19 replies to this topic

[Ramona80]

Fishinghat, you said that people on here had reported ear symptoms (tinnitus, pain, etc.) beginning 2-5 months after getting off of Cymbalta? Is this common for these effects to come in so far after quitting? Is there any reason known as to why they can take that long to show up?

[fishinghat]

In the case of many types of withdrawal there can be delayed effects after the fact. It is believed, especially in the case of psych meds, that it takes the nerves around 2 years to readjust/heal to being off the medication. Many studies of been done on benzos and they show this kind of pattern. Not only do ADs affect the neurotransmitters (usually more than one) but they also can alter the shape of the synapses in the nerve cells where the medicine and/or neurotransmitters attach. These drugs alter the shape of the synapses so they can better 'fit' their molecule in the synapse. During the recovery from withdrawal the nerves can become very fatigued and more sensitive. In addition as the synapses try to return to their normal shape they can go through several changes. Some of these changes may allow other neurotransmitters or other compounds to react with the synapse and can cause strange symptoms to appear. Many drugs, esp over used street drugs can cause long term damage to nerve tissues.

[Raven72]

In the case of many types of withdrawal there can be delayed effects after the fact. It is believed, especially in the case of psych meds, that it takes the nerves around 2 years to readjust/heal to being off the medication. Many studies of been done on benzos and they show this kind of pattern. Not only do ADs affect the neurotransmitters (usually more than one) but they also can alter the shape of the synapses in the nerve cells where the medicine and/or neurotransmitters attach. These drugs alter the shape of the synapses so they can better 'fit' their molecule in the synapse. During the recovery from withdrawal the nerves can become very fatigued and more sensitive. In addition as the synapses try to return to their normal shape they can go through several changes. Some of these changes may allow other neurotransmitters or other compounds to react with the synapse and can cause strange symptoms to appear. Many drugs, esp over used street drugs can cause long term damage to nerve tissues.

 

Interesting facts -fishinghat-, I have had ringing in my ears for what seems like forever. But if I researched it I bet it would all fall back to when I started on all these depression medications. I ultimately ended up having to have the stapes bone in my right ear replaced with a metal rod because it was literally frozen and not able to vibrate at all.

[Ramona80]

So people on this board have reported delayed onset tinnitus? In my case, it came 2 months after getting off Cymbalta. This is common? Or, has been reported on this board?

[fishinghat]

It has been reported on this forum. I can't tell you exactly how many but I would say several (4 to 7?) since I joined in early 2013.

[fishinghat]

I looked at the FDA and they report that about 1 to 2% of the people who start taking a ssri/snri report tinnitus as a side effect. Unluckily FDA does not collect or keep stats on symptoms developed during withdrawals.

[Ramona80]

Thanks, FH.

[Ramona80]

Have people reported tinnitus sounds being added on at regular intervals? Or just new sounds getting added on as time goes on?

 

I started with 2 pinging sounds one morning in November. Then I got loud hissing in both ears. Then things kind of eased up, and it pretty much went away briefly, then came back in left ear, but not right ear.

 

Then weeks later, I got a low, rumbly kind of sound like a truck idling in the distance, just in my right ear. The hissing returned in the right ear as well.

 

Then about 6 weeks later, morse code beeping tones in both ears when there was white noise or water running or something sizzling in a pan. Then about 10 days later, high pitched tones, also in reaction to other noises.

 

Then as time went on, a kind of jangly metallic sound sometimes appearing in either ear.

 

About a month later, a high pitched feedback sound in my left ear, like when a microphone gets too close to its stand.

 

I have been a stress ball, because why do new noises keep getting added on?

 

About a month after I got off Cymbalta completely, I was put on Lexapro. So that confuses things, is the tinnitus due to Cymbalta withdrawal or a Lexapro symptom? (Lexapro is very similar to Celexa. I was on Celexa for 11 years with no side effects, and I even got off it twice with no withdrawal whatsoever.)

 

But also - could the delicate state of my nervous system be causing me to have Lexapro side effects where I wouldn't otherwise?

 

I am so confused. I don't know if I ought to try coming off the Lexapro to see if the tinnitus improves any, or if that would be a huge mistake. The Lexapro has been helping me greatly. But if it is causing the tinnitus, I don't want it. The presence of tinnitus is causing me a terrible amount of anxiety.

[fishinghat]

Tough call Ramona.  As I remember. most develop ringing, or hissing, or some other sounds with little variation with time other then intensity. While the Lexapro can cause tinnitus it may only be temporary. Many loose the tinnitus after being on the Lexapro a few weeks (say 3 to 6 weeks normally). How long you been on it? If it started with the Cymbalta withdrawal it seems logical that it is from that. I know a few who had the tinnitus last months and even left some residual noise after a year or more (unusual though). Of course it slowly tapered during that time.

 

I should have time to look through some of the old posts this evening and I will see what I find and post it for you.

[Ramona80]

Thank you again. I have been on the Lexapro 4.5 months.

 

I had been off Cymbalta 2 months when the tinnitus and other ear issues began. But that coincided with me being on the Lexapro for 2-3 weeks.

 

I've been off the Cymbalta now for 6 months, but instead of tinnitus improving or leveling off, I have continued to get new sounds.

