Can stopping anxiety meds lead to tinnitus?

Anxiety medications are commonly prescribed for people living with mental health conditions, such as generalized anxiety or panic disorder. But did you know that discontinuing these medications can potentially lead to unexpected hearing problems? It's important to be aware of the possible consequences and to have a discussion with your doctor before stopping or making any changes to your medication regimen.

Below, we take a look at two types of anxiety medications that may cause hearing issues after stopping them: benzodiazepines and antidepressants.

Benzodiazepine withdrawal and tinnitus

Quick-take: If you take a benzodiazepine medication (commonly called "benzos"), you may experience tinnitus as a withdrawal symptom, particularly after long-term or frequent use. Tinnitus is the name for hearing a ringing sound in their ears. It can also sound like a whistling, buzzing, or hissing noise. 

What are benzodiazepines? This a class of drugs used for for anxiety, typically on a short-term or as-needed basis to ease acute anxiety symptoms. Benzodiazepines start working quickly but carry risks of withdrawal, rebound anxiety, and dependence issues if used long term. They are not recommended as a first-choice treatment for generalized anxiety disorder because antidepressants are more effective.

Withdrawal symptoms: Withdrawal occurs after frequent or long-term use of benzodiazepines, especially if you suddenly stop taking it or abruptly decrease your dose. If you and your healthcare provider decide that a benzodiazepine medication is no longer serving you, they will guide you through a plan for tapering off it gradually. 

Examples of benzos include:

• alprazolam (Xanax)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)

In depth: What the research shows on tinnitus and 'benzos'

The medical literature includes several case reports and small studies describing a connection between benzo withdrawal and tinnitus. In one case report, a 40-year-old man developed tinnitus after stopping clonazepam. He’d been taking it for 14 years. His doctor began him on a slow tapering schedule, but he decreased the dose faster than his doctor recommended. The tinnitus improved when he returned to taking a higher dose, but it did not completely go away. 

In a 1990 study of 63 people tapering off of benzos, nine experienced tinnitus. It was more common after stopping long-acting benzos (for instance, diazepam) than short-acting ones like lorazepam and alprazolam. Another study of 12 patients revealed similar results, noting that the occurrence and severity of tinnitus decreased over time. Some people experienced tinnitus for up to 8 months after stopping benzodiazepines. 

Resuming benzodiazepine may provide temporary relief from symptoms but isn’t guaranteed to fully eliminate them. The exact timeline for benzo withdrawal-associated tinnitus is unclear, but it is unlikely to be permanent. A cautious taper plan is important to prevent drug-induced tinnitus.

Interestingly, benzodiazepines have been prescribed to treat tinnitus. In the past, it was thought they could play a role in blocking the overstimulation of involved nerves. However, studies have concluded that benzos are not beneficial for tinnitus and may prevent the person’s brain from adapting to the condition.

Antidepressant withdrawal syndrome and tinnitus

Quick-take: Though not common, tinnitus has been reported in association with antidepressant withdrawal. Most reports described the onset of tinnitus occurring after an antidepressant (such as venlafaxine or sertraline) was suddenly stopped. The tinnitus swiftly resolved when they restarted the antidepressant. 

What are antidepressants? Antidepressant medications are typically used to treat depression and anxiety. They take a week or so to start working, and another two to three weeks to reach their full effects. Treatment typically continues for at least six to 12 months. Antidepressant medications are the mainstay of treatment and are taken daily to help keep anxiety symptoms at bay. 

There are several sub-categories of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and dopamine and norepinephrine reuptake inhibitors. Drugs that affect serotonin seem more likely to cause withdrawal symptoms.

What are the withdrawal symptoms? The group of symptoms that occur after stopping antidepressants is known as antidepressant discontinuation syndrome (ADS). ADS begins within 1-10 days of stopping the antidepressant, and typically resolves within a few weeks, though some symptoms can linger for up to a year in some cases. Common symptoms of ADS are body aches, insomnia, nausea, sensations of burning, tingling, or “shocks,” anxiety, irritability, and balance issues including vertigo and dizziness. 

First-line antidepressant options for treating generalized anxiety disorder include:

• Selective serotonin reuptake inhibitors (SSRIs):
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): 
  • venlafaxine (Effexor XR)
  • duloxetine (Cymbalta)

If these medications aren’t effective, healthcare providers may recommend a second-line antidepressant, such as amitriptyline (Elavil) or nortriptyline (Pamelor). 

Mental health and hearing are linked

Medical literature confirms that mental health concerns like anxiety are common among people with hearing loss and tinnitus. We know that age-related hearing loss and tinnitus are associated with psychological distress, leading to anxiety or depression.

In people with cochlear implants, those with tinnitus are more likely to experience anxiety and depression than those without tinnitus, according to a comparative study. 

These findings are not that surprising, given the isolation and loneliness that may occur when hearing loss goes untreated. Interestingly, though, anxiety itself is also associated with an increased risk of hearing loss. A 2015 study investigated the association between anxiety disorder and sudden sensorineural hearing loss (SSHL) using a population-based dataset in Taiwan. The study found that patients with SSHL were more likely to have a prior diagnosis of an anxiety disorder compared to a control group that did not have SSHL. The relationship was most pronounced in individuals ages 44 years and younger. 

More research is needed to determine the reasons why this association exists, but one possibility could be related to anxiety medications—more specifically, the choice to stop taking them. 

Bottom line: Consult a professional before stopping meds

Prescription medications can be highly effective for anxiety disorders. If you are thinking about trying to manage your anxiety without medication, talk with your healthcare provider.

The plan for discontinuing these medications can be more gradual and complex than you might think. For example, if you’re currently taking a high dosage of alprazolam, the recommended taper schedule involves systematically reducing the dosage over a period of 15 weeks before stopping it. 

To avoid hearing-related side effects and other withdrawal effects when stopping an anxiety medication, it is crucial to consult with a professional. If you are experiencing tinnitus or other hearing problems, a hearing care professional near you can help.