Skip to content

Can Amitriptyline Cause Tinnitus? Exploring the Connection

3 min read

Globally, tinnitus affects more than 740 million adults [1.9.1]. For those taking certain medications, a key question arises: Can amitriptyline cause tinnitus? While listed as a possible side effect, the relationship is complex, as the drug is also used to manage tinnitus symptoms [1.6.1, 1.10.3].

Quick Summary

Amitriptyline, a tricyclic antidepressant, is linked to tinnitus as a rare side effect. Paradoxically, it's also prescribed off-label to alleviate the distress associated with chronic tinnitus.

Key Points

  • Dual Role: Amitriptyline can rarely cause tinnitus, but it is also used off-label to treat the distress associated with it [1.6.1, 1.10.3].

  • Uncommon Side Effect: Tinnitus is considered an uncommon or rare side effect of tricyclic antidepressants like amitriptyline [1.2.2, 1.4.1].

  • Mechanism: The exact way it causes tinnitus is unknown but is thought to involve changes in brain neurotransmitters affecting the auditory system [1.5.1, 1.5.5].

  • Consult a Doctor: Never stop taking amitriptyline suddenly if you develop tinnitus; consult your prescribing physician first to avoid withdrawal symptoms [1.10.2].

  • Treatment Focus: When used for treatment, amitriptyline helps manage the anxiety, depression, and insomnia linked to tinnitus, rather than eliminating the sound itself [1.6.3].

  • Dosage and Onset: Tinnitus has been reported at both high and low doses of amitriptyline, sometimes appearing shortly after starting the medication [1.4.2].

  • Reversibility: In many reported cases, drug-induced tinnitus resolves after the medication is discontinued under a doctor's guidance [1.4.5, 1.7.4].

In This Article

What is Amitriptyline?

Amitriptyline is a tricyclic antidepressant (TCA) that has been FDA-approved for treating depression since the 1960s [1.10.1, 1.10.5]. It works by increasing the levels of neurotransmitters like serotonin and norepinephrine in the brain, which helps regulate mood [1.5.3, 1.10.1]. Although effective, it's often not a first-choice treatment for depression today because newer medications, such as SSRIs and SNRIs, generally have fewer side effects [1.8.1, 1.8.3].

Beyond depression, healthcare providers frequently prescribe amitriptyline off-label for a variety of conditions, including [1.10.5]:

  • Chronic nerve pain (diabetic neuropathy, fibromyalgia)
  • Migraine prevention
  • Insomnia
  • Irritable bowel syndrome (IBS)

Common Side Effects

Like all medications, amitriptyline has potential side effects. The most common ones include drowsiness, dry mouth, dizziness, constipation, and weight gain [1.10.1, 1.10.3]. Due to its sedative effects, it is often taken at bedtime [1.10.2].

The Dual Role: Can Amitriptyline Cause Tinnitus?

Tinnitus, the perception of sound like ringing or buzzing without an external source, is listed as a potential side effect of amitriptyline and other TCAs [1.2.1, 1.3.1, 1.10.3]. This is known as ototoxicity, where a medication can cause damage or dysfunction to the ear [1.3.1, 1.3.4]. While possible, it is considered an uncommon or rare side effect [1.2.2]. Case studies have reported tinnitus developing after starting amitriptyline, sometimes even at low doses, and resolving after stopping the medication [1.4.2, 1.4.5]. The exact mechanism isn't fully understood but may involve the drug's impact on neurotransmitters in the brain's auditory pathways [1.5.1, 1.5.5]. An increase in serotonin levels from antidepressants can cause certain nerve cells in the brain to become hyperactive, potentially resulting in tinnitus [1.5.1].

A Paradoxical Treatment

Conversely, amitriptyline is also used as an off-label treatment for tinnitus [1.6.1]. Research suggests that for some individuals, particularly those with severe or chronic tinnitus accompanied by depression or anxiety, amitriptyline can provide relief [1.6.3, 1.6.4]. It doesn't cure the tinnitus itself but helps manage the emotional distress, anxiety, and insomnia that often accompany the persistent sound, improving overall quality of life [1.6.3]. Studies have found it can reduce tinnitus-related disability and improve symptoms [1.4.3, 1.4.4, 1.6.5].

