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Antidepressants for patients with tinnitus - PubMed

  • ️Sun Jan 01 2012

Review

Antidepressants for patients with tinnitus

Paolo Baldo et al. Cochrane Database Syst Rev. 2012.

Abstract

Background: This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2006 and previously updated in 2009.Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic pain, and may be associated with depression or depressive symptoms which can affect quality of life and the ability to work. Antidepressant drugs have been used to treat tinnitus in patients with and without depressive symptoms.

Objectives: To assess the effectiveness of antidepressants in the treatment of tinnitus and to ascertain whether any benefit is due to a direct tinnitus effect or a secondary effect due to treatment of concomitant depressive states.

Search methods: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; PsycINFO; CINAHL; Web of Science; BIOSIS; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 5 January 2012.

Selection criteria: Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus.

Data collection and analysis: Two authors critically appraised the retrieved studies and extracted data independently. Where necessary we contacted study authors for further information.

Main results: Six trials involving 610 patients were included. Trial quality was generally low. Four of the trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. One study investigated trazodone, an atypical antidepressant, versus placebo. Only the trial using the SSRI drug reached the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop-out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. In the trial investigating trazodone, the results showed an improvement in tinnitus intensity and in quality of life after treatment, but in neither case reached statistical significance. Reports of side effects including sedation, sexual dysfunction and dry mouth were common.

Authors' conclusions: There is as yet insufficient evidence to say that antidepressant drug therapy improves tinnitus.

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Conflict of interest statement

None known.

Figures

1
1

Tinnitus compensation: a proposed 'noise cancellation' model in tinnitus. Initially, a tinnitus signal results from peripheral deafferentiation (loss of hair cells from injury, age, noise exposure) and subsequent lesion‐induced reorganisation of central auditory structures. The nucleus accumbens and the associated paralimbic networks in the prefrontal cortex play an important role in long‐term habituation to continuous unpleasant sounds. As long as the NAc‐system is intact (A: "Compensated tinnitus"), the tinnitus signal is filtered out and will not be relayed to the auditory cortex. If the NAc‐system becomes compromised (B: Tinnitus), cancellation of the tinnitus signal at the thalamic level is no longer possible, long‐term reorganisation of auditory cortex sets in and tinnitus perception becomes potentially chronic. Structures with serotoninergic innervation are shown by hatching; inhibitory structures are shown in red: yellow indicates presence of tinnitus signal. NAc = nucleus accumbens; vmPFC = ventromedial prefrontal cortex; MGN = thalamus; TRN = talamic reticular nucleus. Reprinted from Rauschecker JP, Leaver AN, Muhlau M. Turning out the noise: limbic‐auditory interactions in tinnitus. Neuron 2010;66:819‐25, with permission from Elsevier (Rauschecker 2010).

2
2

The Prevalence of Tinnitus (Panel A) and Hearing Impairment (Panel B). From: Lockwood AH, Salvi RJ, Burkard RF. Tinnitus. New England Journal of Medicine 2002; 347(12):904‐10. Values are based on responses to the question "Do you have tinnitus (or) ringing in the ears or deafness (or) other trouble hearing?" Included in the National Center for Health Statistics Survey of noninstitutionalized Americans, 1999.

3
3

Study flow diagram: detail of literature review for the 2012 update.

1.1
1.1. Analysis

Comparison 1 Trazodone versus placebo, Outcome 1 Tinnitus intensity.

1.2
1.2. Analysis

Comparison 1 Trazodone versus placebo, Outcome 2 Tinnitus discomfort.

Update of

  • Antidepressants for patients with tinnitus.

    Baldo P, Doree C, Lazzarini R, Molin P, McFerran DJ. Baldo P, et al. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003853. doi: 10.1002/14651858.CD003853.pub2. Cochrane Database Syst Rev. 2006. PMID: 17054188 Updated. Review.

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References

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References to other published versions of this review

Baldo 2006
    1. Baldo P, Doree C, Lazzarini R, Molin P, McFerran D. Antidepressants for patients with tinnitus. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD003853.pub2] - DOI - PubMed

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