by Neil Bauman, Ph.D.
A lady asked:
Do you have an opinion on which antidepressants are the safest for our ears—e.g. Pamelor, Desipramine, Zoloft, Lexapro, Celexa, etc. Is there one that is significantly less ototoxic than the others?
For my money, I wouldn’t use any of the above. Why? Because there is a much safer alternative—St. John’s Wort. You see, this herbal is not ototoxic at all. Furthermore, according to numerous studies, it works as well as the above drugs for mild to moderate depression. In addition, it doesn’t have all the other bad side effects the above drugs have either.
If you decide to take St. John’s Wort, do two things. First, run it by your doctor or pharmacist. You want to make sure it won’t interfere with any of the other drugs you are currently taking. Second, be sure it says on the bottle that it is standardized to 0.3% to 0.5% hypericin. (Hypericin is the active ingredient.) When you use a standardized formulation, you know exactly how much of the active ingredient you are getting. Otherwise, the active ingredient may vary all over the place, and you don’t want that.
Mary Tuner says
I cannot use any SSRIs as they make me suicidal. I understand that St.John’s wort has the same properties.
Neil Bauman, Ph.D. says
Hi Mary:
Where did you find this information on St. John’s Wort? In all my voluminous researching on drugs over the years, I have never come across anything that indicates that St. John’s Wort has this property. Furthermore, my wife has taken St. John’s Wort for years without any side effects.
Are you sure your information came from a reputational source and wasn’t someone associated with a drug company trying to knock the efficacy of St. John’s Wort so you will buy their products?
Cordially,
Neil
Andreia says
Hi Dr. Neil, Can you tell me if mirtazapine is ototoxic? After I started taking duloxetine combined with mirtazapine my left ear started to ring. I don’t know which one cause me the tinnitus? What do you think Doctor Neil, the tinnitus will go away with time? Best wishes for you all
Grace says
I just wanted to say that I tried St. John’s Wort, and it raised my blood pressure, so be careful with it, please, If it works for you, go for it!
Neil Bauman, Ph.D. says
Hi Grace:
You are right. St. John’s wort can indeed raise the blood pressure in some people. Here’s a quote I found, “St. John’s wort may alter blood pressure and cause increased or uneven heart rate. Use cautiously in people with high blood pressure or abnormal heart rhythms.”
Cordially,
Neil
chzad says
I got light sensitivity rather bad after a few weeks on SJW. Darn!
Neil Bauman, Ph.D. says
Hi Chzad:
What a bummer. Light sensitivity is one of the few side effects of St. John’s Wort, but you are the first person that has told me they became sensitive to light–so I don’t think it is all that common. If you get of St. John’s Wort, hopefully the light sensitivity will go away in time.
Cordially,
Neil
Cesar F says
Hello: I suffer anxiety and panic attacks , depression and lately bipolar, Meniere sindrome/ Firearms Instructor/ Was on Wellbutrin 300 and voila TINNITUS appear ,,,, just to made all more interesting. I research about St. John’s Wort in the internet and seems that doesnt work pretty well for anxiety and panics attacks. I Has to choose between Lexapro 10 mg or Prozac 20mg please advice.. I also take quetiapine 100mgs and Atarax 1mg ( for sleep)
Thanks in advance
victoria says
Hello , looking for a safe alternative to treat my pppd (chronic dizziness with no depression) is St John’s wort a good alternative? thanks
Neil Bauman, Ph.D. says
Hi Victoria:
St. John’s Wort is only for depression–so, since you don’t have depression, St. John’s Wort would not be efficacious in your case.
What I would do if I ever got PPPD is to go to an upper cervical spine chiropractor, especially one who practices the Blair method. Since PPPD can follow car accidents (whiplash), Meniere’s disease and other related vestibular conditions, I wouldn’t be at all surprised if you find your top two vertebrae (C1 and C2) are not in proper alignment. Upper cervical chiropractors specialize in carefully properly aligning these two vertebrae, taking pressure off the vestibulo-cochlear nerve so it begins to function properly again–and then the ear problems simply go away on their own.
