Can mirtazapine cause tinnitus?

In this blog post, we are going to answer the question, “Can mirtazapine cause tinnitus?”. Mirtazapine is an antidepressant which is used to treat a variety of mental health conditions. This antidepressant is associated with a number of side effects ranging from mild to severe. 

Some of the side effects are quite common, while others are rare. This blog will cover the possibility of mirtazapine causing tinnitus and what could be done to get rid of it. 

Can mirtazapine cause tinnitus?

Yes, mirtazapine can cause tinnitus in some individuals, but is a rare side effect. Experts believe that some underlying health conditions can make you more susceptible to this side effect and healthy people have less chances of getting tinnitus.

However, it totally depends on how your body reacts to these medications. In some cases, healthy individuals were found struggling with tinnitus and they had no prescription medication other than mirtazapine. 

This indicates that even if you don’t have any health condition, mirtazapine may still cause tinnitus. It is impossible to predict how your body will react once it is exposed to this medication. 

Some people are sensitive to medications in general and may suffer from unusual side effects which may not be common in other individuals. Some studies have indicated that tinnitus can be caused by several other health conditions and mirtazapine may help with it. 

More research is needed, however, because experts are working to find the safety and efficacy of mirtazapine in tinnitus caused by other reasons. Make sure you immediately report to your healthcare provider if you begin to notice your hearing being compromised.

Tinnitus is characterised as a sensation of ringing ears. You hear some kind of a sound in your ears like ringing, ticking, clicking, buzzing or whistling. 

You could either hear them continuously or after short intervals. This condition gets pretty disturbing when you’re trying to sleep in a silent, peaceful room. Tinnitus affects a lot of people annually. It has different causes and different severity levels. 

It could be a symptom of some underlying health condition or a side effect of certain medication. Drugs which cause tinnitus, hearing loss or different ear/hearing related side effects are known as ototoxic drugs. 

Mild ringing in the ears usually subsides on its own, but sometimes it causes serious disturbance and you might need to discontinue your treatment with mirtazapine, in order to get rid of tinnitus. 

How can mirtazapine cause tinnitus?

Mirtazapine (Remeron) is an antidepressant. It does not belong to any typical class of antidepressants and its mechanism of action is different from SSRIs and SNRIs. It does not block the reuptake of serotonin by any pathway. 

Mirtazapine belongs to the tetracyclic antidepressants. It has a dual mode of action. Mirtazapine is believed to be responsible for the activation of 5-HT1 receptors, which are one of the serotonin receptors. This antidepressant also acts on the noradrenergic system. 

Experts believe that remeron enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin. It also prevents the inhibitory action of the noradrenergic system which hinders the release of serotonin. 

This increased amount of serotonin, which is an excitatory chemical, has multiple effects on your body and brain. It can cause hyperactivity of nerve cells which support hearing and can make you feel like you’re constantly listening to some ringing, ticking, or buzzing etc. 

In some cases, tinnitus begins as a symptom of mirtazapine withdrawal after stopping this antidepressant abruptly. It is also seen in people who tapered off mirtazapine after a long duration of treatment. 

Is there anything that can help you with mirtazapine induced tinnitus?

There are a few you can do to help relieve the symptoms of tinnitus. These include:

Talk to your doctor

The first thing to do is to let your doctor know about your side effects. If it is mild, it is usually advised to not do anything about it as it will begin to subside on its own. If it’s not, then your doctor looks forward to making a move. 

The first approach to get rid of tinnitus is to stop using the culprit medicine, which in this case is mirtazapine. If your tinnitus causes serious difficulty, it most likely indicates that your antidepressant doesn’t suit you and it’s time to change it. 

After discontinuation of depression treatment with mirtazapine, tinnitus begins to subside within 2 to 3 weeks. Make sure you taper off mirtazapine properly in order to avoid withdrawal symptoms. 

Noise cancelling devices

It is difficult to treat tinnitus itself. The best approach is to deal with the underlying condition that causes it in the first place, but your doctor may recommend some noise cancelling device to tone down ringing in your ears. 

This really helps to relieve some of the symptoms and irritability that comes with them.. 

Get your earwax removed 

You can try removing your earwax. Clearing up your ears can sometimes reduce the symptoms of tinnitus, as the built-up wax adds pressure to your ear canal and makes you hear unwanted rigning sounds. 

Therapies for tinnitus 

There are no known medications to treat tinnitus but several therapies are available to help reduce the symptoms. 

For people who can’t seem to get away with it, therapies like Tinnitus retraining therapy (TRT) and Cognitive behavioural therapy (CBT) are used to learn how to cope with tinnitus. 

Cut back on excessive caffeine and alcohol 

Make sure you don’t use any such thing that can contribute to your tinnitus. Limit the intake of alcohol and caffeine, as they can have an impact on your already existing tinnitus. 

When to call your doctor

Reach out to your healthcare provider if:

• You keep hearing loud ringing, buzzing or ticking in your ears. 
• You feel some kind of pain or pressure in your ears
• You stay up all night because of your tinnitus symptoms 
• You feel like your hearing ability is declining 
• You get fever with chills
• You experience burning sensation tight after taking your mirtazapine. 
• You experience unexplained weight gain or loss 
• You experience any other unusual side effects.

What other medications can cause tinnitus? 

