289 replies to this topic

[EBB]

OK, glad we got to the bottom of that - so I should do Lexapro right?? How do I proceed with the question in post 176? Do you think any med will even work to help me?

[fishinghat]

https://www.ncbi.nlm...pubmed/25740916
"Early life stress enhanced the susceptibility to late life stress and resistance to escitalopram treatment through decreasing microRNA-9 expression and subsequently upregulating dopamine receptor D2 expression in the nucleus accumbens."

Note, sounds like it increases dopamine activity.

I found a lot of research showing that Lexapro was allosteric binding for serotonin but found no reference to its relationship with dopamine.

Not too sure if it will help or not.

I did like your drs idea of Seroquel. It definitely blocks dopamine activity at the synapse. I think that may be a good thing to try.
What did your dr think?

I found conflicting information on Luvox and dopamine. Most research suggested it increased dopamine activity in the prefrontal cortex and a couple said it lowered it in the hippocampus (which is the fear center). I really don't have an opinion on this. It does heavily regulate serotonin reuptake so serotonin activity should increase and therefore decrease dopamine activity. Luvox is considered by many as an SSRI and by others as an SNRI but most of what I have read in forums suggest it has a bad withdrawal.

https://www.ncbi.nlm...n00042-0011.pdf

I don't think there is a clear cut answer except try something and see if it works.

Well, I nee to go get some work done so will check back later.

[EBB]

So I am in really bad shape. I am hanging on by a thread. Can you help me with a plan? I don't know what to try first and how to do this. I'm afraid I may have to die. This is not getting better and I have so so many bad cards with the gene issues. I don't want to die and lose and ruin my family. I need help. Seems like I shouldn't try something that has a bad withdrawal - how would that even work?? If I start with something like Lexapro and it doesn't work, what do I do? Do I just move on or taper? I am DESPERATE here for a plan. There must be some sort of strategy right? You tried 6 meds - how did you do that? I don't know how to do this and my doctor gives no acknowledgement of the withdrawal issues with any of these meds. I am so scared and you are my only source for guidance. No one knows about all of this stuff. 

 

My doctor is not a help for strategy. She doesn't understand withdrawal and her suggestion was to be on Seroquel and an SSRI - both. I need serotonin badly. I am crying constantly. I'm so sad I can't see straight. and the anxiety is uncontrollable. I'm obsessing about this constantly and the fact you said it would be YEARS for me. I can't live/feel like this for years. I already want to die. I need help. Please

[juli]

Sweet EBB.  That stressed me out really bad too.  The more I read on the internet the more obsessive my thoughts became.  I had to take myself off the internet and try something.

I really don't think it will be as bad as you think.  Most people don't ever get the gene testing so they don't even know what the test would say.  I feel like that is really tripping you up.

You will feel better.  You will.  I feel like this back and forth has gone on way too long.

Please try Zoloft or Lexapro.  Both of them will get Seratonin back in your brain and you will feel better.  Please don't wait any longer.  You will know right away if it is going to work.  You will feel some relief and the longer you are on it the better you will feel.

On the off chance that you don't get relief, try another.

FH tried a lot of other meds before his doctor had him try an SSRI.  It worked.

Please get started so that you can feel better.

[fishinghat]

"I had to take myself off the internet and try something."

Juli is right. There is soooo much info out there on this stuff and we are still in the dark ages. There is NO clear cut answers. In my case I had a great psychologist at the time and with each change we sat down together and discussed the options before trying anything. Basically you have Zoloft, Lexapro, Seroquel and Abilify you are considering.

Just one persons thought here but … You need to stop the clonidine. (f you think your anxiety is worse and you are not having any more "good" windows then stop it. After a couple days off I would try Seroquel has the most effect on dopamine and the least withdrawal. I would try it first, Second Zoloft because not only the dopamine but also the Serotonin. Should at least help with the withdrawal, Third Lexapro and under no circumstance would I ever try Abilify. The bottom line is you just have to try one and see. You also need to stop the clonidine. (f you think your anxiety is worse and you are bot having any more "good" windows then stop it.

"You will know right away if it is going to work. "
For most of our members it takes around 4 to 6 weeks for the new AD to fully kick in for the rest of our members it would take only a few days. Go figure. But Juli is right. All you are doin g now is wasting time. There is no clear-cut answer.

"FH tried a lot of other meds before his doctor had him try an SSRI. It worked."

