Table 4.
Reported Cases of Tinnitus Coinciding With Antidepressant Treatment
| Author | Presentation | Outcome | Summary |
| Robinson et al51 | A 32-year-old woman abruptly discontinued venlafaxine 100 mg 3 times/d; tinnitus and other discontinuation symptoms occurred within 36 hours | Restarting the medication at 100 mg resulted in resolution of all symptoms within 2 hours |
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| Ahmad52 | The patient appeared to have experienced severe tinnitus as a side effect of venlafaxine; no organic cause for the tinnitus was identified | Venlafaxine was discontinued, and the patient's tinnitus disappeared over the next 7 days; the patient's tinnitus recurred when rechallenged with venlafaxine 75 mg/d; the patient stopped taking venlafaxine, and the tinnitus again subsided and did not recur |
|
| Feder53 | The patient was started on a dose of amitriptyline 50 mg at bedtime that was increased to 100 mg at bedtime at the end of the first week and increased to 150 mg at bedtime at the end of the second week; onset of bilateral tinnitus occurred 2 days later | Amitriptyline treatment was discontinued at the end of the third week because of tinnitus; within 1 week of stopping the medication, the tinnitus resolved; amitriptyline 50 mg at bedtime was started again 3 weeks later; within 2 weeks, the tinnitus recurred; the medication was again discontinued, and the tinnitus resolved within 4 days |
|
| Pondrom and Brahm54 | The patient started venlafaxine; at 4-week reevaluation, the patient reported the new onset of tinnitus and described the sensation as a bilateral constant ringing in the ears that was extremely bothersome but not disabling and occurred in episodes throughout the day with no clear pattern | The patient was switched to decenlafaxine succinate and reported decreased frequency and duration of tinnitus with nearly complete resolution within 7 days |
|
| Racy and Ward-Racy55 | A 37-year-old woman was prescribed imipramine 50 mg/d; after 1 week, she reported that ringing in her ears had started 2 to 3 days after starting imipramine; the tinnitus was so unpleasant that she did not want to continue treatment | The patient's tinnitus stopped when the imipramine dose was lowered to 25 mg/d as advised by her therapist |
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| Racy and Ward-Racy55 | A 15-year-old girl was prescribed imipramine on a graduated regimen of up to 150 mg/d; when the imipramine dose reached 150 mg/d, she complained of ringing in her ears | The patient's medication was reduced to 125 mg/d, and the tinnitus stopped |
|
| Racy and Ward-Racy55 | A 30-year-old woman was prescribed imipramine 100 mg/d; when the dosage was increased to 150 mg/d, she began to complain of nausea and a buzzing sound in her ears | When the medication was reduced to 100 mg/d, her nausea and tinnitus subsided, but she again became depressed; her therapist attempted to find a therapeutic level, increasing the dosage by 10-mg increments; the tinnitus and nausea returned at 120 mg/d; she achieved clinical improvement with 110 mg/d and suffered no further tinnitus |
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| Racy and Ward-Racy55 | A 31-year-old man was prescribed imipramine 150 mg/d and complained of distinct ringing in his ears | When the medication was reduced to 75 mg/d, the ringing was still present but somewhat milder; the patient's therapist discontinued imipramine and substituted desipramine at a dosage of 100–150 mg/d; the patient's tinnitus did not return, and he found the medication helpful |
|
| Evans and Golden56 | A 45-year-old woman began treatment with protriptyline 15 mg/d (divided dose) and increased the dose every 2 days until a dose of 45 mg/d (divided dose) was reached on day 10; she complained of tinnitus (ringing in both ears) 2 days later | Tinnitus persisted for the next 21 days as protriptyline was decreased to 30 mg/d (divided dose); the patient noted moderate amelioration of side effects, but due to continued subjective discomfort, protriptyline was replaced with desipramine at a dose of 75 mg/d, and she experienced only occasional mild tinnitus; desipramine was increased 2 days later to 100 mg/d with no increase of side effects; while taking protriptyline 45 mg/d, the patient subjectively rated the severity of her tinnitus as 6 on a 10-point scale; with dosage reduction, the severity decreased to 4, and with the change to desipramine, she rated her tinnitus as 1 to 2 on the same 10-point scale |
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| Mendis and Johnston57 | A 40-year-old woman developed persisting tinnitus after 3 days’ intake of 10 mg amitriptyline, which had been prescribed for neuralgic foot pain; after starting amitriptyline, the patient complained of sudden-onset severe unilateral left-sided tinnitus | Medication was stopped; however, when the foot pain resolved, the tinnitus persisted; at follow-up 4 months later, the tinnitus had made some gradual improvement and 7 months later was shown to persist at the same level |
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| Langguth et al58 | A 39-year-old man experienced the onset of intense bilateral tinnitus after 3 days of trimipramine intake; he had experienced short episodes of transient tinnitus 8 years previously | Trimipramine was increased from 50 mg to 100 mg and then changed at 6 weeks to amitriptyline 50 mg, but the tinnitus worsened; the patient was switched to citalopram 20 mg, but the depressive episode was not alleviated; the patient was switched to mirtazapine 30 mg, which was augmented with lithium carbonate 900 mg 8 months later |
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| The present case | A 46-year-old woman experienced tinnitus when venlafaxine was discontinued | Tinnitus continued despite reintroduction of venlafaxine |
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