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Tinnitus therapy (MBCT) update No. 1 
| Hello all It's been two weeks since I started Mindfulness Based Cognitive Therapy, which is the tinnitus therapy provided by the Royal National ENT Hospital, London. I thought I'd post short, bullet point updates, so that it's easier to chart progress. Background: I've had T for 10 months from inner ear decompression while scuba diving. Take 75mg Amitriptyline for T-induced insomnia Current regime: 2 x 20 minute meditations per pay. Am also using free MBCT podcasts available from iTunes. Also practicing being mindful during the day T volume: No change. My T remains highly variable, but when I listen out for it the volume and pitch are unchanged. T intrusiveness during day: Improved quite a bit. I had already started to habituate naturally before staring MBCT, but over the past two weeks I have observed a positive change in: a) the frequency of T 'episodes' is somewhat improved b) the emotions I exhibit towards are more than somewhat improved. T intrusiveness during night: Unchanged. Still taking 75mg Amitriptyline every night but plan to taper now that I am doing MBCT. Other changes: MBCT has literally cured 100% the dermatophagia/obsessive skin biting (OCD spectrum) I have battled everyday for 37 years. This outcome has been shocking as I thought I would have this for life. Major improvement in mood, awareness and enjoyment levels of everyday tasks both as a result of fixing my dermatophagia and in general. Difficulty in complying with regime. Meditation: Mostly easy to accommodate but requires giving up other activities (gym). Mindefulness: Very difficult to practice 24/7. Requires lots of effort at this stage. Summary: Quite dramatic changes in a very short space of time. To be clear my T volume/pitch is not changed. The benefits so far are ones I was not expecting. Background on MBCT: http://www.rnid.org.uk/community/forums ... _hospital/ (external link, opens new browser window) | Jason | 07 Apr 2009 13:05 |
| Fascinating, Jason. How long have you been on the Amitriptyline now? As the medication seems to agree with you I can't help wondering if it might be behind your improvement in your mood? | Movie Miscreant | 07 Apr 2009 14:29 |
| 75mg Amitryptiline is a low-level anti-depressant dose as opposed to 10-25mg more typically used for insomnia/muscle relaxant. Good luck with the tapering. Thanks for post re MBCT. | foggie | 07 Apr 2009 15:27 |
| The typical daily adult dosage for Amitriptyline used as an antidepressant ranges between 25mg to 150mg, so 75mg is really an “average” antidepressant dose. Concerning dosages – especially of antidepressants – EVERYONE’S DIFFERENT and 75mg might suit one person’s needs but not the next person’s. | Movie Miscreant | 07 Apr 2009 16:26 |
| Woops, remove the word "typical" from my above post and it makes sense. RNID, please can we have an edit function? | Movie Miscreant | 07 Apr 2009 16:38 |
| RE; amitryptiline I has a conversation with my GP about this drug. She originally recommended it to me and I said I would think about it. In the meantime she came back to me to let me know that another of her patients who didn't have tinnitus before now has this as a side effect of this drug and has had to scale back the dosage. She has written to the company and now has recommended prozac to me (haven't looked yet to see if there are side effects of tinnitus to this) Obviously people like yourself Jason don't find this an issue and can get relief from this. | Mary M | 07 Apr 2009 16:59 |
| Hi all. Re questions: 1) Have been on amitrip for 9 months already. I developed very severe insomnia with my T. I was referred to an NHS sleep consultant at St Thomas' and Ami. was one of the few considered safe for long-term use (apart from Mirtazapine which I hated because of the carb-craving/weight-gain thang.). Consequently, the improvement in mood is in addition to any benefits from Ami. 2) Amitrip is definitely ototoxic for many users (makes tinnitus worse). I have reported on here how Ami. sends my best mate's T through the roof (it's because Ami dehydrates the body - it's actually prescribed for teenage bed-wetting). Fortunately, I'm in the group of people for whom Ami. is not ototoxic. I drink about 3-4 litres of water a day; which may or may not be relevant. Anyway, am posting this from my iPhone. Sorry if it's a bit messy. Jason | Jason | 07 Apr 2009 18:15 |
| Hi. I meant to say: I BELIEVE Ami is ototoxic for many users because it dehydrates the body. That's my own personal hunch. As ever, there is no known medical reason why Ami is theraputic for some T sufferers and ototoxic for others. | Jason | 07 Apr 2009 18:25 |
| Hi. I meant to say: I BELIEVE Ami is ototoxic for many users because it dehydrates the body. That's my own personal hunch. As ever, there is no known medical reason why Ami is theraputic for some T sufferers and ototoxic for others. | Jason | 07 Apr 2009 18:34 |
| Hi. I meant to say: I BELIEVE Ami is ototoxic for many users because it dehydrates the body. That's my own personal hunch. As ever, there is no known medical reason why Ami is theraputic for some T sufferers and ototoxic for others. | Jason | 07 Apr 2009 18:35 |
| Hi Jason I'm not sure the adverse reaction of tinnitus sufferers towards Amitrip is down to ototoxocity. It's more likely down to the brain's changes with the medication. | Movie Miscreant | 08 Apr 2009 07:29 |
| Jason, glad things are going well. Kabat-Zinn's book 'Full Catastrophe Living' mentions someone with insomnia whose sleep patterns improved after the 8 week course. | Urusai | 08 Apr 2009 08:54 |
| Jason, could you say a little more about how Mindfulness practice has improved your dermatophagia? Is it that you have become mindfully aware at the point where you are about to bite and then stop? The reason I'm asking is because someone I know has a teenage son who suffers from trichotilomania (obsessive hair pulling) and I was thinking of recommending MBCT to his mum. | Urusai | 08 Apr 2009 08:59 |
