Which Antidepressants Are Most Likely to Cause Tinnitus?

October 12, 2025 •

4 min read

Approximately 10-15% of the global population experiences tinnitus, a condition some antidepressants can trigger or worsen. Several types of antidepressants are associated with this side effect, prompting patients and clinicians to consider which antidepressants are most likely to cause tinnitus.

Quick Summary

Antidepressants, including SSRIs, SNRIs, and bupropion, have been linked to causing or worsening tinnitus. The risk varies, is sometimes dose-dependent, and may resolve upon discontinuation. The mechanism involves effects on neurotransmitter systems in auditory pathways.

Key Points

SSRI Tinnitus Link: SSRIs like Sertraline (Zoloft) and Fluoxetine (Prozac) have documented reports of causing or worsening tinnitus, potentially due to increased serotonin affecting auditory pathways.
High Incidence with Bupropion: The NDRI bupropion (Wellbutrin) is noted in clinical trial data for having a higher reported incidence of tinnitus compared to placebo, particularly at higher doses.
SNRI Association: SNRIs, including Venlafaxine (Effexor), are also linked to tinnitus, which can appear either during treatment or as a withdrawal symptom upon discontinuation.
TCAs Also Involved: Older tricyclic antidepressants (TCAs) such as Amitriptyline and Nortriptyline have reported associations with tinnitus.
Consult a Doctor: If you experience tinnitus while on an antidepressant, you must speak with a healthcare provider and never stop the medication abruptly to avoid severe withdrawal symptoms.
Dose-Dependent Effect: For certain antidepressants, including bupropion, the risk and severity of tinnitus can be influenced by the dosage.
Mechanism is Complex: The exact way antidepressants cause tinnitus is not fully understood but is thought to involve the disruption of neurotransmitter signaling in the brain's auditory centers.
Underlying Condition Factor: Pre-existing anxiety or depression can complicate the relationship with tinnitus, making it difficult to isolate the medication as the sole cause.
Management Options Exist: Management strategies for antidepressant-induced tinnitus include dose adjustment, switching medications, sound therapy, and counseling.

Antidepressants are crucial for treating mental health conditions, but some classes have been linked to causing or worsening tinnitus, affecting an estimated 10-15% of the global population. This side effect is often dose-dependent and typically resolves after stopping the medication, though it can persist. The exact mechanism is not fully understood but is thought to involve the medication's impact on neurotransmitters in the auditory pathways.

Classes of Antidepressants and Tinnitus Risk

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs increase serotonin levels and have been linked in case reports to new or worsened tinnitus. Serotonin's role in the auditory system suggests increased levels may exacerbate tinnitus. Common examples include Fluoxetine, Sertraline, Paroxetine, and Escitalopram. The proposed mechanism involves potential dysregulation of serotonergic modulation in auditory pathways.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs increase both serotonin and norepinephrine. They are associated with tinnitus as a side effect or a withdrawal symptom. Venlafaxine is a common SNRI with reported cases of tinnitus. Their dual action likely impacts auditory processing.

Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)

Bupropion (Wellbutrin), an NDRI, has a notable association with tinnitus, listed as an adverse reaction on its label, and is often dose-dependent. Clinical trials have shown a higher incidence of tinnitus with bupropion compared to placebo. The proposed mechanism relates to its effects on dopamine and norepinephrine systems influencing auditory signaling.

Tricyclic Antidepressants (TCAs)

Older TCAs, like Amitriptyline and Nortriptyline, have also been linked to tinnitus. Tinnitus can occur as a side effect or during withdrawal.

Comparison of Antidepressants and Tinnitus Risk


Antidepressant Class	Common Examples	Mechanism of Action	Proposed Tinnitus Link	Noteworthy
SSRIs	Sertraline (Zoloft), Fluoxetine (Prozac)	Increases serotonin levels in the brain.	Modulation of serotonergic activity in the auditory pathways, potentially exacerbating tinnitus.	Reports of tinnitus onset or worsening are frequent with several SSRIs.
SNRIs	Venlafaxine (Effexor)	Increases serotonin and norepinephrine levels.	Similar to SSRIs, due to effects on serotonin and potential involvement of norepinephrine.	Case reports link tinnitus to both the initiation and discontinuation of venlafaxine.
NDRIs	Bupropion (Wellbutrin)	Inhibits reuptake of norepinephrine and dopamine.	Enhanced dopaminergic signaling affecting the auditory pathway, which is relevant to tinnitus perception.	Higher incidence reported in some clinical trials compared to placebo; risk is dose-dependent.
TCAs	Amitriptyline (Elavil), Nortriptyline (Pamelor)	Blocks reuptake of serotonin and norepinephrine.	Modulation of neurotransmitters in the central nervous system, affecting auditory nuclei.	Tinnitus can be a side effect, but the relationship is complex; some patients report improvement while others experience worsening.