Actually juli I was on a tricyclic AD and 2 ssri before they tried the Zoloft and it worked. The other two ssri were Lexapro (which had worked great for my anxiety in the past but did absolutely nothing for my withdrawal) and Prozac which I had never tried but it did nothing for me at all. The Zoloft took 3 months to fully kick in but it did slowly help during that time. No wonder people go crazy trying to figure out what to do. There is no set pattern. Like Juli said. 'Just try one'. But I would definitely come off the clonidine first and see if you feel better like before.

[fishinghat]

Oh Yea, and one other thing, what ever you do be sure to only try one thing at a time otherwise you won't know what works and what doesn't.

[EBB]

Thank you Julie and FH,

I'm going to start with Zoloft or Lexapro - unless I'm misunderstanding something.

1. Seroquel blocks serotonin and that's something I really need. It's usually combined with an SSRI. I've also read the withdrawal is horrible ... thoughts?

2. Why do you say Zoloft second due to the dopamine - I thought we concluded it ups dopamine transmission - am I still missing something?

[EBB]

Sweet EBB.  That stressed me out really bad too.  The more I read on the internet the more obsessive my thoughts became.  I had to take myself off the internet and try something.

I really don't think it will be as bad as you think.  Most people don't ever get the gene testing so they don't even know what the test would say.  I feel like that is really tripping you up.

You will feel better.  You will.  I feel like this back and forth has gone on way too long.

Please try Zoloft or Lexapro.  Both of them will get Seratonin back in your brain and you will feel better.  Please don't wait any longer.  You will know right away if it is going to work.  You will feel some relief and the longer you are on it the better you will feel.

On the off chance that you don't get relief, try another.

FH tried a lot of other meds before his doctor had him try an SSRI.  It worked.

Please get started so that you can feel better.

Thank you so much Julie. I am praying that things turn around with Zoloft or Lexapro. I am truly praying

[fishinghat]

1. I have been through Seroquel withdrawal. It took around 6 weeks and was only fairly bad. I have known several who have been through Seroquel withdrawal and most say 4 to 8 weeks. Maybe I am just lucky. You are right about it blocking serotonin.

2. I said dopamine and serotonin. This should help with the withdrawal but once you get past that you may need to focus more on dopamine control.

Not pushing here but I still strongly suggest you stop the clonidine first. You have been on it and had nothing but worse anxiety. If it is causing an increase in anxiety then it will only make the work more difficult for Zoloft or Lexapro. It would ne a shame if it is causing a lot of your problems and you stayed on it. Wean off over a few day period and see if things don't get better. Your choice.

[gail]

Ebb,

All psych meds have withdrawal, but you go slow and it makes it much easier.

After 7 months of suffering, I was put on Seroquel 150xr, it was instant relief.
But it stopped working. It would also be my first choice.

Only one med at a time Ebb!

[EBB]

FH, Gail,

Thank you. I am off the clonidine as of today. I tapered the last 3 days. Here's the thing - I don't understand why I'd do Seroquel since it blocks serotonin. That doesn't make sense to me. I am so low and depressed from serotonin. Yes, the anxiety from high dopamine could be helped with seroquel, but it seems illogical to have no serotonin support.

1. My doc told me that you take seroquel along with an SSRI. Is that not the case?

2. FH, you said to start with Zoloft, but didn't we determine that Zoloft has dopamine transmission? Lexapro may have dopamine transmission, but it's not as certain as Zoloft. So why would I not start with Lexapro?

3. Shipko said I should use liquid Lexapro and start very slow with 1mg. He said when reinstating you have to go very slow. Thoughts?

4. Also, why would I start with a med that has a long withdrawal like Seroquel? I know they all do, but Lexapro I can get off more easily since I'm adding it slow.

I am at a very fragile place here. I am turning over this thread to my husband Chris because it's too stressful right now.

[EBB]

Ebb,

All psych meds have withdrawal, but you go slow and it makes it much easier.

After 7 months of suffering, I was put on Seroquel 150xr, it was instant relief.
But it stopped working. It would also be my first choice.

Only one med at a time Ebb!

Hi Gail, So then what did you do? Are you on something now? Did you have to taper even though it wasn't working? I don't see how I could do a withdrawal on top of withdrawal....

[juli]

EBB - you have to go with your gut since there is no way to know for sure.  You have done more research than anyone could.  I believe your gut is telling you something, so go with it.

