Dr. Nagler's Tinnitus Corner
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Aegyo

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 #16 
I saw you mention that people with fluctuating tinnitus have a much harder time habituating. That’s why I feel like a lost cause.

It makes me so sad when it fades and comes back. Soul destroying.

What is your experience with patients whose tinnitus is stress/depression induced? I have no experience with antidepressants and this is only day 4 on Mirtazapine.
Dr. Nagler

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 #17 
Quote:
I saw you mention that people with fluctuating tinnitus have a much harder time habituating. That’s why I feel like a lost cause.

I do not believe I ever said that people with fluctuating tinnitus have a much harder time habituating. In fact, with TRT the data indicate that the success rates for fluctuating tinnitus and for non-fluctuating tinnitus are similar. And you are doing TRT!

Quote:
What is your experience with patients whose tinnitus is stress/depression induced?

With TRT the cause of the tinnitus is irrelevant.

Seems to me that you may be over-thinking this whole process, and the result is that you are trying to find reasons that you are doomed to fail instead of allowing yourself to succeed. Why don't you show this thread to your TRT clinician, and see if she doesn't agree with me.

All the best -

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Aegyo

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 #18 
It was on Tinnitustalk that I read you replying that to someone and it made me a bit scared. Am trying to find the thread so you can clarify :)

I am indeed overthinking it. That’s the joy of severe depression and panic disorder. I’ve never been on antidepressants before, so I’m hoping the Mirtazipine will nudge my emotions into a better direction.

Technical question though. Will ask my TRT clinician too, but I don’t think she is working tomorrow, so asking you is quicker :)

Am I supposed to hear the shhhhhhh all the time, in any surrounding? Because in the supermarket for instance, I hear my tinnitus loud and clear (as it reacts to sounds), but then I don’t hear the in ear generators. Seems counter productive.
Dr. Nagler

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 #19 
Quote:
It was on Tinnitustalk that I read you replying that to someone and it made me a bit scared. Am trying to find the thread so you can clarify 😉

I have not posted there in more than three years. Perhaps you have me confused with somebody else?

Quote:
Technical question though. Will ask my TRT clinician too, but I don’t think she is working tomorrow, so asking you is quicker 😉

Asking me may at times be quicker, but asking your TRT clinician is far better! Really. She knows you; I do not. She can address your concerns specifically as they apply to you. I can only speak in generalities. I am glad to help and am flattered that you would seek my opinion on a matter of such importance to you, but you are definitely better off asking your own clinician.

Quote:
Am I supposed to hear the shhhhhhh all the time, in any surrounding? Because in the supermarket for instance, I hear my tinnitus loud and clear (as it reacts to sounds), but then I don’t hear the in ear generators. Seems counter productive.

In TRT you set your devices as directed in the morning - and then you leave things as they are regardless of the sound around you. Even if you do not hear your devices in the supermarket, your brain does!

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Aegyo

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 #20 
Hi dr Nagler,

It's been quite a ride since I last posted...

I'm currently under the care of a psychiatric crisis team. A mental health nurse and/or psychiatrist comes to my house every day to try and stabilise me somewhat (and check that I'm still alive...). My psychiatrist says the tinnitus is a "psychogenic manifestation of severe mental health distress".

Losing a child wasn't the only horrible thing that happened in the past couple of years. It has been a non-stop string of terrible things and the general consensus seems to be that my brain is basically saying ENOUGH. And that the sound reactivity of the tinnitus is also directly correlated to my mental health; that my brain is overstimulated by anything and everything at the moment as I'm in this massive, chronic, Fight/Flight mode.

I have 9 different sounds at the moment. 7 Base sounds and 2 different sounds when it reacts to something. It fluctuates very much during the day and I have these daily moments where it suddenly completely backs off into the background.

That's something that I have noticed since wearing the TRT WNG's though. I set them in the morning and leave them alone. During the day they sometimes sound really loud and I now have these moments where I can barely hear them or where I'm completely unaware of them. And the tinnitus kinda flows along with that. So that gives me a bit of a hint what my brain is focusing on at that time. Loud WNG's, loud tinnitus and vice versa.

I wear them all day, only taking them out to shower and sleep.

EMDR has been stopped because I'm so unstable and they won't let me do CBT (yet) for that same reason either. So I'm contemplating starting the Henry & Wilson book on my own, alongside the TRT I'm already doing.

My next TRT appointment is this upcoming Monday.

I feel extremely guilty though. I've been taking Oxazepam and I know that TRT strongly opposes the use of Benzos. I was on Xanax Retard for 4 days but it didn't have any effect on my panic attacks, so I'm back on the Oxazepam, which does take the edge off a tiny bit. I'm so worried it will do the tinnitus harm in the long run though.

And I'm on Mirtazapine, but from what dr Hubbard told me, it can take a bit longer to kick in and my doctor started me on a very low dose to carefully see what it would do to me. So we're upping the dosage slowly, I've been on the minimum dosage for 4 days now. Waiting for it to kick in is difficult. I want to feel happier NOW...but it doesn't work that way of course. Patience is required.

Anyway, I know I ramble quite a bit when I post here. But it's nice to be able to vent to someone who actually understands the distress. And I know I didn't really ask any questions, but your thoughts are always appreciated. I like your direct approach...it's very Dutch ;)

I go from feeling like a lost cause to wanting to trust my psychiatrist that once we stabilise the depression, other things will fall into place.
Dr. Nagler

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 #21 
Aegyo posted [in part]:

Quote:
Anyway, I know I ramble quite a bit when I post here. But it's nice to be able to vent to someone who actually understands the distress. And I know I didn't really ask any questions, but your thoughts are always appreciated. 

I am flattered that you feel comfortable enough to vent here. Truly I am. And I absolutely do understand your distress. But this board is really designed for specific questions and answers, not to "unload" and ask for my thoughts on your numerous very real concerns. That's what therapy is all about! The difficulty, as I see it, is that you really do not have a tremendous amount of confidence in the people you have engaged to help you. It's like you are throwing a bunch of mud against the side of a barn and hoping that something might stick.

If you wish, you can contact me off the board, and we can schedule an hour or so to talk either by phone or Skype in the hopes that we can at least get you pointed in the right direction and possibly resolve some of the conflicting suggestions that those who are trying to help you are presenting.

I will keep a good thought for you.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Aegyo

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Posts: 13
 #22 
I'm doing TRT already, but do you know of anyone specific in the Netherlands who does (CBT) therapy for tinnitus patients?
Dr. Nagler

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 #23 
Sorry, I do not know anybody in The Netherlands well enough to make a recommendation one way or the other. I do know a couple of very good people who work long distance via Skype, but I do not know anybody located in The Netherlands.

Can you put into one sentence that any lay person can understand exactly what you hope to accomplish using TRT or CBT?

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.