by Neil Bauman, Ph.D.
A lady wrote:
I am suffering severe balance problems, hearing loss and tinnitus since stopping Paxil 3 years ago. I never had tinnitus, hearing loss, or balance problems before I stopped taking the Paxil. In fact, I did not have any of these symptoms until about 3 months after I stopped taking Paxil. I was on Paxil for 8 years. At the end, I tapered from 20mg over 3 months as directed by my doctor. I have not taken any other drugs apart from the occasional Paracetamol [Acetaminophen]. Do you know if this is likely to be permanent?
Paxil (Paroxetine) belongs to the class of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs). Paroxetine can cause a number of different ototoxic side effects including hearing loss, tinnitus, hyperacusis (normal sounds are too loud), ear pain and a number of balance problems such as ataxia (staggering gait), dizziness, nystagmus (eyes jerking sideways) and vertigo.
Most people experience these side effects while they are taking the drug, not 3 months after they stop taking it such as happened in your case. This kind of thing can happen with drugs in the Benzodiazepine class, but I wasn’t aware of this characteristic with SSRIs. Perhaps the SSRIs can act similarly to the Benzodiazepine drugs when you have taken them for a long time, such as you have.
This just goes to show that short term studies (a few weeks to a few months) by the drug manufacturers before the drug is approved by the FDA do not catch many/all the side effects caused by extended use.
Now to answer your question—typically, if your hearing doesn’t come back (at least in part) in 30 days or so, the chances of it ever coming back are quite slim. In your case, it has been over 3 years now. Thus, I think your hearing loss is permanent. Also, since tinnitus often accompanies hearing loss, I expect your tinnitus will be permanent too.
I’m a bit surprised that your balance problems haven’t improved. You see, balance problems often appear to improve with time as your brain learns to compensate for the faulty balance signals coming from your inner ears. However, that does not mean the balance system in your ears is fixing itself. Rather, your brain is learning to tune out the bad balance signals from your ears, and is relying on your eyes and proprioceptive system for balance information.
If any reader has had a similar experience when using SSRIs, I’d love to hear your story.
If you want to check out the ototoxic side effects of the drugs you are taking (or thinking of taking), look them up in “Ototoxic Drugs Exposed“. This book contains information on the ototoxicity of 877 drugs known to damage ears (and information on 148 ototoxic chemicals too).
I have been on citalopram for 7 days 10mgs and the day 8 and 9 20mgs
i got ringing in the ear and the when I went to 20mg the ringing went so loud I couldn’t barely hear
i got off right away since it is a known side effect.
its been 3 months and i still hear the ringing?
how much longer do you think?
I have the same problem since 3 weeks ago I started lexapro and I have to stop it after 5 days my ears ringing so loud but after a few day without the drog it have gone.
My doctor give a presciption of Paxil and told me when you feel better start with paxil I started yesterday my first pill and the noise ears started againg.
I hope it can help anothers how sufer it.
I will go to my doc. next week and ask for another kind of medicine.
I noticed that the comment above about using paxil and tinnitus is quite old (2010) but I am experiencing exactly the same thing. I have finish taking paxil after taking it for 7 years and have been left with tinnitus in the left ear and have hearing loss. I am waiting for a MRI scan, balance tests and a hearing aid.
I am too. Went off Paxil 3 months ago after tapering and now balance off when walking. Vertigo ringing in head shocks go up the back of my head and I twitch for no apparent reason occasionally
I have started cycling off Paxil . I started using it for hot flashes at recommendation of my gynecologist. I have been on it for 5 months. Since starting to wean off, I have had ringing in one ear, balance issues and feel lightheaded when I move my head. Dreams have been bizarre.
Hi Sheila:
I’d say you are tapering off Paxil too fast if you are experiencing those side effects. See my article on Citalopram for details on a safer taper rate. You can read it at http://hearinglosshelp.com/blog/tapering-off-citalopram-safely-without-side-effects/
Cordially,
Neil
How was your MRI scan? Has tinitus stopped?
Dr Neil, do you have any sources on where Paxil causes hyperacusis? I am not disputing this, I just want to do some more research on it. I quit paxil after years and a few months later noticed severe decreased sound tolerance and then T. Thanks. I tried Trintellix and then Viibryd before I had the T and went off those and still had the T. Now I’m back on paxil bc of my anxiety.
Hi Ryan:
Paroxetine (Paxil) causes tinnitus, hearing loss and hyperacusis in numbers of people. So just taking the Paxil can make your tinnitus worse.
Now, where can you find that Paxil causes hyperacusis. Well, it is reported in the Physicians’ Desk Reference (PDR) in the USA and in the Compendium of Pharmaceuticals and Specialties (CPS) in Canada. Furthermore, somewhat more than 100 people have complained to the FDA that Paxil caused their hyperacusis.