 

Start the Lexapro.  I started at 5mg.  I did have anxiety for the first couple weeks but I knew it would happen.  I didn't freak out about it, took my xanax and it passed.

 

You can do this.  You need relief my friend.

[EBB]

EBB - you have to go with your gut since there is no way to know for sure.  You have done more research than anyone could.  I believe your gut is telling you something, so go with it.

 

Start the Lexapro.  I started at 5mg.  I did have anxiety for the first couple weeks but I knew it would happen.  I didn't freak out about it, took my xanax and it passed.

 

You can do this.  You need relief my friend.

Thanks Juli, So after a couple of weeks the anxiety went away?

[fishinghat]

1. Usually that is the case.
2. Simply because Zoloft has better serotonin control than Lexapro and now your issue is probably serotonin from withdrawal.
3. Reinstating? I assume you were on it before. There is a theory that many drs believe that is you have taken a specific antidepressant less than 2 years earlier than startup should be slow as it is more likely to work better. There is some debate about that. It is also believed that ADs usually do not work as well the second time round for MOST. Like Juli said pick one and try it. By the way the Clonidine will mostly be out of your system within 24 hours and if it was causing any anxiety you should start noticing the difference starting about then.
4. I reviewed some of the medical research on the Seroquel and some said NO withdrawal and some said short term withdrawal at worse. Mine was easy and those people I am familiar with said it was fairly easy nut I have also read the stories in some of the forums. Flip a coin.

This is from the drug insert for Seroquel. I would tend to agree with it. 2 month taper is normal for most people I know.

5.19 Discontinuation Syndrome
Acute withdrawal symptoms, such as insomnia, nausea, and vomiting have been described after abrupt cessation of atypical antipsychotic drugs, including SEROQUEL. In short-term placebo-controlled, monotherapy clinical trials with SEROQUEL XR that included a discontinuation phase which evaluated discontinuation symptoms, the aggregated incidence of patients experiencing one or more discontinuation symptoms after abrupt cessation was 12.1% (241/1993) for SEROQUEL XR and 6.7% (71/1065) for placebo. The incidence of the individual adverse events (i.e., insomnia, nausea, headache, diarrhea, vomiting, dizziness and irritability) did not exceed 5.3% in any treatment group and usually resolved after 1 week post-discontinuation. Gradual withdrawal is advised.

[juli]

Yes the anxiety went away after two weeks.  It wasn't severe anxiety but I definitely noticed it.  If you are worried about it you could do the liquid and start super slow.

[gail]

Hi Gail, So then what did you do? Are you on something now? Did you have to taper even though it wasn't working? I don't see how I could do a withdrawal on top of withdrawal....

Yes, it needed tapering even if didn't work long. While on Cymbalta, the same, it made me worse, tapered from 30 to 15, then off. Hell was hell before it and after it.

I've tried 8 meds since, treatment resistant. I'm on Paxil and the fact that I need Gabapentin plus opioids helps a bit. No miracle cure yet, sorry!

[fishinghat]

That is why they call it 'practicing' medicine. lol

[gail]

Ah! Einstein, never thought about this! Practicing...A good one here!

[fishinghat]

Sorry gang that I have been off the post so much lately. I had 2 deep freezes and a clothes washer go out in 7 days. What a mess. I have frozen food in a dozen different peoples houses, finally got in new deep freezes and got them going now I have to go back and get all the food. I think I did manage to fix the clothes washer myself so I will run a few loads tomorrow. I should be around more starting around Wed or Thu.

[EBB]

So sorry FH, what a pain! Hope things ease up.

So, I started taking liquid Lexapro 1mg Saturday so I've had 2 doses. Last night (second night) was kept awake by ongoing bladder issues and a new symptom of mild tinnitus. Overall, especially this evening I feel better. This morning, however, I felt bad. What are your thoughts on Lexapro and tinnitus? Should I stop and switch to Zoloft and see if it clears? I do not want tinnitus, esp if it gets worse. I saw you mentioned in an old post to Ramona80 that Lexapro causes tinnitus in only 1%. Looking online, however there's a ton about Lexapro AND Zoloft and tinnitus. Interestingly, Shipko was quoted somewhere saying all ADs cause tinnitus and Zoloft is the worst offender. I'm only on 1mg - could I just be adjusting? Thoughts?

[fishinghat]

Actually Shipko is just about spot on but one thing he didn't mention is that one of the most common symptoms of Cymbalta withdrawal is tinnitus. Will post some info on it in a few minutes.

