Can sertraline cause ringing in the ears

Anxiety/stress are common comorbid factors to chronic tinnitus. Thus, it common to see patients with tinnitus on selective serotonin reuptake inhibitors (SSRIs). SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by limiting its reuptake into the presynaptic cell, thereby increasing the level of serotonin available to bind to the post-sympatic receptor. SSRIs are commonly used to treat depression, anxiety, panic disorders, obsessive-compulsive disorder, chronic pain, etc. Common examples are sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). Previous research has suggested limited improvement in tinnitus with SSRIs and that use of these drugs with tinnitus patients should be limited to the application of treatment of the co-morbid anxiety/depression and not for tinnitus directly. There are also reports of tinnitus onset or exacerbation with SSRI.

Recently, Tang et al (2017) have provided some further insight into the role of serotonin on tinnitus and some additional support to not using SSRIs for tinnitus management. Using mice, Tang and colleagues examined changes induced by serotonin in the dorsal cochlear nucleus (DCN), the portion of the cochlear nucleus with inhibitory characteristics. Aberrant serotonin signaling has previously been implicated with hyperactivity in the DCN related to tinnitus. Tang identified that serotonin does not simply or globally increase activity in the DCN, but rather the neurotransmitter appears to suppress signaling through the auditory pathway while enhancing transmission through a multisensory pathway. This activation may have positive biological implications, such as integration of multisensory input for response to salient environmental events or negative implications, such as tinnitus and help explain modulation of tinnitus with head movement and changes in jaw position.

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Reference

Tang and Trussell. (2017) Serotonergic Modulation of Sensory Representation in a Central Multisensory Circuit is Pathway Specific. Cell Report 20(8):1844-1854.

Antidepressants are a very important treatment option for people dealing with depression. Depression is also one of a number of mental health concerns linked to tinnitus. However, some researchers say some antidepressants can aggravate tinnitus issues.

What are the causes of tinnitus?

Tinnitus is a symptom, not a disease itself, and can have a number of causes. Tinnitus is most often caused by hearing loss, specifically damage to the inner ear. Hearing loss is often due to aging or loud noise exposure. Tinnitus can also be caused by thyroid problems, blood circulation problems, head or neck injuries, and some medications. There is no cure for tinnitus, although it can be treated.

In addition to being a physical issue, tinnitus has been linked to mental health concerns. An estimated two million people have tinnitus so severe they have reported depression, anxiety, anger, post-traumatic stress disorder, insomnia, and even thoughts of suicide.

While antidepressants help millions of people a year – 1 in 6 Americans take them or other psychiatric drugs – some researchers are now saying antidepressants could be a contributing factor to tinnitus.

Antidepressants work by balancing chemicals in your brain that affect your mood and emotions. Some antidepressants affect serotonin levels. Serotonin is a natural mood stabilizer, which helps reduce depression and regulates anxiety. It also has a number of physical effects, such as healing wounds and maintaining bone health.

However, some antidepressants elevate serotonin levels, and there are nerve cells in the brain that become hyperactive when exposed to these increased levels of serotonin. This can raise anxiety levels and can result in tinnitus.

That said, not all antidepressants may exacerbate tinnitus. If yours do, you should talk to your doctor about switching to a new medicine. It is very important you do not stop taking any antidepressant before first talking to your doctor, though.

It is also very important to know that, even though underlying emotional problems are common in tinnitus sufferers, antidepressants should not be used to treat tinnitus.

What are treatment options for tinnitus?

There are treatment options for tinnitus, however. Sound therapy, such as white noise or nature sound machines, has been beneficial in alleviating tinnitus by helping sufferers to avoid silence. Hearing aids can treat the hearing loss often associated with tinnitus. The audiologists at CEENTA also fit devices that use built-in sound generators to provide pleasant sound to the auditory cortex that disrupts the awareness of the tinnitus signal in the brain.

This blog is for informational purposes only. For specific medical questions, please consult your physician. If you have tinnitus and would like to make an appointment with an audiologist, call 704-295-3000. You can also schedule an appointment online or through myCEENTAchart.

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