I don’t know what kind of research you plan to do, but there is not much–just mentions that Paxil causes hyperacusis.
Cordially,
Neil
What can you do for the vertigo?
Hi Esmeralda:
Depends what caused your vertigo. If you are taking a drug that causes vertigo, for example, stopping the drug may get rid of your vertigo.
If your vertigo is caused by your C1 and C2 vertebrae in your upper neck being out of proper alignment, then seeing an upper cervical chiropractor to get them back in proper alignment is the solution.
Thus, the solution varies depending on the cause. What caused your vertigo?
Cordially,
Neil
I experienced hyperacusis (plus a myriad of other symptoms) after taking Paxil (paroxetine) for many years. I now have almost complete hearing loss in my left ear.
I took paxil for about 9 years from 1997-2006. Shortly after weaning myself off, I noticed a slight ringing in both of my ears. Gradually over the years it continued to progressively get worse. It is constant. I am concerned at this pace, within the next few years, I will have severe hearing loss. It is already fairly loud and annoying but I have adjusted as I have know other choice. Previously, I had thought that the tinnitus may have been a side effect from the paxil but when I had researched the internet in the earlier years, I had not found any relations to my experience. Who do I report this to? How do we prevent this drug from being manufactured? Thank you
Hi Gina:
Paroxetine (Paxil) is known for causing hearing loss and tinnitus in many people. So, your tinnitus is likely the result of taking Paroxetine for all those years. In addition, a good percentage of those thousands of people with tinnitus also now have hearing loss.
For your information, tinnitus does not cause hearing loss. It is the other way around. Hearing loss very often results in the tinnitus.
You can always report adverse side effects to the FDA. They’ve already received hundreds of reports for hearing loss and tinnitus in regards to Paroxetine. If you want to add your experience to those that have already been reported, just click on the following link.
https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home
Cordially,
Neil
Hello:
If you suffer ototoxicity can your balance, gait, vertigo come on suddenly then subside for a long period then return just as suddenly?
Hi Shabaka:
I wouldn’t say it is impossible, but I can’t think of anyone that has reported that. I know that some ototoxic side effects take years to show up–but the person is still taking the drug. Also, while on a drug, I know of people whose ototoxic side effects come on, then go away, and then come back months later. But these people are still taking the drug.
Why do you think it is an ototoxic drug that is causing this and not some other factor?
Cordially,
Neil
In 1980 (age 26) I had a full hearing workup because I also “felt” that my inner ear had a blockage (I can hear myself when I speak). Other than that, nothing abnormal except for a very slight hearing loss in left ear.
Eight years later, I was suddenly stricken with severe vertigo out of the blue (age 34) which lasted about 5 weeks & came back intermittently, less severe. Was told that the problem is where the ear organ meets the brain stem, but nothing can be done. It’s worse every April. When laying down, if I turn to the left, I get a strong vertigo reaction, minus the nausea. It quickly passes, so, from what I’ve read it’s BPPV.
Tinnitus became more significant over the years: louder ringing.
Vertigo episodes were less often & much less severe after doing Cawthorne exercises for almost a year.
Muffled hearing is still present & I began having difficulty understanding certain spoken words.
Due to other medical issues (mostly back surgery that wasn’t successful), in 2001, I was prescribed Paxil, 20 mg twice daily. Around 2014-15, I reduced the dosage by tapering down by taking 30mg (20 in the morning & 10 at night) for about 2 weeks, then down to 20 mg once daily (which I continue to this day (May 2019).
In 2015 (age 61), I woke up with SSHL in my left ear. Thought it was wax & couldn’t get to PC Dr. for 2-3 weeks. I did not realize this was a medical emergency! He saw cloudy fluid behind the eardrum, prescribed antibiotics & when I returned 1 week later, said cloudiness is gone, but fluid is still there. Sent me to an ENT ~ got an appt a week later. Had a full workup with AuD in his office. Learned that I am 100% deaf in the left ear; probably due to a virus, but I hadn’t been sick. He injected a steroid thru my eardrum in a last ditch attempt to restore my hearing. Nothing, nerve is dead, yet I have ringing in both ears, sometimes very loud in the left ear. Supposedly, the brain is sending signals, but they’re not reaching the ear organ. I went to an ENT who does mostly cochlear implants in pediatric patients, for a 2nd opinion. After an exam & seeing my recent test results, I was told the same thing: “sorry, nothing can be done to restore the hearing in that ear”.
Unilateral hearing is awful; can’t identify where sounds are coming from.