| Hi Urasai - the dermatophagia thing was a completely unexpected side effect. In terms of how it's working I would say 80% of the benefit is as a result of the compulsion disappearing (strange, I can't explain why) and 20% is being mindful just before the act. I've posted this phenomenon on the on trich/derm forums to see if anyone else has experienced this. Reading the posts on these sites, people describe falling into a trance like state when pulling/biting/picking. Of course this is the very state of mind that mindfulness attempts to change. Hope that helps. MM - agree Ami effect likely caused changes in brain activity by this TCA. However, there was a paper published by Journal of Psychopharmacology very recently where they have reviewed rarer incidences of ami-induced ototoxicity: Journal of Psychopharmacology The incidence of amitriptyline- induced ototoxicity is less well recognised. http://jop.sagepub.com/cgi/content/abstract/22/5/574 (external link, opens new browser window) An unusual case of prolonged tinnitus following low-dose amitriptyline D. Mendis Department of ENT Surgery, Queen's Hospital, Burton-on-Trent, UK, dulanimendis@yahoo.com M. Johnston Department of ENT Surgery, Derby Royal Infirmary NHS Foundation Trust, Derby, UK We report on a case of unilateral tinnitus after a short course of low-dose amitriptyline for neuralgic foot pain. This has been described in the literature previously at much higher doses and is associated with prolonged administration; we present our case with a review of the current literature in-order to raise awareness of this possible complication of anti-depressant therapy. We also propose a novel hypothesis for the pharmacological basis of amitriptyline-induced tinnitus. Key Words: amitriptyline • ototoxicity • tinnitus | Jason | 08 Apr 2009 10:38 |
| Hi I am interested in any info or experience on Amitriptyline, as although Mirtazapine does make me sleep well and makes my tinnitus less audible, I permanently feel "away with the fairies" and don't like the hunger/weight gain associated with it. Ideally, I want a harmless drug that can make you sleep, long-term....What is everyone else taking for sleep? | Violetdusk | 08 Apr 2009 13:01 |
| Hi Violetdusk You know, Amitriptyline is one of those that keeps coming up on this board and people are really polorized, both in their clinical response and their opinions of the drug. For me it works excellently. Neither my GP nor my Sleep consultant at St Thomas' were prepared to consider habit-forming pills for more than 28 days, so the options available to me were Mirtazapine, Amitriptyline or sedating antihistamines. I put on so much weight with Mirtazapine that I had to have a Reductil/Subutramine (weight loss drug) on top, which for me was crazy. Fortunately Amitrip works for me. I have been on it nine months. I usually take 75mg at 9pm. At 11pm I go to bed and by 11.30 I am asleep. I wake between 6am and 7am refreshed with little hangover (it was awful at first), with maybe one or two night time interruptions. The side effects - dehydration - I have learned to work around. Both the Sleep consulant, my GP and ENT agree I can stay on it for life with no health consequences but they are confident - as am I - that I will come off it by following tinnitus therapy. Indeed I am already tapering. There are others also this boards who are able to tolerate Amitriptyline and its use (as well as that of Nortriptyline) have been clinically trialled with positive results. http://www.ncbi.nlm.nih.gov/pubmed/11771024 (external link, opens new browser window) HOWEVER, for lots of people with tinnitus, Amitriptyline is about the worst drug they can take. When my best friend tried it he went into a tinnitus spike that knocked him out for days. There are plenty on this board that have had the same reaction. Because of these binary responses (good or awful) I believe many are reluctant to try the drug and many GPs who have heard the terrible stories are reluctant to prescribe it - which is all fair enough. The only question remains; if you can't tolerate Mirtaz or Amitrip then what options are open to you, which I guess is where you are Violetdusk. And I don't know what the answer is. Possibly you could harass you GP about other antidepressants that have a sedative effect at specific dosages. Finally, I should say that in investigating the full range of sedatives my consultant tried promethazine hydrochloride, Diphenhydramine Hydrochloride and other sedating antihistamines. These kind of worked for me but the hangover was horrendous and I also ended up with Restless Leg Syndrome, which was a price I wasn't prepared to pay. You might react differently however. Good luck. Jason | Jason | 08 Apr 2009 17:54 |
| antrip did me no good at all. Took me hours to go to sleep but seemed to kick in next day when it gave me a hangover effect. | katarina | 08 Apr 2009 22:28 |
| Hi sorry to hear that Katarina. Yours is another good example of how Ami works very differently for different people. It is worth noting that Ami does take a while to kick-in (2 - 3 hours before bed). Tinhead is another person who has had excellent results from Ami - you can read his experience in MM's new thread on TRT. | Jason | 09 Apr 2009 00:44 |
| Violetdusk Just to say...whatever you decide be careful about coming off Mirtazapine quickly. I consider myself as someone who can cope easily with different drug regimes. However, when I came off Mirt. without long tapering I went completely bonkers; and I do mean like a crazy person living on the street Please be super-careful in exit-ing this drug. Bests - Jason | Jason | 09 Apr 2009 19:26 |