[fishinghat]

If it was from the Lexapro and was going to fade it would have done it by now. If from the Cymbalta withdrawal it start to have faded some by now but is still definitely possible to be from that. It could also be a permanent effect from the Lexapro. I am going to hit the medical journals tonight and see what I can find. It may take me a couple days though. Bear with me. Very interesting.

[Ramona80]

Thanks. I am worried sick about this. I am afraid of being left with permanent tinnitus.

 

I talked with my doctor on the phone this morning and she said I could try reducing the dose of Lexapro for a month and see if that improves it.

[fishinghat]

That is an idea but even if you cut back it will take a full 4 weeks for blood levels to stabilize. I hate to see you cut back on something that is helping you so much. You are the only one who knows how bad you feel and it is your call. Either way we are here.

[fishinghat]

Partial list of entries on this site referring to tinnitus.

You will see a pattern, the gaster the withdrawal the worse the tinnitus and the longer lasting the occurance. It also seems to be more common in those on the generic form.

My website search showed 4 more pages of entries but my patience and time gave out on me. LOL
Medical journal info to follow.

Bee 11/29/11
I have been on Cymbalta for 6+ years, also taking 60mg 2x day. I have constant tinnitus.

Marcia 1/24/12
On my journey I am a few days off cymbalta and have the brain zaps, inc tinnitus, aches and pains, chills.

Marcia 1/26/12
Not 10 minutes go by without brain zaps of varying degrees as well as severe tinnitus. At times its just the usual ocean sound, but at times it is a whooshing, pulsating pressure feeling/sound that is very disconcerting.

Jenni 1/26/12 (during withdrawal)
My osteopath found that my neck was very seized up which doesn't help with neck/head/sinus/ear pain and tinnitus. All my symptoms felt better after my appt including the whooshing noise. Maybe a back massage or even just lying in a hot, shallow bath.

BuzzBuzz 3/23/13 (during withdrawal)
The brain zaps and tinnitus are pretty bad,...

SusanMoore 3/28/13 (during withdrawal)
I have also developed what I now know as Tinnitus and this I am told, does not go away.

Answer from lady Nancy
Don't worry Susan the Tinnitus does go away, it takes awhile but it will go away

THP 3/30/13 (during withdrawal)
I started at 60 mg per day and tried to go to every other day which was a nightmare. Severe tinnitus, nausea, emotions, etc.

Lady Nancy 4/16/13 and many many other times. An excert from section 5.7 of the drug insert for Cymbalta.

"During marketing of other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been
spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including
the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric
shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures.
Although these events are generally self-limiting, some have been reported to be severe."

Fishinghat 4/17/13 Posted full excert.

5.7 Discontinuation of Treatment with Cymbalta
Discontinuation symptoms have been systematically evaluated in patients taking duloxetine. Following abrupt or tapered discontinuation in placebo-controlled clinical trials, the following symptoms occurred at 1% or greater and at a significantly higher rate in duloxetine-treated patients compared to those discontinuing from placebo: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. During marketing of other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures.
Although these events are generally self-limiting, some have been reported to be severe.
Patients should be monitored for these symptoms when discontinuing treatment with Cymbalta. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose maybe considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate [see Dosage and Administration (2.4)].

Zappinist 5/19/13 during withdrawal
No tinnitus right now, which has been bad recently, but zaps are still there.

Tomitsu 6/11/13 dw
I do have tinnitus and I get the odd brain zap here and there.

Dogs Rule 7/2/13 7 weeks off
This withdrawal will not stop. The really hideous days of zaps and sweating and nausea are over, but lingering symptoms remain: dizziness, tinnitus, and milder zaps.

Irish Eyes 3/21/13
I quit taking Cymbalta in June 2012. I had brain zaps, impaired mental processing, the swishing sound when you move your eyes side to side and tinnitus.
By the end of August I felt almost normal. Then my left foot started tingling. Then in October I got tinnitus.
Last week I start having the swishing sound when I move my eyes back and forth but just when I first wake up.
It's been 9 months and I'm having some of the same symptoms I had in July. Anybody else out there experiencing this?

Afg1202 10/4/13
And this tuning-fork-in-my-head feeling is horrible. And there is so little literature on what helps tinnitus

Thismoment 1/5/14
I might describe my own withdrawal experience like this- bead counting from 30 mg over 6 weeks @ 2.3%.
Difficult// weeks 1-2 smooth/ weeks 3-6 coarse/ weeks 7-12 medium/ weeks 13-24 fine + some medium/ weeks 25-48 fine/ weeks 49-52 smooth/ weeks 53-68 smooth and still improving subtly. I still have two symptoms that are probably permanent- a continuous tension-type headache and tinnitus in my right ear.

Thismoment 1/7/14
My last Cymbalta bead was the end of July 2012, which is getting close to a year and a half now. I still have two symptoms I didn't have before I started the drug. I have a constant headache, and tinnitus in my right ear. Both are tolerable, and I consider myself lucky because after 2 years on the drug I was fried...

FiveNotions 2/18/14
I've had severe tinnitus thanks to cymbalta....it had been so bad that I cldnt hear people talking directly to me...now it's faded a bit, and I have periods of time where it's almost gone...last week I was able to hear my kitchen clock tick! Today, it's bad, like a jet engine in my head...I've had it so long, years, that I've trained myself not to notice it....

