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allancurran

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 #1 

Hello Dr Nagler

Hope you are well and may I ask another question?

You might recall I've had Tinnitus since 1997.  In October 2018 I woke up with increased T and new sounds.  

Since 2015 I've been on Venlafaxine, which was prescribed to me when I fell into a depression following developing something very similar to MdBS.  I found the Venlafaxine took care of it pretty much straight away.  Going on the belief that if I came off Venlafaxine these symptoms might return, I simply stayed on it, albeit in a low dose [37mg per day].

7 to 8  weeks ago I questioned whether or not the Venlafaxine was making my tinnitus worse as a lot of people say its a fairly potent anti- depressant.  So, having consulted my GP, he switched me to Fluoxetine [20mg].

I seem to recall seeing an old post of yours on Tinnitus Talk asking about Prozac, so I thought I'd ask.

In the first few weeks of taking Fluoxetine nothing notable happened [My GP just switched me from one to the other] however in the past 3 weeks I've noted that my tinnitus frequency is very high and sounds seem louder.  I'm not experiencing ear pain or fullness.

Have you had any similar stories like this?

I'm now contemplating what to do....do I taper off anti-depressants altogether and see if there's an improvement in my Tinnitus; but I run the risk of sliding into a depression or do I try another anti-depressant?  Do you know of any anti-depressants to avoid or any that fair better than others for tinnitus and mood?

Thank you

Allan

 

 

 

 

 

 

 

Dr. Nagler

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 #2 
Allan, how long were you on the fluoxetine before you noticed a change in your tinnitus?

Stephen M. Nagler, M.D.

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No bird ever soared in a calm. Adversity is what lifts us.
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allancurran

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 #3 
Switched from V to F about 7 to 8 weeks ago, Its in this past 3 weeks that I noted sounds seem louder (although not painful) and my T more intense.

It's not like on week 4 I suddenly noted it but more like on week 7 I've looked back and 'wow these past few weeks have been intense'

I hope that helps?
Dr. Nagler

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 #4 
Got it. So it wasn’t until seven weeks after starting fluoxetine that you began to notice some slight changes in your tinnitus. May I ask what exactly makes you think it was specifically the fluoxetine that caused these changes?

Stephen M. Nagler, M.D.

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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
allancurran

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 #5 
I just don't recall my Tinnitus as being as severe or feeling like sounds bother me as when I was on the V.

Nothing specific, it's just the only real change.

Thank you
Dr. Nagler

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 #6 
I don’t think it was the fluoxetine. If it was, you’d have noticed a difference much earlier.

Seems to me you are trying to outguess your tinnitus. In my experience that is a strategy doomed to failure.

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
allancurran

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 #7 
Ok Dr Nagler, thank you. I'll be reviewing my medication with my GP in a week or two. I have read there was a study that showed SSRIs could aggravate T.
allancurran

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 #8 
Do anti depressants not take some time to build up in the system Dr Nagler?
Dr. Nagler

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 #9 
Quote:
Ok Dr Nagler, thank you.

You are welcome.

Quote:
I'll be reviewing my medication with my GP in a week or two. I have read there was a study that showed SSRIs could aggravate T.

SSRIs and around a gazillion other drugs have the potential to aggravate tinnitus, but they rarely do.

Quote:
Do anti depressants not take some time to build up in the system Dr Nagler?

Yes, it takes a while to achieve the maximum antidepressant effect pharmacologically. But as far as side-effects go, they generally show up within the first two or three weeks.

Stephen M. Nagler, M.D.

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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
allancurran

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 #10 

Hi Dr Nagler

Your last sentence - that's the thing, it was about week four (which is not too far from weeks 2 or 3) that I found that my T seemed higher pitched but when you have severe T anyway sometimes you don't automatically join the dots at the beginning, especially when nearly every day is a bad day.

Its only when you've had a subsequent 3 weeks [i.e week 7 of being on F] of every day being a bad day  do you then reflect and think 'Hey hang on a second, this has been this way now for almost three weeks and I'm certain it wasn't like this when I took the Venlaxafine'

Do you see what I mean?  I wouldn't normally start looking for reasons my tinnitus was seemingly worse after a few days of it seemingly being worse, but when it persists for weeks then you start to track back and wonder?  And then you start looking for potential reasons.

I'm also looking at my blood pressure meds as a potential culprit - losartan potassium - but the switch from V to F has been the only notable change.

If I switch medications or taper off altogether I shall let you know if there has been a change.  The downside for me is its a vicious circle:  I suffer low mood/depression because I  have tinnitus so I take an anti-depressant to boost my mood which helps me live with the tinnitus  but in turn may make my  tinnitus worse ....inhale.....for which I take an anti-depressant for to help me cope with it and then I realise now I don't know what the Hell to do for the best.

I either switch meds; go back to V or come off and see what happens all the while running the risk of my mood plummeting.

Tinnitus is a curse.

Thank you again.

 

Dr. Nagler

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 #11 

 

Quote:
Your last sentence - that's the thing, it was about week four (which is not too far from weeks 2 or 3) that I found that my T seemed higher pitched but when you have severe T anyway sometimes you don't automatically join the dots at the beginning, especially when nearly every day is a bad day.

