What is Tinnitus?
Tinnitus is a neurological condition characterized by the perception of sounds such as ringing, buzzing, or whistling in one or both ears, without an external source. It's often described as an auditory phantom sensation. This condition can be temporary or chronic and is usually caused by damage to the inner ear, head or neck injuries, or exposure to loud noise. It can significantly impact quality of life, causing issues like anxiety, depression, and sleep disturbances. It's estimated that 10%-15% of adults experience tinnitus [11], [13], [12].
Tinnitus is a medical condition characterized by reports of hearing a sound, frequently described as a ringing, when there is no objective auditory stimulus. This subjective sound can be experienced in one or both ears, and it can be periodic, occurring at specific times in bursts or constant.
There are many clinical subtypes of tinnitus, with different triggers, sounds, frequencies, and neurobiology, making it a very heterogeneous condition.
Prevalence of Tinnitus
Tinnitus is a common condition, affecting approximately 10-15% of the population, with 1-2% reporting that it significantly impacts their quality of life.
Neurobiology of Tinnitus
Tinnitus is a curious neurobiological condition since it involves disruption of both auditory and central, non-auditory brain regions.
Tinnitus is commonly triggered by damage to the cochlea, the inner part of the ear that registers the volume and pitch of incoming sound. Nonetheless, persisting tinnitus no longer relies on damage to the cochlea. Cutting the auditory nerve, which connects the cochlea to the auditory cortex, did not stop tinnitus ringing [3].
Several central nervous system mechanisms could explain tinnitus. These include [3]:
- Reduction of GABA-ergic inhibition
- Central gain: a general increase in excitability, partially caused by insufficient GABA-ergic inhibition
- Insufficient noise cancelling
- Cross-modal activation: Activation of another sensory experience which can cross-activate the auditory system. For example, tactile stimulation of the forehead.
- Cholinergic excess: acetylcholine is the primary excitatory neurotransmitter deficient in frontotemporal dementia and Alzheimer’s disease. Excess acetylcholine can over-stimulate the brain, making ‘hallucination-like’ states more likely.
What Is Lexapro?
Lexapro, containing the active escitalopram, belongs to a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs).
Lexapro is commonly prescribed for depression and anxiety, but antidepressants like Lexapro should not be used for ADHD [4].
How Does Lexapro Work?
Lexapro improves mood by increasing serotonin levels in your brain – a critical regulator of mood, appetite, and alertness. This is done by blocking serotonin's reuptake (re-absorption) and increasing the brain's serotonin [5]. Serotonin is a neuromodulator. This means that it can adjust the excitation and inhibition of neural activity in the brain, for example, in the prefrontal cortex, thereby regulating attention.
As a benefit compared to other antidepressants, Lexapro can act as an allosteric modulator of serotonin reuptake, which makes it better tolerated than other SSRIs [5].
Lexapro and Tinnitus
Can Lexapro Cause Tinnitus?
Although there are drugs in the central nervous system that could alter the brain's excitation-inhibition balance, it is highly unlikely that Lexapro would trigger tinnitus.
Curiously, one woman was found to develop symptoms of tinnitus after stopping Lexapro, which indicates that Lexapro is unlikely to cause tinnitus [6].
Antidepressants other than Lexapro have been associated with tinnitus. However, the chance of this happening is very low, since the studies discussed in the review were on a case-study basis [7].
Pharmacological Management of Tinnitus
There has been some investigation of how best to manage tinnitus, mainly due to its debilitating impact on some patients. However, there are still no FDA-approved therapies for tinnitus. This does not mean there are no drugs to manage your symptoms; they just have not had systematic trials to support their approval, and whether or not your tinnitus ceases will be highly individual.
The specific classes of drugs that have been investigated for managing tinnitus symptoms include anaesthetics, anticonvulsants, antidepressants, antihistamines, benzodiazepines, diuretics, and corticosteroids [8, 9].
Antidepressants in Tinnitus
Antidepressants have been used to treat tinnitus, although their efficacy remains controversial. Some studies suggest that antidepressants may help manage underlying psychological problems rather than directly affect the tinnitus [10]. For example, underlying depression or anxiety could contribute to tinnitus, so taking antidepressants would help.
Selective serotonin reuptake inhibitors (SSRIs), such as Lexapro, have been used in some cases. However, the evidence to evaluate their effectiveness is insufficient to conclude, particularly regarding Lexapro/escitalopram [9].
Summary: Can Lexapro Treat Tinnitus
In summary, no, according to the scientific evidence to date, there have not been any beneficial effects of Lexapro in managing tinnitus, nor significant evidence to indicate Lexapro causes tinnitus. There are no FDA-approved pharmacotherapies for tinnitus, but other classes of drugs could provide more symptom relief. If you may be experiencing tinnitus symptoms, make sure to consult a healthcare professional, as they will be able to assess the best therapeutic plan for you individually.