Clara 2/26/14
I wish I had a cure for this constant tinnitus. It drives me nuts at times. Just another Cymbalta gift that refuses to go away!

BelaLugosisDad 3/5/14
Tinnitus. - non stop in both ears.

ThisMoment 3/14/14

I've been off Cymbalta for nearly 20 months, and I think I'm probably 95% back; I'm still a little achy in my muscles, I have tinnitus in my right ear, and I have a constant (24/7) tension-type headache that no NSAID will touch. These items are probably chronic, but I'll report back when I hit the 2 year mark this summer.

ThisMoment 3/23/14

Currently at 95%+ function with a few residual withdrawal artifacts: tinnitus, chronic headache, low dopamine. I am back to "normal", but I have a palpable 'different' feeling of myself compared to before I started this adventure, but that was 4 years ago and certainly the passage of time alone has an effect

ThisMoment 4/3/14

I have a constant headache, tinnitus, and fatigue. My level of depression is about the same as when I started Cymbalta.

Phillyguy1 4/24/14
....being off in that 8-10 week window. I pretty much went off cold turkey. I've experienced similar with good and bad days. My biggest issue has been acute vertigo and tinnitus in my right ear. Some days it's been better than others for sure.

Sodone61 4/24/14 Off 5 weeks
No more paresthesia and headaches and the tinnitus (both ears, bad) is gone.

FiveNotions 4/24/14
Tinnitus...I hadn't thought about it in weeks....which meant I haven't had much of it (cymbalta gave it to me big time)....then, just this afternoon, kaboom....it's back, and with a vengeance....sounds like I've got a toilet flushing, sink running, and crickets chirping simultaneously inside my head....when I had it all the time I learned to ignore it....then, when it went away, I was astonished at being able to hear clocks tick and birds sing....now it's driving me nuts because Ive forgotten how to ignore it....it's gonna keep me awake tonight for sure....

Xman 4/25/14
Mine is much better, although I still have it in my right ear intermittently. I am intrigued that there is a pattern forming regarding the right ear tinnitus...
My tinnitus started during crapalta. Never had it before and have no inner ear problems whatsoever. My right ears--
Hickupp 5/8/14
Sorry Clara but at least for me it has never gone away and I've been off for several years. It doesn't happen every day but it still happens.
Clara 6/18/14 6 to 8 months off.
FINALLY coming alive again! And the tinnitus seems to have mostly GONE AWAY!!!!! So grateful about that!!!!
Xman 5/25/14
Thankfully. Also the buzzing in my ears and tinnitus like noise is less in severity. I am a little over 3 months post crapalta.

ThisMoment 5/5/14
After 42 days of tapering off by bead-counting, I swallowed my last bead on July 31, 2012. That was 22 months ago (approximately 660 days)!
I have two lingering side-effects that are probably permanent-- tinnitus in my right ear, and a constant (24/7) tension-type headache that I've had since i began the withdrawal more than two years ago

Must read...
https://www.cymbalta...om/?hl=tinnitus

Downtongirl 6/29/14 dw
Lots of ear pressure, pain, and the already existing tinnitus that I have developed from benzo tolerance/withdrawal was worse.

Downtongirl 7/3/14 dw
I developed tinnitus/hyperacusis last summer from what I believe to be tolerance withdrawals from klonopin but this Cymbalta makes it much worse. Anyone else experience this?

Answer by FiveNotions
As for the tinnitus, oh yeah, that was one of my long lasting effects....it got much much worse during the first weeks of withdrawal...then it almost disappeared, and I got all excited because I could hear my kitchen clock ticking....never knew it did that!....but then it came back.....it's faded a bit, and comes and goes....

MichB 7/7/14 dw
Oh yes! I have tinnitus too. If there is other noise around me it's not so bad but I can still hear it. Anytime it's quiet it sounds like an attack of locusts!! It's irritating but sadly I'm used to it. If its one of the few lasting permanent effects from getting off this poison I'll be fine.

Gail 7/21/14 5 months off
Tinnitus, which I can tolerate and on and off headaches that I can handle.

brzghoff 7/30/14 11 weeks off
For me getting off C has been rough, for the first month and a half or so it was a lot of physical stuff, joint and muscle pain - lots - serious gastro issues, nausea, the runs, etc, confusion, tinnitus.

Guest_Notsureaboutit_* 8/2/14 1 week off
Ears Whirring, Like A I Have A Helicopter In Them.

Response by Donewithcrap 8/2/14 Off
I have ringing in both ears and have had this for years now. I gets worse at tines but never goes away. I have tried "Ring Stop" but it didn't help me.

Response by ShadyLady 8/3/14 Off
I had the 'whirring swooshies' (great description!) for about 3 weeks after stopping the C-dope!

Pheobster 8/3/14 dw
Tinnitus has set in. Not super loud but enough to be another irritant.

tomitsu 9/2/14 off
I have anxiety and depression I didn't have before taking cymbalta. I have tinnitus and suicidal ideation is a reality. I have memory loss. I believe my symptoms are permanent as they have not gone away. I'm deeply disturbed by the symptoms.

Gail 10/7/14 off
tinnitus here also

nerdluvin 10/13/14 3 days off
For the past couple of weeks, I get intense migraine-level headaches (no brain zaps) and tinnitus in my ears.

