Most antidepressants list Tinnitus as a side effect that can be caused or exacerbated (made worse). But, as annoying as your Tinnitus might be, you probably still need your antidepressants. So, which antidepressants cause or do not cause Tinnitus? Which is the best antidepressant for Tinnitus? Let’s explore.
All Antidepressants are Ototoxic (Tinnitus Causing)
Ototoxic = Medicines that can cause hearing, balance and other problems of the ear, including Tinnitus
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The bad news is that all antidepressants are ototoxic. It’s just that some are better than others. Whether you take the old generation tricyclic variety of antidepressants or the new generation SSRI type of antidepressants, Tinnitus is a risk you just can’t avoid as a side effect.
However, you can talk to your doctor about possibly swapping your current antidepressant for a less ototoxic one, if the possibility exists. Below is a list of popular antidepressants and their common brand names. They are ranked in a descending order of ototoxicity. The ones on the top of the list are more ototoxic than the ones on the bottom of the list.
Antidepressants that cause or exacerbate Tinnitus (Ranked Worst to Best)
Source = A 2018 Report on Drug Ototoxicity, by ATA.org (American Tinnitus Association)
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| Drug | Popular Brand Name | |
| Higher Ototoxicity | Paroxetine | (Paxil ®) |
| Alprazolam | (Xanax®) | |
| Bupropion | (Wellbutrin®) | |
| Medium Ototoxicity | Venlafaxine | (Effexor®) |
| Duloxetine | (Cymbalta®) | |
| Clonazepam | (Klonopin®) | |
| Lower Ototoxicity | Lorazepam | (Ativan®) |
| Sertraline | (Zoloft ®) | |
| Quetiapine | (Seroquel ®) |
If you are on Paxil or Xanax or one of the highly ototoxic antidepressants, you can talk to your doctor about switching to a less ototoxic one, like Seroquel.
Despite ototoxicity getting a lot of press in recent times, doctors largely do not consider it as a factor when deciding on an antidepressant that you will go on. There are many forums where people suffering with Tinnitus have expressed their angst and frustration at how the use of Antidepressants like Wellbutrin have caused their Tinnitus condition.
It May Not Be Your Antidepressant!
Besides antidepressants, other common drugs are ototoxic as well. From medicine taken to manage arthritis to blood pressure to even OTC pain killers like Aspirin and Tylenol, here’s a list of other ototoxic drugs you might be taking.
If you take any of these drugs on a regular basis or even frequently, talk to your doctor about replacements. If you take both antidepressants and one or more of the drugs mentioned below, going off at least one of the drugs you are on is highly advisable, to help you seek relief from Tinnitus.
| Drug | Popular Brand Name | |
| Higher Ototoxicity | Alendronate | (Fosamax®) |
| Acetylsalicylic acid | (Aspirin) | |
| Metoprolol | (Lopressor®) | |
| Acetaminophen | (Tylenol ®) | |
| Medium Ototoxicity | Hydrocodone | (Vicodin®) |
| Atorvastatin | (Lipitor®) | |
| Omeprazole | (Prilosec®) | |
| Lower Ototoxicity | Gabapentin (Neurontin®Amlodipine) | (Norvasc®) |
| Ibuprofen | (Advil ®) | |
| Lisinopril | (Zestril ®) |
Best Antidepressant for Tinnitus
The following is an opinion we have arrived at after reading through countless forum posts and anecdotal evidence provided by thousands of people. This drug is definitely NOT non-ototoxic. But, it is definitely far less ototoxic than any of the antidepressants mentioned in the table above.
The best antidepressant for Tinnitus, according to us, is St. John’s Wort. Please note that the link provided is an affiliate link. If you purchase this product through this link, we earn a small commission at no extra cost to you. Should you not wish to let us earn that commission, simply head on to Amazon and search for St. John’s Wort and then choose a popular product.
Why St. John’s Wort is the best antidepressant for people with Tinnitus?
As mentioned earlier, the incidence of ototoxicity is much lower than for antidepressants. It is also a natural product. It is also non-addictive.
St. Johns Wort is actually the popular name for Hypericum Perforatum. It’s a flowering plant that’s found commonly all around the world.
How to choose a St. John’s Wort pill and dosage?
Look for products that contain Hypericin, the active ingredient, in a 0.3% to 0.5% standardization. Commonly used dosage usually varies from 300 to 900 mcg.
Does it have side effects?
Taking this natural antidepressant might result in light sensitivity, where your skin aversely reactions to sunlight. The chances of this are slim, but it is the most widely reported side effect.
Like mentioned earlier, St. John’s Wort can also cause or worsen your Tinnitus. But, the chances of it doing that are much lower than tricyclic or SSRI antidepressants that we talked about earlier.
Please note that St. John’s Wort is a natural remedy for depression and not anxiety.
What else can you do about antidepressants and Tinnitus?
Antidepressants are not the only remedy for depression, even if they are the most popular treatment option, by a very long margin. But, there are alternatives.
Psychotherapy, an active and healthy lifestyle changes like exercising regularly and eating healthily can also help with depression. If anything, one can combine these alternate treatments with antidepressants. Combining these modalities will allow you to reduce your antidepressant dosage. A reduction in dosage will also mean a reduction in ototoxicity. This can then result in a less intrusive ringing in the ears.
Do not take Antidepressants to cure Tinnitus!
Antidepressants are meant to treat depression. But, there’s been a growing trend of people taking antidepressants to try to cure themselves of Tinnitus. Though antidepressants are ototoxic or Tinnitus causing, there’s a common misconception that they cure Tinnitus! Your doctor would have most probably NOT prescribed you antidepressants for your Tinnitus. But, if they did or if you are self medicating yourself with antidepressants for off label use, please stop. It can make your Tinnitus much worse.
Any relief you might have felt is probably relief felt from a reduction in stress and anxiety that you associate with your Tinnitus condition! It is not because antidepressants are resolving your Tinnitus. They will almost always make it worse, as time goes on.