Tinnitus could be a side effect of your mirtazapine but use of some other medications are more common causes of tinnitus. Such meds include:

Non-steroidal anti-inflammatory drugs (NSAIDS) 

Non-steroidal anti-inflammatory drugs and aspirin can cause tinnitus. This is more common when you’re taking a high dose of these drugs. 

Do not use these for a longer period of time as they not only cause ototoxicity but can also cause several other side effects like gastric pain, diarrhoea, acid reflux, etc. 

They are also not recommended to use concomitantly with mirtazapine, as the combination may increase the risk of bleeding. 

Antibiotics 

Antibiotics are antibacterial agents which are used to treat moderate to severe kinds of bacterial infections. These agents are known to cause tinnitus, including azithromycin, tobramycin, clarithromycin, gentamicin, streptomycin etc. 

These drugs are well known for producing ototoxicity, hepatotoxicity and nephrotoxicity. Fluoroquinolones (moxifloxacin, levofloxacin, ciprofloxacin) can also cause tinnitus. 

High ceiling loop diuretics

Diuretics are used to remove excess sodium and water from your body. This class of diuretics include the most commonly used med, furosemide (lasix). They can cause tinnitus and loss of hearing. 

Beta-blockers

Beta-blockers are antihypertensives. They are also used to manage cardiac activity in patients with coronary artery diseases (CAD). These agents are also known to produce tinnitus or ringing in the ears. 

Make sure you’re not using any one of the above mentioned drugs along with mirtazapine, which might enhance your tinnitus. Always talk to your healthcare provider if you have to take multiple medications at the same time. Some medications are incompatible with one another.

They cancel out each other’s beneficial effects and cause even more side effects. Drug-drug interaction is a serious issue. It’s better to check if your medicines are safe to take concomitantly. 

Conclusion

In this blog, we learned about mirtazapine induced tinnitus. Tinnitus is characterised as a sensation of ringing ears. You hear some kind of a sound in your ears like ringing, ticking, clicking, buzzing or whistling. You could either hear them continuously or after short intervals.

Mirtazapine induced tinnitus, if mild, usually goes away in 3 to 4 weeks of treatment. For some people, it can take much longer, up to 4 to 5 months, but extreme ringing in the ears indicates that you need to stop your antidepressant as it’s not the right choice for you. 

Make sure you use this medication or any other medication only when your doctor has advised it. Using medications which can affect your brain is not something ideal and should not be encouraged unless it is absolutely necessary to do so. 

FAQs: mirtazapine tinnitus

Can taking mirtazapine cause tinnitus?

Yes, mirtazapine can cause tinnitus in some individuals, but is a rare side effect. Experts believe that some underlying health conditions can make you more susceptible to this side effect and healthy people have less chances of getting tinnitus.

However, it totally depends on how your body reacts to these medications. In some cases, healthy individuals were found struggling with tinnitus and they had no prescription medication other than mirtazapine. 

Which antidepressant is best for tinnitus?

Tricyclic antidepressants (TCAs) can be used to help relieve the symptoms of tinnitus in people suffering from mental health conditions associated with ringing in the ears. Some studies indicate that SSRIs might also be used, but the results are inconclusive. 

Can tinnitus go away if you quit your antidepressants?

Yes, if your antidepressant is the one causing it. In this case, the first approach is to stop using your antidepressant. If your tinnitus causes serious difficulty, it most likely indicates that your antidepressant doesn’t suit you and it’s time to change it. 

After discontinuation of depression treatment with antidepressant, tinnitus begins to subside within 2 to 3 weeks. 

Can antidepressants cause permanent tinnitus?

No, antidepressants don’t cause permanent tinnitus and not all antidepressants can produce this side effect. If you’re experiencing antidepressant induced tinnitus, inform your healthcare provider. If it is mild, it might go away on its own within 2 to 3 weeks. 

If it is severe, you may have to change your antidepressant as it clearly isn’t the right choice for you. Do not change or stop your antidepressant without your doctor’s approval. 

What medications make tinnitus worse?

• Antibiotics, including azithromycin, tobramycin, clarithromycin, gentamicin, streptomycin etc. 
• Non-steroidal anti-inflammatory drugs and aspirin
• Diuretics, including the most commonly used med, furosemide (lasix)
• Beta blockers
• Chemotherapeutic agents
• Controlled substances

References

• R N Golden et al. Arch Intern Med. (1994) – Antidepressants and tinnitus https://pubmed.ncbi.nlm.nih.gov/8002694/
• Zheng-Quan Tang, Laurence O. Trussell (2017) – Serotonergic Modulation of Sensory Representation in a Central Multisensory Circuit Is Pathway Specific https://www.cell.com/cell-reports/fulltext/S2211-1247(17)31098-7?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2211124717310987%3Fshowall%3Dtrue
• S A Anttila et al. CNS Drug Rev. Fall (2001) – A review of the pharmacological and clinical profile of mirtazapine https://pubmed.ncbi.nlm.nih.gov/11607047/
• Mirtazapine Tablet – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-13706-4047/mirtazapine-oral/mirtazapine-oral/details#:~:text=Mirtazapine%20is%20used%20to%20treat,(neurotransmitters)%20in%20the%20brain.
• National Library of Medicine – Mirtazapine https://medlineplus.gov/druginfo/meds/a697009.html