FiveNotions 10/13/14 Off 10 months
I had tinnitus ... actually, after 10 months off, I still have it ... think it's permanent, due to the cold turkey

Thread Titile - Off Crapalta 6 Mos. Or More - What Symptoms Do You Still Have? 10/15/14
    FiveNotions - 8 months off - The tinnitus returned several months ago, and is even louder and more constant than ever.
    Clara - Tinnitus comes and goes, much less intense.
    Gail - 8 mths - Tinnitus

ThisBetterPass 10/17/14
Looking back, I did start having problems with tinnitus when they switched me over to generic probably about two years ago.

Downtongirl 11/20/14 Off
I have developed tinnitus about 1 1/2 years ago and don't want to take anything to make that worse and nsaids are listing as being ototoxic...

FiveNotions 12/6/14 1 yr off
I am (so far) left with some apparently long-lasting after effects ... severe tinnitus,....

Shouldclean 3/31/15 3 mths off
Over a years time I weaned from 60 mg to 0. I was due to finish the end of January and was weighing the microscopic beads of 20 mg pills. I was in so much muscle pain that my husband suggested I go cold turkey, which I did on Christmas Day. My pain almost immediately was cut by 75%. I also had dizziness and tinnitus.

Sfava987 6/18/15
But after stopping the 20mg, I had the full blown discontinuation syndrome and could not drive or function. So, I went back on the 20mg and stayed there for a couple months, but the Tinnitus and some brain fog remained along with burning pain in my heels and the bottom of my feet.

ThisMoment 8/1/15 3 years off
I still have short-lived events that feel like ripples of withdrawal, and I still have a few symptoms that continue to fade: tinnitus, headache, unsteady balance, and GI instability







 

[fishinghat]

Things that list tinitus as a common symptom during dicontinuation;
Benzos
Coffee
Alcohol
Opium
SSRI
SNRI
Bath Salts
Dilantin and more...

Seven complete articles on treating tinitus.
Each link is followed by the title of the article in bold.
Articles concerning rTMS have the word "note" in front of the title.

https://www.ncbi.nlm...les/PMC4637057/
Note - Efficacy and Safety of Repeated Courses of rTMS Treatment in Patients with Chronic Subjective Tinnitus.
"Repeated application of rTMS seems to be useful in tinnitus management and should preferentially be offered to patients who experience a worsening of their tinnitus during the intertreatment interval, irrespective of their response to the first treatment course."

https://www.ncbi.nlm...les/PMC4678896/
Note - Combined rTMS treatment targeting the Anterior Cingulate and the Temporal Cortex for the Treatment of Chronic Tinnitus.
"This pilot study demonstrated the feasibility of combined mediofrontal/temporoparietal-rTMS-stimulation with double cone coil in tinnitus patients but failed to show better outcome compared to an actively rTMS treated control group."

https://www.ncbi.nlm...les/PMC4772792/
Noten- Triple-site rTMS for the treatment of chronic tinnitus: a randomized controlled trial.
"We report a tendency towards a modest, sustained long-term effect of the triple-site stimulation protocol in comparison to the single-site protocol."
Table 2
Adverse events for both treatment groups.
single-site rTMS triple-site rTMS
transient adverse events
 muscular tension 1 -
 headache 6 3
 blurred vision 1 -
 increase in tinnitus loudness 3 -
 mood swings 1 -
 dizziness - 1
 feeling of heaviness in the legs - 1
ongoing adverse events
 increase in tinnitus loudness 3* -
 broadening of the frequency range of the tinnitus - 1
/pmc/articles/PMC4772792/table/t2/?report=objectonly
*One of those three patients dropped out after two days of treatment.

https://www.ncbi.nlm...les/PMC2832848/
Emerging pharmacotherapy of tinnitus
Summary og medicines used for tinitus.

https://www.ncbi.nlm...les/PMC3563643/
Note - rTMS Induced Tinnitus Relief Is Related to an Increase in Auditory Cortical Alpha Activity
"Several studies indeed show tinnitus relief after rTMS, however effects are moderate and vary strongly across patients."

https://www.ncbi.nlm...les/PMC3227628/
Treatment options for subjective tinnitus: Self reports from a sample of general practitioners and ENT physicians within Europe and the USA
"A structured online questionnaire was conducted with 712 physicians who reported seeing at least one tinnitus patients in the previous three months. They were 370 general practitioners (GPs) and 365 ear-nose-throat specialists (ENTs) from the US, Germany, UK, France, Italy and Spain."
"Despite a large variety of treatment options, the low success rates of tinnitus therapy lead to frustration of physicians and patients alike. For subjective tinnitus in particular, effective therapeutic options with guidelines about key diagnostic criteria are urgently needed."


https://www.ncbi.nlm...les/PMC4761664/
Sensorineural Tinnitus: Its Pathology and Probable Therapies
"The most common form of treatment of tinnitus is pharmacological agents and behavioral treatment combined with sound therapy. Less common treatments are hypnosis and acupuncture. Various forms of neuromodulation are becoming in use in an attempt to reverse maladaptive plastic changes in the brain."