I’d go to a Blair chiropractor that has had success in treating people with Meniere’s disease although upper cervical chiropractors that use other methods (NUCCA, atlas orthogonal, grostic, knee-chest, etc.) that have had success in helping those with Meniere’s would also be a good bet.
You can find upper cervical chiropractors near you by going to http://www.upcspine.com/prac2.asp?rid=4 if you are in Canada or the USA (or click the “Practitioners” button at the top if you are elsewhere in the world). Then choose one near you that catches your fancy. Find out whether they think they can help you and go from there.
Cordially,
Neil
Elizabeth lasko says
I ordered this. Are you supposed to stay out of direct sun while taking it? How long can you take it for?
Neil Bauman, Ph.D. says
Hi Elizabeth:
St. John’s Wort can increase sun sensitivity in some people–so you want to be careful until you see whether sun affects your skin when you take St. John’s Wort. It may or may not.
St. John’s Wort is not habit forming and thus you can take it as long as you need to without worrying about it negatively affecting your body as far as I know.
Cordially,
Neil
Yola says
I get shoulder And neck muscle stiffness and pain In my skin on the arms,burning sensation . Seems it’s linked to anxiety…which non ototoxic drug can I take for anxiety?
Neil Bauman, Ph.D. says
Hi Yola:
All anti-anxiety drugs are ototoxic so I can’t answer your question. However, if you gave me a list of 3 or 4 drugs that your doctor thinks would help you, I can tell you which of them (in my opinion) is the least ototoxic.
My philosophy is to have counseling to find the cause of your anxiety and learn how to effectively deal with it so you don’t have to take drugs. Besides, drugs don’t get rid of anxiety, just hide it until you quit taking the drugs then it resurfaces.
Cordially,
Neil
Rebecca Jones says
Tinnitus and pain hyperacusis are the cause of my anxiety and depression. Life was amazing before these conditions disabled me overnight and out of the blue in December 2020. I am also suicidal and can think of no way out other than to die. My neuro wants me on amitriptyline and propanalol as a migrane preventer (which could be the cause of my subsequent ear issues) but I am too scared to take either of those drugs because they are ototoxic. I desperately need something for anxiety and depression as well as it feeds the hyperacusis.
Please can you advise. I’m desperate.
Neil Bauman, Ph.D. says
Hi Rebecca:
Any ideas what caused your tinnitus and hyperacusis back in December? Were you listening to loud music or exposed your ears to some very loud sound?
You need something to help you cope. Since basically all drugs are ototoxic to some degree in some people, if you have to take a drug to help you through this rough time, one trick that can help you fly under the ototoxic radar is to take the lowest dose that will do the job. Unfortunately, some doctors like to increase the dose and that is when the ototoxic side effects begin.
For example, if you took 10 mg of Amitriptyline you may not have any ototoxic side effects, but they could show up at 30 or 40 mg. So the lower the dose, the less the risk.
Propranolol is less ototoxic than Amitriptyline so if it helps you, you might consider it. Again, the lower the dose, the less the risk of side effects.
In addition, you need to learn how to get your anxiety under control. Breathing exercises are good–and you can practice them anywhere and any time you feel particularly anxious. There are websites that show you how to use breathing exercises.
What are you presently doing to deal with your tinnitus and hyperacusis? You need professional help from a person that is knowledgeable with both of these conditions as both can be successfully treated.
Cordially,
Neil
Lilly Tilly says
Rebecca, please listen to the “Tinnitus Relief Sound” on youtube (I have it too). One of these (they are very different) may help a little. Read the people’s comments, so you know you are not alone. Get blood test to find if you are deficient in any vits/minerals. Join Forums. I had hyperacusis for the first few years (22 yrs of T now) but it went away, hope yours does too.
