Antipsychotic Drugs That Cause Tinnitus
While antidepressants are commonly prescribed for tinnitus treatment, they paradoxically can also cause tinnitus as a side effect, and the evidence for antipsychotics causing tinnitus is limited to isolated case reports rather than systematic documentation. 1
Evidence for Antipsychotic-Induced Tinnitus
The available medical literature does not establish a clear, direct causal relationship between antipsychotic medications and tinnitus. The provided guidelines focus primarily on other adverse effects of antipsychotics—including cardiac effects (QTc prolongation), extrapyramidal symptoms, metabolic disturbances, and neuroleptic malignant syndrome—but do not specifically list tinnitus as a recognized adverse effect. 2
Antidepressants and Tinnitus: The Documented Connection
The stronger evidence exists for antidepressants rather than antipsychotics:
Antidepressants are frequently prescribed to treat tinnitus but research raises concerns because tinnitus itself is a documented side effect of antidepressant medication. 1
Tricyclic antidepressants (TCAs) have been studied in four trials involving 405 patients, showing slight improvement in tinnitus, though these effects may be attributable to methodological bias. 3
Selective serotonin reuptake inhibitors (SSRIs) like sertraline and paroxetine, along with nortriptyline, can be considered first-line antidepressants in treating tinnitus-related distress, though a Cochrane review found insufficient evidence that antidepressant therapy improves tinnitus overall. 4, 3
No specific type of antidepressant has been identified as more likely to cause tinnitus as a side effect. 1
Clinical Context and Psychopharmacological Considerations
When tinnitus occurs in psychiatric patients:
Higher anxiety, depression, somatoform disorder clusters, impulsivity, and hostility are commonly found in patients with tinnitus. 4
Psychotropic drugs may diminish tinnitus through improving general psychiatric comfort and direct central nervous system influence rather than through a specific anti-tinnitus mechanism. 5
Mood stabilizers like carbamazepine, valproate, and gabapentin can be effective alternatives. 4
Benzodiazepines (short-acting like alprazolam and midazolam, or longer-acting like clonazepam and diazepam) are effective for anxiety symptoms that may accompany tinnitus. 4
Practical Clinical Approach
If a patient on antipsychotics develops tinnitus:
Consider other more common causes first, as antipsychotics are not well-documented tinnitus triggers. 1
Evaluate for concomitant antidepressant use, which has stronger evidence for causing tinnitus. 1, 3
Assess for underlying psychiatric symptoms (depression, anxiety) that may be exacerbating tinnitus perception rather than the medication directly causing it. 4, 5
When pathophysiologic causes are excluded, consider that tinnitus may be exaggerated by psychopathological symptoms rather than being a direct drug effect. 4