Summaries of articles on treating tinitis.

https://www.ncbi.nlm...pubmed/26960786
Therapeutic role of Vitamin B12 in patients of chronic tinnitus: A pilot study.
"This pilot study highlights the significant prevalence of Vitamin B12 deficiency in North Indian population and improvement in tinnitus severity scores and VAS in cobalamin-deficient patients receiving intramuscular Vitamin B12 weekly for 6 weeks further provides a link between cobalamin deficiency and tinnitus thereby suggestive of a therapeutic role of B12 in cobalamin-deficient patients of tinnitus. "
http://www.ncbi.nlm..../pubmed/8484483
Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss.
"These observations suggest a relationship between vitamin B12 deficiency and dysfunction of the auditory pathway. Some improvement in tinnitus and associated complaints were observed in 12 patients following vitamin B12 replacement therapy. The authors recommend that routine vitamin B12 serum levels be determined when evaluating patients for chronic tinnitus."
https://www.ncbi.nlm...les/PMC3645155/
The Role of Plasma Melatonin and Vitamins C and B12 in the Development of Idiopathic Tinnitus in the Elderly
"Comparing the plasma levels of the markers between elderly with and those without tinnitus, the plasma levels of melatonin (p=0.01) and vitamin B12 (p=0.03) were significantly lower among the elderly with tinnitus compared to those without, while the difference in the plasma level of vitamin C (p=0.6) was not.)
https://www.ncbi.nlm...les/PMC4765244/
Tinnitus: Is there a place for brain stimulation?
Nothing "to support or discourage the application of brain stimulation in tinnitus."

https://www.ncbi.nlm...pubmed/26938213
Electroacupuncture for Tinnitus: A Systematic Review.
"Due to the poor methodological quality of the primary studies and the small sample sizes, no convincing evidence that electroacupuncture is beneficial for treating tinnitus could be found. "

https://www.ncbi.nlm...pubmed/26910854
Randomized Controlled Trial of a Perceptual Training Game for Tinnitus Therapy
"The results suggest that the attention training game may have reduced focus on the tinnitus, potentially through improved selective attention. "Terrain" was superior to "Tetris" in the population tested and therefore shows promise as a management option for tinnitus. Further testing in a larger, more general, population would be enabled through improving the game's accessibility."

https://www.ncbi.nlm...pubmed/26901425
Cortical Reorganisation during a 30-Week Tinnitus Treatment Program.

https://www.ncbi.nlm...pubmed/26890094
Neuronavigated left temporal continuous theta burst stimulation in chronic tinnitus.
"In our study, verum cTBS was not superior to sham which highlights the persistent need for improving non-invasive brain stimulation techniques for the treatment of tinnitus."

https://www.ncbi.nlm...pubmed/26868680
Maladaptive plasticity in tinnitus - triggers, mechanisms and treatment
"Maladaptive neural plasticity seems to underlie these changes: it results in increased spontaneous firing rates and synchrony among neurons in central auditory structures, possibly generating the phantom percept. This Review highlights the links between animal and human studies, and discusses several therapeutic approaches that have been developed to target the neuroplastic changes underlying tinnitus."

https://www.ncbi.nlm...pubmed/26867083
Internet-Delivered Cognitive-Behavior Therapy for Tinnitus: A Randomized Controlled Trial
"Using a randomized controlled trial design, we replicated prior findings regarding positive effects of Internet-delivered CBT on tinnitus-related distress and associated symptoms."

https://www.ncbi.nlm...pubmed/26817797
Note -Long-Term Distributed Repetitive Transcranial Magnetic Stimulation for Tinnitus: A Feasibility Study.
"Our study demonstrated that rTMS can be delivered in a distributed schedule that is well-tolerated, feasible and may prove to be clinically beneficial. A long-term distributed rTMS schedule for tinnitus may warrant investigation as an alternative to the short-term aggregated treatment schedules more frequently used previously. For the many varied therapeutic uses of rTMS (established and investigational), treatment schedules are relatively unexplored, and deserve further attention."

https://www.ncbi.nlm...pubmed/26790209
[Deep needling and shallow needling at three acupoints around ear for subjective tinnitus: a randomized controlled trial].
"Acupuncture at the three acupoints around ear deeply could apparently improve tinnitus, and reduce tinnitus sound levels for subjective tinnitus. The effect is better than that by shallow needling at the three acupoints."

https://www.ncbi.nlm...pubmed/26773752
Auditory and visual 3D virtual reality therapy as a new treatment for chronic subjective tinnitus: Results of a randomized controlled trial.
"Virtual Reality appears to be at least as effective as CBT in unilateral subjective tinitus patients."

https://www.ncbi.nlm...pubmed/26771015
Feasibility and Safety of Transcutaneous Vagus Nerve Stimulation Paired with Notched Music Therapy for the Treatment of Chronic Tinnitus.
"After 10 treatment sessions, 15/30 patients (50%) reported symptom relief."
"This study has demonstrated the feasibility and safety of tVNS paired with notched music therapy in patients with chronic tinnitus, with the use of a pad-type electrode attached to the auricular concha."

https://www.ncbi.nlm...pubmed/26747828
Tinnitus and its current treatment-Still an enigma in medicine.
"As yet, there are no Food and Drug Administration approved drugs available and the quest for a new treatment option for tinnitus focus on important challenges in tinnitus management. A number of options have been used to treat patients with tinnitus, but outcomes have been limited."