 

Did coming off the Clonidine help the anxiety? Curious

[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...
http://www.cymbaltaw...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

Things that list tinbitus as a common symptom during discontinuation;
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

https://www.ncbi.nlm...les/PMC2832848/
Emerging pharmacotherapy of tinnitus
Summary of 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 tinnitus intensity 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
Simpsonet 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."

[EBB]

Thanks for all of the info - do you know or is there a way to find out if Ramona80's tinnitus resolved? She was on Lexapro after Cymbalta too and thought it could be Lexapro and I think I saw in a later post she's on Paxil now.

Wondering:

1. I've noticed improvements since the Lexapro. I usually feel good in the evening and through the night when I wake up to pee I feel ok. Around 6 am I wake up and take the 10 beads of Cymbalta. When I wake after that a couple hours later I feel awful - don't want to get out of bed. It get a bit better throughout the day usually and especially around 12 hours later when the C has worn off. This seems to be a pattern. How stable to I have to be to drop a bead? I really don't want to get worse, but I think the C I'm still taking is making things worse.

2. It seems to me the tinnitus has to be related to the Lexapro bc it started the day I started the Lexapro - doesn't it seem like that has to be it? Why would withdrawal tinnitus start when I started the Lexapro?

3. Should I just continue with the Lexapro despite tinnitus?

4. Yes anxiety did improve after Clonidine stopped. It was making things quite a bit worse. I read several studies where this happens. Some say it has to do with a nervous system interaction that responds differently and it actually becomes a stimulant.

[fishinghat]

I always recommend a person gets stable when they feel like they are OK. Nearly normal but most people don't have that much patience.  lol If you drop a bead now it will just make things flare up. I would wait until the Lexapro kicks in some more.

 

You might send Ramona80 a PM about her tinnitus.

 

The tinnitus may be because of the Lexapro. It could also be a coincidence. The only way to be sure is to stop the Lexapro and see if it goes away. I don't think that would be fun.

 

You are the third person I know of that has had that reaction to clonidine. Sorry it didn't work out for you.

[juli]

Hi EBB - I was going through reinsatement with a friend I met on a forum.  She was feeling better on week four and then out of the blue came down with tinnitus and the flu symptoms.  I think the new withdrawl symptoms can come out of nowhere.  I believe hers lasted about a week and then was much better.

[EBB]

Now on 1mg of Lexapro liquid. Shipko says I should go to 2mg and then 3 every 2 WEEKS! I'm on the verge here. I started the Lexapro Sat and felt a bit better Sat and Sun (placebo?). Then not so good again. I'm on 2.5 Ativan and a lot of hydroxyzine. What else will help this damn anxiety?? I'm about 31/2 months and this is damn torture. FH, you've told me because of my genes I could be this way for years. This is absolutely the worst thought I keep having over and over. I can't feel like this for years. Is there anything else that will keep me alive? Thisis all impossible - I've got 10 beads to get off, the Ativan addiction which isn't even touching my anxiety. And thoughts that I won't feel stable for years. How do I do this? HELP!!! 

[EBB]

Hi EBB - I was going through reinsatement with a friend I met on a forum.  She was feeling better on week four and then out of the blue came down with tinnitus and the flu symptoms.  I think the new withdrawl symptoms can come out of nowhere.  I believe hers lasted about a week and then was much better.

Thank you Juli, I appreciate your support very much. I am a wreck going slow with the Lexapro. Ears buzzing, nauseous, and anxiety that laughs at 2.5mg a day of Ativan. Hydroxyzine is koolaid. I have NEVER been so scared in my life. I don't have a life anymore. I don't have me. Thank you for writing to me. I just hope I will be as lucky as you with the Lexapro.

[juli]

Hi EBB don't worry you will feel some start up issues but I really think it will get better.

 

You should look at Cheryl123 "Reinstate?" story.  There are similarities to your situation.  Her anxiety was so so bad.  Her doc started her on 2.5mg Celexa and it took some time for her to feel good effects.  I think her doc kept her on that for 2 weeks and then upped it to 5mg.  They went real slow but she ended up feeling better.  She really used the Klonopin to deal with the anxiety until the Celexa kicked in.

 

Remember that all of this is withdrawl, not necessarily your underlying condition.  Have patience and give your nervous system time to heal.

 

Do you have biofeedback providers where you live?  It was a life saver for me when I was going through all this crap.

[juli]

I am going out of town but I will be praying that you feel better soon.