Comparison: Cause vs. Treatment

To clarify this dual role, here is a comparison:

Feature Amitriptyline as a Cause of Tinnitus Amitriptyline as a Treatment for Tinnitus
Scenario Tinnitus begins or worsens after starting the medication [1.4.2]. Used to manage the emotional distress associated with chronic tinnitus [1.6.1, 1.6.3].
Mechanism A potential ototoxic effect or alteration of central auditory processing via neurotransmitter changes [1.5.1, 1.5.5]. Modulation of serotonin and norepinephrine to reduce associated depression, anxiety, and insomnia [1.5.3, 1.6.3].
Prevalence An uncommon or rare reported side effect [1.2.2, 1.4.1]. A common off-label application for managing severe or bothersome tinnitus symptoms [1.6.1].
Outcome Tinnitus often resolves after discontinuing the medication, though prolonged cases have been reported [1.4.5, 1.7.4]. Can lead to significant improvement in tinnitus-related disability and quality of life [1.4.4, 1.6.2].

What to Do If You Suspect Amitriptyline-Induced Tinnitus

If you start hearing ringing or other sounds in your ears after beginning amitriptyline, it's crucial to act carefully.

  1. Do Not Stop Taking the Medication: Suddenly stopping an antidepressant like amitriptyline can lead to withdrawal symptoms, including headache, nausea, and a worsening of depression [1.10.2].
  2. Consult Your Healthcare Provider: Inform your doctor about the new symptom immediately. They can assess the situation to determine if the tinnitus is related to the medication or another cause.
  3. Discuss Your Options: Your doctor may recommend several courses of action, such as adjusting the dosage, waiting to see if the side effect subsides, or switching to an alternative medication [1.7.4].

Alternatives to Amitriptyline

If amitriptyline is suspected of causing tinnitus, a doctor might suggest other antidepressants that may carry a lower risk. Alternatives can include other classes like SSRIs (e.g., sertraline, fluoxetine) or SNRIs (e.g., duloxetine, venlafaxine), though it's important to note that these classes have also been linked to tinnitus in some cases [1.2.1, 1.8.1]. The choice of an alternative depends on the individual's overall health profile, the condition being treated, and potential side effects [1.8.2].

Conclusion

The relationship between amitriptyline and tinnitus is complex. While it can cause tinnitus as a rare side effect, it is more frequently used to help manage the psychological burden of the condition. The perception of whether it is a cause or a cure depends heavily on individual patient response. Because of this dual nature and the risks of altering medication, anyone experiencing tinnitus while taking amitriptyline should seek professional medical advice before making any changes to their treatment plan. Communication with a healthcare provider is essential to safely navigate side effects and find the most effective treatment strategy.

For more information on tinnitus and its management, you can visit the American Tinnitus Association.

Frequently Asked Questions

Tinnitus is considered a rare or uncommon side effect of amitriptyline and other tricyclic antidepressants [1.2.2, 1.4.1].

In many cases, tinnitus caused by medication may be reversible and can resolve after the drug is stopped, but this should only be done under the supervision of a healthcare provider [1.7.4, 1.4.5]. Permanent cases, though rarer, have been reported [1.4.5].

Doctors prescribe amitriptyline for tinnitus not to cure the sound, but to treat the often-debilitating anxiety, depression, and insomnia that accompany the condition. It helps improve the patient's quality of life by managing these related symptoms [1.6.1, 1.6.3].

You should contact your prescribing doctor immediately. Do not stop taking the medication on your own, as this can cause withdrawal symptoms. Your doctor can help determine the cause and recommend the best course of action [1.10.2, 1.7.4].

Yes, other classes of antidepressants, including SSRIs (like Zoloft and Prozac) and SNRIs, have also been linked to tinnitus as a possible side effect [1.2.1, 1.2.4].

Tinnitus has been reported at various doses. Some case studies mention it occurring after a dose increase to 150mg/day, while at least one unusual case reported it after a short course of just 10mg [1.4.2].

If stopping the medication isn't an option, management strategies include sound therapies (like white noise machines), Tinnitus Retraining Therapy (TRT), hearing aids, and cognitive behavioral therapy (CBT) to help make the tinnitus less bothersome [1.7.1, 1.7.2].

References

  1. 1
  2. 2
  3. 3
  4. 4
  5. 5
  6. 6
  7. 7
  8. 8
  9. 9
  10. 10

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice.