Is Lexapro (escitalopram) associated with tinnitus?

Lexapro (Escitalopram) and Tinnitus

Yes, Lexapro (escitalopram) can be associated with tinnitus, both as a side effect during treatment and as a withdrawal symptom when discontinuing the medication. This association is important to recognize when managing patients on SSRIs like escitalopram.

Medication-Related Tinnitus

• Tinnitus affects approximately 10% of the US adult population and can present as various sounds including hissing, buzzing, ringing, pulsations, or clicking noises 1
• Antidepressants, including SSRIs like escitalopram (Lexapro), have been reported to cause tinnitus as a side effect 2, 3
• Medication-induced tinnitus is typically bilateral and non-pulsatile in nature 1
• Several antidepressants have been documented to cause tinnitus, including fluoxetine, trazodone, bupropion, venlafaxine, and various tricyclic antidepressants 2

Clinical Approach to Medication-Induced Tinnitus

• When tinnitus develops during Lexapro use, determine if the tinnitus began specifically after starting the medication 1, 4
• Assess if the tinnitus is pulsatile or non-pulsatile, as this helps determine the underlying cause 5
• For non-pulsatile tinnitus without focal neurological abnormalities or asymmetric hearing loss, imaging studies are generally not recommended 5
• If the tinnitus is unilateral or asymmetric, or associated with hearing loss, a comprehensive audiological examination is recommended 5

Withdrawal-Related Tinnitus

• Tinnitus can also occur during withdrawal from SSRIs like escitalopram 4
• For withdrawal-related tinnitus, stabilizing the dose may help reduce symptoms 1
• Similar to benzodiazepines, withdrawal from SSRIs can cause rebound symptoms including tinnitus 4

Management Options

• If tinnitus is determined to be medication-related, consider:

  1. Dose adjustment (if clinically appropriate) 1
  2. Medication switch to an alternative antidepressant with potentially lower risk of ototoxicity 3
  3. Gradual tapering if discontinuation is planned, to minimize withdrawal symptoms including tinnitus 4

• For persistent tinnitus regardless of cause:

  • Cognitive Behavioral Therapy (CBT) has the strongest evidence for improving quality of life in patients with persistent tinnitus 5, 1
  • Sound therapy may provide symptomatic relief 5
  • Hearing aids may be beneficial if there is associated hearing loss 5
  • Antidepressants are generally not recommended specifically for treating tinnitus itself 5, 6

Important Considerations

• The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) clinical practice guidelines make a strong recommendation against using antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for primary treatment of persistent tinnitus 5
• Cochrane reviews have found insufficient evidence to support antidepressant use specifically for treating tinnitus 6
• Patients with tinnitus and severe anxiety or depression require prompt identification and intervention, as suicide has been reported in tinnitus patients with coexisting psychiatric illness 5
• When prescribing Lexapro, inform patients about the potential risk of tinnitus as a side effect or withdrawal symptom 1, 4

Monitoring

• Monitor for other side effects of Lexapro, which can include sedation, sexual dysfunction, and dry mouth 4
• If tinnitus persists despite addressing medication-related factors, consider other etiologies and appropriate evaluations 5