by Neil Bauman, Ph.D.
A man asked:
Do you have any information as to the permanence of the side effects (especially hearing loss or tinnitus) of the following SSRIs?
Celexa (Citalopram) 2
Lexapro (Escitalopram) 2
Luvox (Fluvoxamine) 3
Zoloft (Sertraline) 3
Paxil (Paroxetine) 4
Prozac (Fluoxetine) 4I’m curious as to why two of these SSRIs receive a severity rating of 4 when the worst antibiotics receive a 5. Are the SSRIs really that dangerous at prescribed levels? If you don’t have the answers perhaps you could recommend a place I could find further information (i.e. The Physicians’ Desk Reference, or a web site database on drug side effects?)”
You ask some excellent questions and I wish I had definitive answers to give you. I have scoured all the sources you mention, and many more, and what I have reported in my book Ototoxic Drugs Exposed is what I have found.
The truth is, the ototoxic side effects of drugs are seldom specifically studied during drug trials. As a result, information on ototoxicity is sketchy at best. That is why little or nothing is officially known about the permanence of the ototoxic side effects of most drugs, including the SSRIs.
When I rate any drugs for their risk of ototoxicity, it is my own personal and subjective rating based on very incomplete data. This rating is based on any information available to me at the time I made it. It is typically not based on the results of double blind, or other studies. I may be totally off the mark, but this rating is still my best guess. You can use these ratings as a guideline if you want, or totally ignore them. However, if you don’t have a clue about the ototoxic risk of a given drug, this risk rating could be a good starting point in deciding whether you might want to risk the ototoxic side effects of taking that drug or not.
My purpose is to warn people ahead of time that many drugs are ototoxic, and also give them the best information I have found about any given drug’s degree of ototoxicity.
“Are the SSRIs really that dangerous at prescribed levels?” This is a difficult question to answer because there is very little concrete data available. Furthermore, doctors are free to prescribe drugs at any dosage they want, for as long as they want. However, if the dose exceeds the levels used during the drug trials, no one knows what the risk of any resulting ototoxic side effects may be. To complicate things further, some people are very sensitive to drugs in general so they might have an ototoxic reaction at the “recommended” dose, while others may not experience any ototoxic side effects even when taking the drug at higher than recommended levels.
However, I have heard from a sufficient number of people that have had ototoxic side effects from taking SSRIs that I believe these drugs can be dangerous to our ears.
Unfortunately, all too often, ototoxic side effects are not reported to the Food and Drug Administration (FDA) like they are supposed to be. It seems that doctors very seldom report any side effects to the FDA, so the few side effects reported actually represent an enormous number of people who got these same side effects. Thus, ototoxic side effects are not the rare occurrences they might appear to be. Even the FDA estimates that less than 1% of all the side effects of drugs are ever reported to them. In the case of the side effects of ototoxic drugs, I believe the true number reported is only a small fraction of 1%.
Getting back to the permanence of ototoxic side effects, what I included in Ototoxic Drugs Exposed is pretty well everything I had found out about that drug up to that time. So if I don’t indicate anything about permanence, nothing was specifically said about it. As time goes on, and as people tell me their stories as to the permanence of a given drug’s ototoxic side effects, I gain more information and will include it in future editions.
For all the drugs on your (above) list, I have not seen any studies to indicate whether their ototoxic side effects are permanent or not. However, for Zoloft (Sertraline) and Prozac (Fluoxetine) I have a number of anecdotal reports from people taking them that indicates both good news and bad news. The good news is that for some people part of their hearing loss is
temporary. The bad news is that most of these people also reported a significant degree of permanent hearing loss. One anecdotal report revealed that the resulting hearing loss and tinnitus were permanent, and gave no indication that any hearing ever came back. That is why I urge caution whenever you are considering taking any drug thought to be ototoxic.
For general information on the side effects of ototoxic drugs, search this website for the many articles on various ototoxic drugs.
For more complete information and for individual listings on each of the known ototoxic drugs and chemicals, check out Ototoxic Drugs Exposed.