https://www.ncbi.nlm...pubmed/26649534
Clinician-Supported Internet-Delivered Psychological Treatment of Tinnitus
"For the 6 studies comparing Internet treatment against a no-treatment control condition, a moderate effect size was found (Hedges's g = 0.58). The 3 studies comparing Internet treatment against face-to-face group treatments showed a small difference."

https://www.ncbi.nlm...pubmed/26632254
The efficacy of individual treatment of subjective tinnitus with cognitive behavioural therapy.

https://www.ncbi.nlm...pubmed/26619701
[Therapeutic perspectives in the treatment of chronic subjective tinnitus].
"There are no effective therapies for the treatment of chronic subjective tinnitus. The present study aims to compare two therapeutic approaches: Tinnitus Retraining Therapy (TRT) and a Biopsychosocial Approach (BPS). Results show no difference in evolution of tinnitus' perception between the beginning of the study and after 12 months of treatment in both treatment groups."
https://www.ncbi.nlm...pubmed/26609769
Potassium channels as promising new targets for pharmacologic treatment of tinnitus: Can Internet-based 'crowd sensing' initiated by patients speed up the transition from bench to bedside?

https://www.ncbi.nlm...pubmed/26557055
Note - Repetitive transcranial magnetic stimulation induces oscillatory power changes in chronic tinnitus.
"This is the first study to show tinnitus-related alterations of neuroplasticity that were specific to stimulation site and oscillatory frequency."
"Moreover our findings confirm the role of the left temporal and the right frontal areas as relevant hubs in tinnitus related neuronal network. Our results underscore the value of combined TMS-EEG measurements for investigating disease related changes in neuroplasticity."

https://www.ncbi.nlm...pubmed/26547700
Antioxidant therapy in the elderly with tinnitus.
Prospective, randomized, double-blinded, placebo-controlled clinical trial. The sample consisted of 58 subjects aged 60 years or older, with a complaint of tinnitus associated with sensorineural hearing loss. The treatment regimens were: Ginkgo biloba dry extract (120mg/day), α-lipoic acid (60mg/day)+vitamin C (600mg/day), papaverine hydrochloride (100mg/day)+vitamin E (400mg/day), and placebo.There was no benefit from the use of antioxidant agents for tinnitus in this sample.
https://www.ncbi.nlm...pubmed/26541232
Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments.
"There was improvement in quality of life (Tinnitus Handicap Inventory), with good response to sound therapy using customized settings in patients who did not respond to previous treatments for tinnitus."

https://www.ncbi.nlm...pubmed/26498289
Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial.
"No statistically significant difference was found between anodal and sham stimulation regarding either immediate or long-lasting effects over the 2 weeks follow-up period. Deterioration of symptoms and alteration in tinnitus characteristics were reported by a few patients. There were no significant long-term beneficial effects following tDCS of the left temporoparietal area. "

https://www.ncbi.nlm...pubmed/26467416
The Management and Outcomes of Pharmacological Treatments for Tinnitus.
Table 1.
Pharmaceutical treatment effects on tinnitus.
Drugs Authors Subjects Placebo Controlled Dosage Results Side Effects
Lidocaine Melding,
et al. (1978) 78 Open-label 1-2 mg per kg of body weight intravenously for 3-4 minutes Highly effective in patients with Organ of Corti damage None
Nortriptyline Sullivan
et al. (1989) 19 Placebo-washout Maximum 50 to 150 mg per day Tinnitus loudness and severity decreased Dry mouth, dyspepsia, constipation, orthostatic hypotension
  Sullivan
et al. (1993) 92 Placebo controlled 50 to 150 mg/mL for six weeks Depression and tinnitus loudness decreased Anticholinergic side effects, sedation
Amitriptyline Podoshin
et al. (1995) 218 Placebo controlled 10 mg 3x/day for 10 weeks Improvement in more than 40% Sedation
  Bayar et al. (2001) 37 Placebo controlled 50 to 100 mg daily for six weeks Decreased tinnitusintensity and subjective relief Sedation, dryness of mouth
  Mendis
et al. (2008) 1 Case study 10 mg for three days Neurologic foot pain resolved Tinnitus
Imipramine Tandon
et al. (1987) 475 Chart review 150 to 250 mg per day Depression improved Tinnitus
  Evans et al. (1981) 1 Case study 15 to 45 mg per day No improvement in depression Tinnitus
Sertraline Zoger et al. (2006) 76 Placebo controlled 25 to 50 mg daily for 16 weeks Improved loudness, severity Sexual side effects
Paroxetine Robinson
et al. (2005) 115 Placebo controlled Maximum of 50 mg per day for 100 days No better than placebo Sexual dysfunction, drowsiness,
dry mouth, sweating,
insomnia, gastrointestinal distress, tremor, headache
Alprazolam Johnson
et al. (1993) 36 Placebo controlled 0.25 or 0.5 mg for one week, increased to maximum of 1.0 mg for some for 56 days Reduction in loudness Excessive drowsiness; more dreams
  Jalali et al. (2009) 36 Placebo controlled 0.5 mg 1-3 times per day for 8 weeks No improvement None
Clonazepam
Ginkgo biloba Han et al. 2012) 38 Open-label 0.5 mg Clonazepam; 4.0 mg GB increased from 1 to 4 doses per day for 5 weeks Clonazepam more effective than GB; tinnitus annoyance, duration, and loudness decreased Drowsiness
Gabapentin Bauer et al. (2006) 39 Placebo controlled Maximum 2,400 mg for 20 weeks Decrease in annoyance Dizziness, fatigue
  Witsell et al. (2006) 76 Placebo controlled 1800 mg daily for five weeks No significant difference Mouth sores, decreased libido
Amino-oxyacetic Acid Reed et al. (1985) 10 Placebo controlled 50 to 75 mg four times a day for one week Subjective lessening of tinnitus in 3/10 Worsening of tinnitus upon withdrawal; dizziness, lightheadedness, disequilibrium, nausea, and headache at higher doses (400 mg/day)
Lamotrigine Simpson
et al. (1999) 31 Placebo controlled 25 to 100 mg daily for 8 weeks No significant difference Nausea, vomiting, headache
Carbamazepine Donalson I (1981) 62 Placebo controlled 100 mg No significant difference Tinnitus returned rapidly post-injection
Memantine Figueiredo
et al. (2008) 43 Placebo controlled 5 to 10 mg 1-2 times per day for 90 days No significant difference Dizziness, high blood pressure, insomnia, stomachache
Flupirtine Salembier
et al. (2006) 24 Open-label 100 mg twice a day for three weeks No significant difference Amnesia and concentration disorders
Neremexane Suckfull et al (2011) 320 Placebo controlled 25 to 75 mg daily for 16 weeks Decreased annoyance and impact on life at higher dosage Dizziness, headache, vertigo, fatigue, hypertension
Acamprosate Azevedo et al. (2007)
Sharma et al. (2012) 50

