sound enrichment. A fan, soft music or a sound machine keeps the room from being silent, which makes the ringing less prominent.
• Hearing care. If you have hearing loss, hearing aids can bring back outside sounds and make the ringing less noticeable for many people.
• Regular movement and daylight. Walking and time outdoors support mood and sleep.
• Connection. Talking with friends, family or a tinnitus support group can make you feel less alone with it.

These can be combined with medicine for depression or anxiety. They are not a reason to stop a prescription without your prescriber's guidance.

What the research says

• Antidepressants are not a routine tinnitus treatment. The main US clinical practice guideline on tinnitus, published in 2014, advises doctors not to routinely prescribe antidepressants with the goal of easing persistent tinnitus itself. The guideline notes that individual situations differ.
• Treating mood still matters. When depression or anxiety is present, it deserves care in its own right. Some small studies suggest people with tinnitus and depression feel less bothered when their mood improves, but results are mixed.
• Cognitive behavioral therapy (CBT) has good support. The same guideline recommends CBT for persistent, bothersome tinnitus. CBT does not change the sound, but it helps many people feel less distressed and sleep better.
• Side-effect data are limited. Most information about antidepressants causing tinnitus comes from side-effect reports, which cannot prove cause, rather than from studies designed to answer the question.

Talking to your prescriber

Never stop, skip or change an antidepressant on your own. Instead, bring clear information to your prescriber. Helpful questions include:

• Could my ringing be related to this medicine, a recent dose change or a missed dose?
• Is this likely to settle with time, or should we consider a change?
• If a change is needed, how do we taper safely?
• Do any of my other medicines or supplements affect the ears or interact with this one?
• Can you refer me for CBT or to an audiologist who works with tinnitus?

Your next steps

1. Write a timeline: when the ringing started, when you began the medicine, and every dose change or missed dose.
2. Score your ringing and mood daily for two weeks, from 0 to 10 each, and bring the notes to your appointment.
3. Keep taking your medicine as prescribed while you wait to talk with your prescriber, and use a pill organizer or phone reminder to avoid missed doses.
4. Ask about tinnitus-focused CBT and a hearing test, which can help no matter what is causing the ringing.
5. Use gentle background sound at night, like a fan or soft music, to make the quiet less harsh while you sleep. Keep it softer than your tinnitus so it blends in rather than drowning it out.
6. Tell someone you trust how the ringing and your mood are affecting you, so you are not carrying it alone while you sort things out with your care team.