Sam says
I am taking 25 to 30 mg hydroxyzine and 15 mg mirtazapine for the last 3 months. About a week ago I started having ringing in one of my ears. I started searching the reason than I learned about tinnitus now I have very low eeee sound in my ears . Witch drug you think is the cause . I am going to my doctor tomorrow to see alternatives. Is it mirtazapine or hydroxyzine. I am willing to stop hydroxyzine but scarred to quit mirtazapine
Neil Bauman, Ph.D. says
Hi Sam:
According to my calculations, Mirtazapine is at least twice as ototoxic as Hydroxyzine. Furthermore, I have several anecdotal reports of people getting tinnitus from taking Mirtazapine, but none from people taking Hydroxyzine.
So my money is on the Mirtazapine as causing your tinnitus.
Cordially,
Neil
Butch says
Diazepam is not ottotoxic
Neil Bauman, Ph.D. says
Hi Butch:
You really are ignorant about the side effects of drugs aren’t you? How can you say that Diazepam isn’t ototoxic when thousands upon thousands of people have reported to the FDA’s data base that they have gotten ototoxic side effects from taking this drug? Furthermore, both the Compendium of Pharmaceuticals and Specialties and the Physicians’ Desk Reference drug books list it as ototoxic.
Maybe you haven’t experienced ototoxic side effects from taking this drug, but that doesn’t apply to everyone.
Cordially,
Neil
Andrew says
Hi Dr Neil, I’m currently on Sertraline 50mg but have terrible pulsatile tinititus in one ear. Do you know the least ototoxic ssri? Thanks in advance
Neil Bauman, Ph.D. says
Hi Andrew:
According to my information, Sertraline is one of the least likely SSRIs to cause tinnitus. Since tinnitus is often dose related, what would happen if you reduced the dose by 50%?
Other than that, you could try another SSRI. Unfortunately, I don’t have any information on which ones specifically cause pulsatile tinnitus which is a vascular problem, rather than a true tinnitus problem. Thus I can’t steer you to any specific SSRI. You and your doctor would need to try others and see what happens.
Cordially,
Neil
Gregia says
Will tinnitus from mirtazipine go away?
Neil Bauman, Ph.D. says
Hi Gregia:
I’m sure it does for some people, but I really don’t know what percentage that is. The people that contact me are the ones that seem to have permanent tinnitus.
One nasty thing about quitting Mirtazapine too fast is that you can develop severe tinnitus. Thus, I recommend a very slow taper for coming off this drug to avoid this. By a slow taper, I mean reducing your dose by one/third of 1$ per day which would take 300 days. Alternately, reduce by 10%/month on the reducing balance. This too will take a year or more. But if it prevents severe, permanent tinnitus, you’ll be really glad you did it this way.
Cordially,
Neil
Ang says
Dr recently put me on cymbalta, I had an ear infection at the time which brought on increased tinnitus. I’m worried the cymbalta could be making the humming in my head worse. Not sure if it is the med or something else. In your opinion is cymbalta highly ototoxic and if so what med do you consider the least ototoxic for anxiety and depression.
Neil Bauman, Ph.D. says
Hi Ang:
I rate Duloxetine (Cymbalta) as moderately ototoxic. If you are worried that it could make your tinnitus worse, be aware that hundreds upon hundreds of people have reported it causes tinnitus, so there is a good chance that your increased tinnitus is from this drug.
Anxiety and depression are two different conditions. If I was depressed, I’d take the herbal St. Johns Wort, not one of the many ototoxic prescription drugs. Likewise, for anxiety, I’d take the herbal Valerian to help calm me down.
Cordially,
Neil
Lou says
Hi,
I stopped taking Zoloft in Dec of 2021 (only took it for six months). I developed tinnitus out of the blue in April 2022. Overnight I have developed anxiety and depression. I am scared to get back on any SSRIs/benzos for fear of otoxicity. Is it possible damage to my ear was cumulative (use of headphones, etc) and perhaps Zoloft attributed to that?
Neil Bauman, Ph.D. says
Hi Lou:
Did you stop the Zoloft “cold turkey” or did you taper of it to some degree or other?
What happened in April that could have caused the tinnitus. Were you extra anxious, stressed or depressed? Did the anxiety and depression come as a result of the tinnitus–you worried about it and developed anxiety and depression? Or was it the other way around and you became anxious and depressed for some reason and that caused the tinnitus? Which came first?
