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9.4) Treating Tinnitus: anti-depressants, tranquilizers, and muscle relaxants




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This article is from the Tinnitus FAQ, by markb@cccd.edu (Mark Bixby) with numerous contributions by others.

9.4) Treating Tinnitus: anti-depressants, tranquilizers, and muscle relaxants

Many tinnitus sufferers become depressed from having to deal with the
constant noise. Treating the depression may make the tinnitus seem
less severe. But beware that certain ototoxic anti-depressants may
_worsen_ tinnitus. SSRI anti-depressants may temporarily worsen
tinnitus for the first few weeks, but risk fewer side-effects as
compared to the older tricyclic drugs.

Tricyclic anti-depressants, such as Nortriptyline and benzodiazepines,
such as Alprazolam (Xanax) were used in one study in which some people
reported improvement.

Possible reasons:

(1) Patients just think they feel better (placebo effect).

(2) Since these drugs are central nervous system depressants, auditory
responsiveness diminishes.

(3) Tinnitus is stress-related - i.e. muscle tension in neck & jaw
restricts blood and lymph flow.

Alprazolam (Xanax)

A double-blind study with placebo control showed 76% of the subjects
benefited with tinnitus reductions of at least 40%, whereas only 5% of
the placebo subjects had an improvement. Try 0.5mg at bedtime. Can be
addicting, and may make you feel excessively mellow.

An abstract of an article describing the Xanax study:

Use of Alprazolam for Relief of Tinnitus
A Double-Blind Study
Robert M. Johnson, PhD; Robert Brummett, PhD; Alexander
Schleuning, MD
(Arch Otolaryngol Head Neck Surg. 1993:119:842-845)

OBJECTIVE: To systematically test the effectiveness of
alprazolam as a pharmacological agent for patients with
tinnitus.

DESIGN: Prospective, placebo-controlled, double-blind study.

PATIENTS: Forty adult patients with constant tinnitus who
had experienced their tinnitus for a minimum of 1 year and
who resided in the Portland, Oreg., metropolitan area.
Twenty patients were randomly assigned to the experimental
group and 20 to the control group.

RESULTS: Seventeen of 20 patients in the experimental
(alprazolam) group and 19 of the 20 in the placebo (lactose)
group completed the study. Of the 17 patients receiving
alprazolam, 13 (76%) had a reduction in the loudness of
their tinnitus when measurements were made using a tinnitus
synthesizer and a visual analog scale. Only one of the 19
who received the placebo showed any improvement in the
loudness of their tinnitus. No changes were observed in the
audiometric data or in tinnitus masking levels for either
group. Individuals differed in the dosages required to
achieve benefit from the alprazolam, and the side effects
were minimal for this 12-week study.

CONCLUSIONS: Alprazolam is a drug that will provide
therapeutic relief for some patients with tinnitus.
Regulation of the prescribed dosage of alprazolam is
important since individuals differ considerably in
sensitivity to this medication.

Reprint requests to 3515 SW Veterans Hospital Rd., Portland,
OR 97201 (Dr. Johnson).

Here's the Conclusion section of the article:

CONCLUSION. It appears that alprazolam is beneficial in
treating some patients with tinnitus. Because long-term use
of a benzodiazepine is not recommended, it probably should
be used as an option when the patient cannot benefit from
tinnitus maskers, hearing aids, or other therapy. Patients
who elect to continue taking the drug are prescribed it for
a maximum of 4 months. The dosage is then reduced by 0.25 mg
every 3 days before it is completely discontinued. Once the
drug therapy program has been terminated, it is not resumed
for at least 1 month. For some patients, the tinnitus
remained at a low level. Also, some patients are able to
continue the drug at daily dosages of 0.5 mg and 1.0 mg. It
is important to regulate the prescribed dosage of alprazolam
since individuals differ considerably with regard to
sensitivity to this medication.

Patients in the Portland study reported an average tinnitus loudness
of 7.5 dB before Xanax treatment, and 2.3 dB after.

Klonopin

Same class of drug as Xanax, but somewhat less effective and less
addictive. Klonopin has not been tested for tinnitus reduction in
rigorous scientific studies.

A word of warning:

Big-time antidepressants like the tricyclics and Prozac cannot be
expected to have an effect if the tinnitus sufferer does not suffer
from an affective disorder originating in brain chemistry. Minor
tranquilizers may help. But people should beware of trusting their
friendly local internist/GP to prescribe drugs of this type. Current
knowledge of psychopharmacology is essential. GP prescriptions of
these drugs have messed up more facets of people's lives than just
their hearing.

 

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