Antidepressants for Tinnitus
Last reviewed October 2026 · Based on 4 studies
Bottom line
Older trials of tricyclic antidepressants showed slight improvements in tinnitus, and in a 2025 trial about four in ten people on two drug combinations had a meaningful drop in tinnitus severity. But the effects may reflect trial bias, a Cochrane review found insufficient evidence, and the 2025 combinations were not significantly better than placebo.
What it helps with
- Eases tinnitus — Mixed results, evidence grade C (Limited). A Cochrane review found insufficient evidence from low-quality trials, and a 2025 placebo-controlled trial of two drug combinations showed no significant difference between groups; downgraded for inconsistency and risk of bias.
What it is
Antidepressant drugs, including tricyclics, SSRIs and trazodone, have been used to treat tinnitus in people with and without depression [1]. A 2025 trial tested two combinations: nortriptyline with topiramate, and verapamil with paroxetine [2].
What the research says
Cochrane review. Six trials with 610 people. All four tricyclic trials (405 people) suggested a slight improvement in tinnitus, but this may be due to methodological bias. The one SSRI trial (120 people, the only one of the highest quality) found no overall improvement, with possible benefit at higher doses in a subgroup. A trazodone trial showed improvements that did not reach statistical significance. The review concluded there is insufficient evidence [1].
2025 placebo-controlled trial. 78 adults with moderate to severe tinnitus were randomised to nortriptyline-topiramate, verapamil-paroxetine or placebo for 8 weeks. Tinnitus Functional Index scores fell from 58.4 to 46.3 on the first combination and from 54.6 to 42.2 on the second, while the placebo group's fall was not statistically significant, but the difference between groups was not significant either [2]. In a follow-up analysis, 42% and 41% of the two drug groups reached a meaningful (13-point) improvement [3].
Network meta-analysis. A 2025 analysis of 60 trials ranked fluoxetine first for tinnitus loudness, though the loudness analysis showed signs of publication bias [4].
Doses used in studies
In the 2025 trial, average doses were about 44 mg nortriptyline with 59 mg topiramate, or 207 mg verapamil with 28 mg paroxetine, over 8 weeks [3]. This is what the trial used, not a recommendation.
Safety and interactions
Side effects. Sedation, sexual dysfunction and dry mouth were common in the trials [1].
Interactions, limits, pregnancy and other conditions. No tinnitus-specific data were found. These are prescription medicines, so anyone considering them should ask a doctor first.
Caveats and open questions
Most trials were low quality, with inadequate outcome measures, high drop-out, or no separation of effects on tinnitus from effects on anxiety and depression [1]. The 2025 trial was small, single-centre and 8 weeks long [2].
References
- Antidepressants for patients with tinnitus.. Cochrane Database Syst Rev, 2012.
- Efficacy of Nortriptyline-Topiramate and Verapamil-Paroxetine in Tinnitus Management: A Randomized Placebo-Controlled Trial.. Otolaryngol Head Neck Surg, 2025.
- Optimal Dosing of Nortriptyline-Topiramate and Verapamil-Paroxetine Combinations in Tinnitus Treatment.. Laryngoscope, 2025.
- Pharmacotherapy options for the management of subjective tinnitus: a systematic review and network meta-analysis.. BMJ Open, 2025.