My right ear has moderate hearing loss & everything still sounds muffled. A BTE hearing aid helps somewhat by eliminating the muffled sounds, but it just amplifies all sound. Unless I’m in a quiet environment with 1 or 2 people, it’s very difficult. In a group of people, I miss certain words & have to guess/figure out what they’re talking about. I always need to turn so my right ear is facing the persons mouth, which is awkward socially. To alleviate that, I bought a separate unit (called MY PAL) that works with my Ally hearing aid. It’s a microphone in it that a friend can clip to their shirt or blouse collar & the sound comes directly into my ear and is clearer. It’s great for one-on-one conversations. Dinner parties are awful in that there’s just a roar of sound. I’m isolated so much of the time.
My main question is whether it sounds like the Paroxetine caused this & whether I’m at risk for losing the remaining hearing in my right ear since I’m still taking the medication (20 mg daily). I’m terrified of that happening!
Hi Janet:
From what you have described, I can’t say whether the Paroxetine was the culprit or not. Certainly taking Paroxetine has caused hearing loss in hundreds upon hundreds of people (as reported to the FDAs database). Some people have reported hearing loss and tinnitus in the months after beginning taking Paroxetine, while others have reported it took “7 years” to “many years” to cause severe hearing loss. So it is possible that the Paroxetine is the culprit, or it may be that a virus caused your hearing loss (or a combination of both).
Why are you still taking the Paroxetine after all these years? Why not taper off it SLOWLY and take a non-ototoxic antidepressant such as the herbal St. John’s Wort if you still need an antidepressant? Then you wouldn’t have to worry about Paroxetine causing further hearing loss.
Cordially,
Neil
I took paroxetine for one year only and after 3months of stopping have tinnitus is there any hope for stopping tinnitus or any cure for it
Hi Asmaa:
Many, many people end up with tinnitus from taking Paroxetine (Paxil). I don’t have much information as to whether your tinnitus will be temporary or permanent. Actually a lot depends on your emotional attitudes.
You should learn how to habituate to your tinnitus so it won’t bother you whether it fades away or not. Basically, you need to accept that tinnitus is NOT a threat to your well-being. This gives your limbic system permission to let it fade away. If you focus on your tinnitus and worry about it–this tells your limbic system it is a threat to your well-being (you wouldn’t worry about it if it wasn’t) and therefore it constantly brings it to your attention. So focus on the loves of your life and by so doing ignore your tinnitus (as much as is humanly possible) and let it begin to fade away.
My book, “Take Control of Your Tinnitus” chapters 16 and 17 in particular show you how to do this. You can see it at https://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ . Get the eBook and you can start reading it in 5 minutes.
Cordially,
Neil
I read this i got worry, I have just take paxil for 2 days only. Will i get tinnitus or hearing loss, I have stop for now, will call doctor to change my medicine’
thanks
victor
I have a story like this as well. I had only been taking Paxil for 3 months and ran out of medicine. After 2 weeks I started to get a very strange pressure in my ears and tinnitus. The pressure was so horrible I thought there had to be something wrong maybe an infection. I went multiple times to the specialist for it and I had no issues he could see in my ears. 2 weeks later (still having the issue) dizziness started this dizziness was so bad I could hardly walk. My eyes twitched more issues kept arising. I had been off of the medicine for over a month when I went to the neurologist. I went for an MRI and x-ray on my head and neck to look for issues. The doctor put me back on the Paxil thinking it would help and it did but I had already stopped the medicine for 6 weeks at this time and the symptoms only progressed until I started them again . Now I am afraid I will never be able to change medicines even tapering off I start all of the same side effects that progress the longer I am not taking Paxil.
Hi Vanessa:
As you know, Paroxetine (Paxil) is one of the selective serotonin reuptake inhibitor (SSRI) drugs. You should NEVER stop these drugs “cold turkey” for any reason as you’ll be at a high risk of horrible withdrawal side effects as you have found out to your sorrow. In fact, of all the antidepressants, Paxil was one of the four worst for withdrawal side effects.
In order to get off Paxil safely, you need to do a slow taper. A “safe” slow taper is 10% reduction per month on the descending balance. For some people even that slow rate can be too fast.
If you begin to see withdrawal side effects showing up, it is a good idea to stop the taper at that point and wait until the side effects go away and then resume your taper at a slower rate.
This can take a minimum of a year and maybe longer depending on how your body reacts to the tapering process.
Note that if you are taking other psychotropic drugs at the same time, the side effects can be even worse. Also, never taper off more than one drug at a time Start with the one with the worst side effects and taper off it before you begin on the next one in order to minimize the risk of getting withdrawal side effects.
Cordially,
Neil