Its only when you've had a subsequent 3 weeks [i.e week 7 of being on F] of every day being a bad day  do you then reflect and think 'Hey hang on a second, this has been this way now for almost three weeks and I'm certain it wasn't like this when I took the Venlaxafine'

Do you see what I mean?  I wouldn't normally start looking for reasons my tinnitus was seemingly worse after a few days of it seemingly being worse, but when it persists for weeks then you start to track back and wonder?  And then you start looking for potential reasons.


Yes, I see what you mean. And I honestly think you are going about this all wrong.

Quote:
I'm also looking at my blood pressure meds as a potential culprit - losartan potassium - but the switch from V to F has been the only notable change.

If I switch medications or taper off altogether I shall let you know if there has been a change.  The downside for me is its a vicious circle:  I suffer low mood/depression because I  have tinnitus so I take an anti-depressant to boost my mood which helps me live with the tinnitus  but in turn may make my  tinnitus worse ....inhale.....for which I take an anti-depressant for to help me cope with it and then I realise now I don't know what the Hell to do for the best.

I either switch meds; go back to V or come off and see what happens all the while running the risk of my mood plummeting.


Having truly suffered from severe depression, I can tell you that if I found a drug that helped appreciably, I would stay on it - - even if I thought it made my tinnitus a bit louder.

 

Quote:
Tinnitus is a curse.

Tinnitus is not a curse. Tinnitus is a sound that is not associated with a sound wave. It therefore has no power of its own and thus cannot be a curse. What is making your tinnitus a curse is your reaction to it. It is not your fault that you react to your tinnitus the way you do. But the problem is your reaction nonetheless. It saddens me that you have yet to grasp this basic principle.

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
allancurran

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 #12 

Hi Dr

Thanks for the quick response.

I admire your backbone I must say [in relation to willing to have increased T if your depression was helped] , although I can understand that depression is often the bigger problem.

I do grasp what you mean regarding its my reaction to the T that is the problem, not the noise itself.  Its just a hard bitter pill to swallow when you can almost feel this high pitched ring sitting beneath the surface of your skin on your ear.  Sometimes I just want to scoop it out with an ice cream scoop or stick a drill in it to kill 'it'.

I'm currently trying to get these rules into my thick skull:

A - accept it and realise....

C - Can't change it

C - Can't control it

C - Can control how I react

But that's not a very good mnemonic!

Thanks again.

 

All the best 

 

Allan

Dr. Nagler

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 #13 
Quote:
I admire your backbone I must say [in relation to willing to have increased T if your depression was helped] , although I can understand that depression is often the bigger problem.

Overcoming tinnitus does not take backbone. Overcoming tinnitus takes strategy. Allen, if you are in London and want to drive to Manchester, all the backbone in the world will not help if you insist on driving south.

Quote:
I'm currently trying to get these rules into my thick skull:

A - accept it and realise....
C - Can't change it
C - Can't control it
C - Can control how I react

Well, for sure you didn't get those rules from me. For instance, I have never suggested that anybody try to "accept" his or her tinnitus. I certainly do not accept mine. And as far as your fourth rule goes, I do not believe you can consciously control your reaction to your tinnitus. The forces at work there are largely subconscious.

I wish you well.

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
allancurran

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Posts: 41
 #14 

Thank you for your response Dr Nagler, I'm trying I know.

May I ask you another question?

I believe I mentioned in my anti-depressant post about sensitive hearing and protection?

In the past few weeks I've been wary of things like doors slamming; kids screaming; kitchen noises [plates etc] passing buses; open plan office chatter; fire alarms going off; hand driers;  road traffic noise both when walking in the street and whilst driving.

I still dont get any pain; discomfort or fullness when I hear these noises - I just seem to hone in on them and my awareness is high that they are there.  Recently I'm feeling that anxiety surge in anticipation of these noises.

Have you come across this?  Is it more akin to phonophobia than it is hyperacusis?  How do I treat it?

 

 

Dr. Nagler

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 #15 

Quote:
Thank you for your response Dr Nagler, I'm trying I know.

Not a problem. Tinnitus and DST (Decreased Sound Tolerance) can be quite a challenge.

Quote:
May I ask you another question?

Sure.

Quote:
I believe I mentioned in my anti-depressant post about sensitive hearing and protection?
In the past few weeks I've been wary of things like doors slamming; kids screaming; kitchen noises [plates etc] passing buses; open plan office chatter; fire alarms going off; hand driers;  road traffic noise both when walking in the street and whilst driving.
I still dont get any pain; discomfort or fullness when I hear these noises - I just seem to hone in on them and my awareness is high that they are there.  Recently I'm feeling that anxiety surge in anticipation of these noises.
Have you come across this?

Sure I have come across it. Numerous times!

Quote:
Is it more akin to phonophobia than it is hyperacusis?

What did your LDL testing reveal?

Quote:
How do I treat it?

That would largely depend on the results of your LDL testing. Please answer the above question so I can answer yours.

Best regards -

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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