Sertraline Discontinuation-Associated Tinnitus
Rapid discontinuation of sertraline can precipitate an antidepressant discontinuation syndrome, which is commonly seen after abrupt SSRI cessation. [1] Tinnitus has been described in association with sertraline use and has been reported to start around the time of sertraline discontinuation in published case reports. [2], [3]
Discontinuation Syndrome After Abrupt Sertraline Cessation
Abrupt discontinuation of sertraline should be avoided because discontinuation reactions are common when stopping is abrupt. [1] The SmPC reports that, in clinical trials, the incidence of reported withdrawal reactions was 23% with discontinuation versus 12% with continuation. [1]
Evidence Linking Discontinuation to Tinnitus
A published clinical case report described relatively rapid-onset tinnitus during sertraline treatment that began to subside shortly after stopping sertraline, with resolution after about one week. [2] A published case study abstract reported unilateral tinnitus occurring as a withdrawal phenomenon after sertraline withdrawal in a patient. [3] A review of pharmacological treatments for tinnitus summarizes that case reports exist describing tinnitus onset in temporal proximity to medication changes that include antidepressant discontinuation. [4]
Causality Strength and Clinical Interpretation
The available evidence base for tinnitus after sertraline discontinuation consists primarily of case reports and narrative review material. [2], [3], [4] Epidemiologic effect sizes for tinnitus specifically after rapid or abrupt sertraline discontinuation are not established in the sources reviewed here. [2], [3]
Clinical Management Implications
Sertraline should be tapered rather than stopped abruptly to reduce the risk of discontinuation reactions. [1] If tinnitus occurs after discontinuation, re-initiation of the previously prescribed dose and then more gradual tapering are approaches described in sertraline product labeling for intolerable discontinuation symptoms. [1]
Practical Risk Minimization
Gradual dose reduction over at least one to two weeks is recommended to reduce the risk of withdrawal reactions when stopping sertraline. [1] Clinical observation for discontinuation symptoms is typically expected within the first few days after discontinuation. [1]
Differential Diagnosis for New-Onset Tinnitus Around Discontinuation
Tinnitus after stopping sertraline should trigger evaluation for other common tinnitus etiologies because discontinuation is not the only plausible cause of new tinnitus in the peri-discontinuation time window. [5] Common tinnitus causes listed by clinical references include earwax buildup and other otologic and non-otologic etiologies. [5]