If you exposed your ears to loud music, etc., that can certainly be the cause of your tinnitus. Noise damage is cumulative. Your ears can only accept so much abuse before they rebel so to speak and tinnitus is one result. Hearing loss is another.
Certainly Zoloft can contribute to tinnitus, but in your case, the tinnitus didn’t occur until 4 months later so I don’t really think the Zoloft was the culprit, but there is always a chance.
Cordially,
Neil
Lou says
Thank you so much for responding . I was pretty happy before the tinnitus started in April. So the tinnitus came before the anxiety/depression/insomnia. I would love suggestions on what to do for those. I may try CBT therapy to help me as well. If Zoloft didn’t cause my tinnitus (I did taper off) perhaps it would be safe to go back on it. I am so miserable. I have been using clonazapam sparingly.
Neil Bauman, Ph.D. says
Hi Lou:
Many people that develop tinnitus worry about their tinnitus–so they become anxious and depressed and that can certainly affect sleep.
I take it you had anxiety/depression long before you got the tinnitus and that was why you were on the Zoloft–correct? If so, you need to figure out what caused this in the first place and deal with it. Just trying to drug it into submission doesn’t get rid of the underlying cause, thus you are stuck with taking drugs. Have you tried a good psychologist/counselor that is skilled in helping people deal with their anxiety issues?
To me that would be a good first step.
Cordially,
Neil
Anne Mielnik says
I am taking 30 mgs of duloxetine and would like to change to st johns wart. what is the best way to do this
Neil Bauman, Ph.D. says
Hi Anne:
That’s a good question and I’m afraid I don’t have a good answer for you so what follows is just what I think may be a good approach.
What I’d do is taper down on the Duloxetine and at the same time taper up on the St. John’s Wort. Since you are not trying to totally get off needing to take anything, but changing from one thing to another, I think you could do a faster taper–perhaps over 3 months rather than a year. As you reduce the percentage of your dose of Duloxetine, increase that same percentage of St. John’s Wort. Thus, for example, by the time you’ve cut your Duloxetine by 25%, you are taking a 25% dose of St. John’s Wort, when you reach a 50% reduction of Duloxetine, you should be taking a 50% dose of St. John’s Wort and so on.
Remember, this is just my gut feeling, so take it for what it’s worth and then make up your own mind how you will proceed.
Cordially,
Neil
Marija says
I had hearing loss due to viral infection on my left ear 13 years ago. My right ear showed no signs of nerve damage but hearing on that ear come and go. I noticed that taking antibiotics (gentamicine) , antidepressants (paroxetine), dental anaesthesia make it worse to the degree that i cannot hear anything. After stopping the treatment hearing would come back in a week to month. Five months ago I was diagnosed with agitated depression and given ssri (fluoxetine) 20mg first two monts, 40mg next two months and 60mg last month. I should have continued with the last dose but last week (one month into 60mg dose) I woke up completely deaf on right ear. I stopped taking fluoxetine immediately but so far no improvemens. Hopefully this will not be permanent. Can St. John’s Wort help with agitated depression without affecting my hearing and if so please suggest dose.
Currently taking Alpha lipoic acid 600mg daily and NAC 600mg in case that may interfere with St. John’s Wort.
Thanks
Neil Bauman, Ph.D. says
Hi Marija:
As you have found, certain drugs can cause you to lose much hearing, but after you stop taking them, your hearing can largely come back again. This doesn’t always happen. The higher the dose, the more likely this is to happen. Thus, if you had stayed ta the 20 mg dose, your hearing might have remained, maybe even at the 40 mg dose, but the 60 mg dose was obviously too much and took out your hearing. You can still hope your hearing will come back, but there are no guarantees.
I’ve never heard of St. John’s Wort affecting hearing. But there is the odd case of it causing tinnitus, especially when taking it in super-high doses.
I’d start with the dose they suggest on the bottle. Typically that would be 300 mg capsules. The bottle I’m looking at says to take 1 capsule 3 times a day.