Other Factors Influencing Antidepressant-Induced Tinnitus

Underlying conditions like depression or anxiety can increase the likelihood of experiencing tinnitus, making it hard to distinguish from medication effects. Dosage also plays a role, with higher doses sometimes increasing the risk, particularly with bupropion. Antidepressants are considered potentially ototoxic, but the exact mechanism for tinnitus is still debated, focusing on neurotransmitter impacts.

What to Do If You Develop Tinnitus on Antidepressants

Do not stop taking your medication suddenly. Abrupt discontinuation can worsen withdrawal symptoms, including tinnitus.
Contact your healthcare provider. Discuss your symptoms to determine if the antidepressant is the cause and rule out other factors.
Explore dosage adjustment or switching. Your doctor might recommend a lower dose or a different antidepressant class.
Consider alternative management strategies. Sound therapy, stress reduction, and counseling can help manage tinnitus symptoms.

Conclusion

SSRIs, SNRIs, NDRIs (like bupropion), and TCAs have been associated with tinnitus, although the risk and incidence vary. The mechanism is complex and likely involves neurotransmitter effects in the auditory system. If you experience tinnitus while on an antidepressant, consult your doctor for guidance on potential solutions, and never stop medication without medical advice.

Disclaimer: The information provided is for educational purposes only and is not a substitute for professional medical advice. Always consult with your healthcare provider for any health-related questions or concerns.

Keypoints

SSRI Tinnitus Link: SSRIs like Sertraline (Zoloft) and Fluoxetine (Prozac) have documented reports of causing or worsening tinnitus, potentially due to increased serotonin affecting auditory pathways.
High Incidence with Bupropion: The NDRI bupropion (Wellbutrin) is noted in clinical trial data for having a higher reported incidence of tinnitus compared to placebo, particularly at higher doses.
SNRI Association: SNRIs, including Venlafaxine (Effexor), are also linked to tinnitus, which can appear either during treatment or as a withdrawal symptom upon discontinuation.
TCAs Also Involved: Older tricyclic antidepressants (TCAs) such as Amitriptyline and Nortriptyline have reported associations with tinnitus.
Consult a Doctor: If you experience tinnitus while on an antidepressant, you must speak with a healthcare provider and never stop the medication abruptly to avoid severe withdrawal symptoms.
Dose-Dependent Effect: For certain antidepressants, including bupropion, the risk and severity of tinnitus can be influenced by the dosage.
Mechanism is Complex: The exact way antidepressants cause tinnitus is not fully understood but is thought to involve the disruption of neurotransmitter signaling in the brain's auditory centers.
Underlying Condition Factor: Pre-existing anxiety or depression can complicate the relationship with tinnitus, making it difficult to isolate the medication as the sole cause.
Management Options Exist: Management strategies for antidepressant-induced tinnitus include dose adjustment, switching medications, sound therapy, and counseling.

Frequently Asked Questions

Tinnitus is the perception of sound, such as ringing, buzzing, hissing, or whistling, in one or both ears when no external sound is present. It can be intermittent or constant.

Yes, tinnitus has been reported as a side effect for several classes of antidepressants, including SSRIs, SNRIs, NDRIs (like bupropion), and TCAs.

There is no single class definitively proven to have the highest risk for everyone. However, bupropion (Wellbutrin) is notable for having a higher reported incidence rate in some clinical trials compared to placebo. Additionally, SSRIs are frequently cited in case reports for both causing and worsening tinnitus.

Antidepressant-induced tinnitus is considered a rare side effect, but the actual incidence varies among different medications and individuals. In some clinical studies for bupropion, the incidence has been reported between 3% and 6% depending on the dosage.

For most people, tinnitus caused by an antidepressant will resolve or subside after the medication is discontinued. However, there are some rare cases where medication-induced tinnitus has persisted after stopping the drug.

You should immediately contact your healthcare provider. They can help determine if the medication is the cause and discuss options such as adjusting the dosage, switching to a different antidepressant, or exploring other management strategies. Never stop taking your medication abruptly without medical guidance.

Paradoxically, some antidepressants, particularly TCAs and SSRIs, have been studied for their potential to alleviate tinnitus symptoms, especially in patients with co-morbid depression or anxiety. However, the evidence for this is mixed and their benefits remain unclear in many cases. Routine use for tinnitus is not recommended.