40 Placebo controlled
Placebo controlled 333 mg 3x daily for
three months
333 mg TDS 3x daily
for 45 days Improvement
over placebo
Significant improvement over placebo Epigastralgia, choking

Worsening intensity
(2 participants)
Cyclobenzaprine Coelho at al. (2011) 49 open-label max high dose: 30 mg; max low dose: 10 mg high dosage saw a reduction in THI dry mouth, sleepiness, constipation
  Vanneste et al. (2013) 95 open-label 10 mg 2x/day for 4 weeks reduction in distress and intensity worsening intensity
Naltrexone Vanneste et al. (2013) 106 open-label up to 50 mg for four weeks tinnitus distress reduced in some none
Deanxit Meeus et al. (2011) 28 placebo-controlled 1 mg per day for three weeks 3/28 report tinnitus improvement none
Betahistine Sonmez et al. (2013) 68 placebo-controlled 48 mg per day for three months slight improvement in loudness and on THI pyrosis, nausea
Pramipexole Sziklai et al. (2011) 40 placebo-controlled maximum dosage: 0.7 mg 3x/day for 4 weeks 35% of pramipexole group improved dizziness, allergic reactions
Piribedil De Azevedo
et al. (2009) 56 Placebo-controlled 50mg daily No difference from placebo Nausea, dizziness
Simvastatin Canis et al. (2011) 94 placebo-controlled 40 mg/day for 4 months reported improvement but not significant worsening tinnitus
Vitamin B12 Berkiten et al. (2013) 83 placebo-controlled 1 g/mL injected daily for 5 days, then once a month for 12 months no significant change N/A
Zinc Coelho et al. (2013) 89 placebo-controlled 220 mg zinc sulphate daily for 4 months no significant change indigestion

https://www.ncbi.nlm...pubmed/26459345
Slow Cortical Potential Neurofeedback in Chronic Tinnitus Therapy: A Case Report.
https://www.ncbi.nlm...pubmed/26433054
Cannabinoids, cannabinoid receptors and tinnitus.
https://www.ncbi.nlm...pubmed/26430749
Note - A Pilot Study of EEG Source Analysis Based Repetitive Transcranial Magnetic Stimulation for the Treatment of Tinnitus.
"Low-frequency rTMS decreased tinnitus significantly after active, but not sham, treatment. Responders in the EEG source analysis-based rTMS group, 71.4% (5/7) patients, experienced a significant reduction in tinnitus loudness, as evidenced by VAS scores. The target site of neuronal generators most consistently associated with a positive response was the frontal lobe in the right hemisphere, sourced using high-density EEG equipment, in the tinnitus patients. After left temporoparietal rTMS stimulation, 42.8% (3/7) patients experienced a decrease in tinnitus loudness."

https://www.ncbi.nlm...pubmed/26422238
The effect of noninvasive brain stimulation on neural connectivity in Tinnitus: A randomized trial.
"Sixteen patients received active rTMS treatment; 14 patients received sham treatment. There were no differences between the active and sham groups in baseline functional connectivity. Neither treatment with rTMS nor sham therapy resulted in statistically significant functional connectivity changes in the examined brain networks."

https://www.ncbi.nlm...pubmed/26413574
The Effect of Korean Red Ginseng on Symptoms and Quality of Life in Chronic Tinnitus: A Randomized, Open-Label Pilot Study.
"Fifty-nine patients completed the planned protocol. Significant improvements were observed between initial and post-treatment THI scores in patients receiving 3000 mg/day KRG. Treatment with 3000 mg/day KRG for 4 weeks significantly improved role emotional and mental health scores in the SF-36 survey.These results suggest that KRG may improve tinnitus symptoms and mental wellbeing in chronic tinnitus patients."

https://www.ncbi.nlm...pubmed/26406286
An evaluation of the Reltus ear massager for short-term tinnitus relief.
'Supression of tinitus loadmess to auditory stimulation was found in 87% of participants and to tactile stimulation in 83%. No significant differences were found in the effectiveness between the four vibration stimulation points, or between the left and right ear of the participants. The Reltus produced a sound that resulted supression of tinitus.'
"It is the auditory artifact of the Reltus that was responsible for short-term tinnitus suppression."
This device rates a 2.5 out od 5 stars on Amazon.

https://www.ncbi.nlm...pubmed/26388055
The Development of Acceptance of Chronic Tinnitus in the Course of a Cognitive-Behavioral Group Therapy.
"CBT is considered an effective treatment for tinnitus distress in patients with chronic tinnitus. Acceptance of chronic tinnitus clearly improved within a CBT group therapy."

https://www.ncbi.nlm...pubmed/26261868
Treatment of tinnitus.

https://www.ncbi.nlm...pubmed/26248783
The effectiveness of psychological interventions among tinnitus sufferers: A review.
"Psychological interventions were more effective in reducing psychological impacts of tinnitus than non-psychological interventions such as the use of tinnitus maskers. Nevertheless, the combination of the treatments yielded more superior outcomes."

[Ramona80]

Thanks, FH, you rock!

 

You don't have to look up anything else, that's very time consuming!

 

I still don't know what to think...regarding my Lexapro. People have reported (anecdotally) getting tinnitus and ear pressure/pain on Lexapro. To complicate the issue, sometimes when you're in withdrawal from one antidepressant, going on a new one could give you side effects you wouldn't otherwise have, or so I've read.

 

Interesting that people get delayed withdrawal symptoms. I did, for instance, I took my last Cymbalta on Sept. 21st, but things declined badly over the next month. I got terrible sadness and crying, I mean, like being in a deep, dark hole. My muscle spasms got worse, I got vibrating in my muscles, the myoclonic jerks/insomnia worsened. At that time I was put on the Lexapro. Felt better.

 

2-3 weeks later, there came tinnitus, as well as ear pain & pressure, seeming to be Eustachian tube related...also rhinitis. That's when it seemed like my allergies went crazy, my eyes, my nose, my larynx, my bronchial tubes.

 

My ear symptoms have settled down, the pain and pressure doesn't happen anywhere near like it used to, but the tinnitus has continued to increase in number of types of sounds I have. I spoke with a pharmacist who felt like at this point I wouldn't sill be getting new sounds, 6 months out. He felt like it was more likely the Lexapro, given the timetable.

 

I don't want to misstep and make things worse. I don't want to stay on the Lexapro if it is going to keep increasing my tinnitus. But I don't want to reduce my Lexapro if that is going to increase my tinnitus (if it IS in fact due to Cymbalta withdrawal).

 

I want my life back. It's been a year of such fear and unpleasantness (that's putting it delicately, isn't it?!) I just want to find some peaceful ground. This is so hard.

[fishinghat]

No clear cut answer. You can wait to see if it fades (withdrawal related) or cut the Lexapro and see if that helps.
Consider...
Only 1% report tinnitus as a side effect of Lexapro and most of that is temporary) and

Eli Lilley in there drug insert warns of severe tinnitus during Cymbalta withdrawal.

More likely withdrawal. Maybe some of the treatments in the articles above will give you an idea for a temporary treatment until it disappears.

[Ramona80]

Thank you for all your research, FH.

[lady2882Nancy]

No wonder my tinnitus did not last.

I have taken amitriptyline for years 20 years for my IBS-D and when I was having so much trouble with that the doctor upped my dose and then at 12 weeks off Cymbalta I was put on Zoloft (aka sertraline) for the anxiety.

Both of these meds showed positive results in reducing tinnitus. I guess my Psychiatrist really did know what she was doing although I have never really doubted her after that first initial appointment and the Zoloft/sertraline worked so well on my anxiety. I still trust her opinion more than any other doctors' lol.

I also have stuck with my high potency vitamin which has plenty of Vitamin B12 although the injection is said to be far superior.

 

Thanks fishinghat for all the great information.

[Ramona80]

I had tinnitus 2 years ago, in one ear, along with a crackling noise and it lasted for one month. Looking back through my old medication bottles, that was when I was switched from one generic Cymbalta to another, I felt sick around that time, too...shaky, sick to my stomach, just very weird and "off." At the time, my doctor said it was probably fluid in my ear and/or allergies and it would take some time but it would resolve. Makes me wonder, though.

 

With this tinnitus, I definitely have had other ear issues going on -- pain and pressure intermittently over the winter, sometimes burning pain, a pain with crackling when one Eustachian tube opened on a couple occasions, pain behind my ear/jawbone, hyper-reactive muscle that's on my left eardrum, and I've been waking up with that muscle spasming in the morning. It has started contracting really quickly about 20 times when I wake up, the past 10 days or so. I've had so many muscle spasms with this withdrawal, makes me wonder if it's withdrawal related.

 

All the ear exams I've had by doctors have been normal and showed nothing unusual, eardrums look normal, no fluid behind the ear.