Make sure that somewhere on the bottle it says the words “standardized” “hypericin” and “0.3%” Unless it says those three things, you don’t have a clue what you are actually taking.
As far as I know, I don’t think taking Alpha lipoic acid and NAC will affect the St. John’s Wort, but that is just my gut feeling.
Cordially,
Neil
Sam says
Hi Dr Neil,
I’m likely going to have to take clomipramine for my severe ocd. Do you have any reports of permanent tinnitus from this drug or does it tend to go ways as per your post on tricyclics? Would I be better off with an SSRI?
Neil Bauman, Ph.D. says
Hi Sam:
Personally, I’d go with Clomipramine rather than an SSRI. It has a low risk of causing tinnitus and in numbers of people the tinnitus eventually goes away when you stop taking it. Note that the volume of tinnitus can be related to dose–the larger the dose, the louder your resulting tinnitus, so take the smallest dose that works and you may avoid tinnitus or have it quite soft.
Cordially,
Neil
Mike says
Hi Dr Neil, I have been on Lexapro for about 13 years and for 10 of those I was at 10mg. For the last 3 years I have been on 20mg/day. I also take 1mg of clonidine /day and 1800mg of gaba. I recently started tinnitus and am wondering if it could be the Lexapro or the other medicines combined. I have taken all three of these together for the last 3 years with no problems. Could this just develop from over time? No inuries to my ears or anything loud that has happened. Can I taper off these medicines myself? Thank you!
Neil Bauman, Ph.D. says
Hi Mike:
Many people get tinnitus when their dose is increased. That is why you could have been on the Lexapro for 10 years without any side effects showing up, then after the increase, your tinnitus showed up–albeit some years later.
That is one of the things about drugs–side effects can be delayed by days, weeks, months or years depending on whatever. I’m not saying it is so in your case, but it could be.
Are there any other factors coming into play now such as increased depression or anxiety or stress? Any of those could cause the tinnitus to occur now.
You could taper off them yourself, but it wouldn’t be wise. You should run it by your doctor first.
If it were me, I’d taper off the Lexapro first, then when you are safely off it, then the Clonidine. You might want to stay on the GABA.
Since you have been on the Lexapro for 13 years, you need to do a slow taper–something in the order of reducing the dose by 10% per month on the reducing balance. This will typically take you more than a year before you get to a safe jumping off spot.
Cordially,
Neil
Hili says
Hi, I suffer from otosclerosis as well as depression and anxiety, I would like to know which ssri/ antidepressant is safest to take and is least ototoxic? for me it’s hard to tell if the decline in hearing is due to otosclerosis or the new drug. was just put on fluvoxamine and I feel I’m experiencing tinnitus and hearing impairment, but I can’t tell for sure it’s because of the new drug. is tinnitus a passing side effect that will subside as the body adapts to the drug? is fluvoxamine considered safe? and what about brintellix?
I would appreciate any guidance or suggestion.
thank you, and thank you for this forum and for your time 🙏
Neil Bauman, Ph.D. says
Hi Hili:
Typically otosclerosis (at least at the start) causes a conductive loss. Drugs typically cause a sensorineural hearing loss. So your audiogram should show an air-bone gap if you have a conductive loss due to otosclerosis, and a sensorineural hearing loss if the drugs are damaging your hearing.
I think you’ll find that drug induced tinnitus tends to stay as long as you are on the drug–and may or may not go away when you get off the drug. This is also true of Fluvoxamine.
As far as ototoxicity goes, Fluvoxamine is mildly ototoxic. I rate it as a 1.5 out of 5 with 5 being severely ototoxic. However, if I needed an antidepressant, I’d not take a prescription drug, at all, but would take the herbal St. John’s Wort. It is as effective as the other anti-depressants and typically is not ototoxic, nor does it have all the other nasty side effects that prescription anti-depressants have.
Vortioxetine (Brintellix) is probably somewhat less ototoxic than Fluvoxetine, but I still rate it as a class 1.5. Of the two I’d likely choose Vortioxetine over Fluvoxetine.
Cordially,
Neil