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Antidepressants for patients with tinnitus

Centro di Riferimento Oncologico--CRO Aviano (PN) Italy, Hospital Pharmacy, Via Pedemontana Occidentale, 12, Aviano (PN), Friuli-Venezia-Giulia, Italy.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2006; DOI: 10.1002/14651858.CD003853.pub2
Source: PubMed

ABSTRACT Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation, and it is frequently associated with depression or depressive symptoms. Six studies involving a total of 610 patients matched the inclusion criteria for this review. Four evaluated three tricyclic antidepressant agents (amitriptyline, nortriptyline and trimipramine) for the treatment of tinnitus. These studies did not find enough evidence to prove the efficacy of these agents in the management of tinnitus. One study evaluated paroxetine, a selective serotonin reuptake inhibitor antidepressant, and one evaluated trazodone, an atypical antidepressant. Neither of these studies showed benefit of paroxetine or trazodone in the treatment of tinnitus. Side effects, though relatively minor, were common in all groups of antidepressants. Further research is required.

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    • "A recent neuroimaging study showed that the prefrontal area, where the integration of cognitive and emotional processing occurs, is involved in the development of chronic tinnitus. Based on these relationships, antidepressive medications such as tricyclic nortriptyline and serotonin reuptake inhibitors improve tinnitus as well as depression [6] [7]. "
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    ABSTRACT: Abstract Conclusion: The study showed that combined repetitive transcranial magnetic stimulation (rTMS) on the auditory cortex and prefrontal cortex has more benefit than rTMS on the auditory cortex alone for tinnitus control in patients with depression. Further studies for the most optimal combination of stimulation on both areas are needed. Objective: Recent studies suggest that the neuronal network changes of chronic tinnitus are beyond the auditory pathway. There is increasing evidences for the application of rTMS on multiple brain cortices in addition to the auditory cortex for the treatment of tinnitus. Sequential rTMS was performed on the auditory cortex alone as well as the auditory cortex combined with prefrontal cortex in patients with both chronic tinnitus and depression. Methods: Patients who presented with chronic tinnitus of more than 1 year were enrolled in the present study (seven males, four females; mean age 54 years). To select the site for the rTMS, PET CT was performed. Patients received the first rTMS on the primary auditory cortex for 5 days and on the primary auditory cortex and prefrontal cortex in the second application after tinnitus relapse. The Tinnitus Handicap Inventory (THI), visual analog scale (VAS), and Beck Depression Inventory (BDI) were evaluated before and after rTMS. Results: The mean THI score of the eight patients with depression changed from 77.5 ± 15 to 61.8 ± 20.1 after the second rTMS. There was statistical significance only for the second rTMS. The VAS score changed from 8.6 ± 1.6 to 6.3 ± 1.8 after the first rTMS and from 7.6 ± 2.4 to 4.6 ± 2.7 after the second rTMS, showing statistically significant changes both times. The THI changes after the second rTMS were greater than after the first rTMS, and the changes in VAS score showed a similar pattern. The changes in BDI score, which indicates the severity of depression, showed a variable pattern after rTMS. Patients with mild depression (10≤ BDI score <16, n = 4) showed significant improvement of THI with the second combined rTMS (ΔTHI = 24.5) as compared with the first rTMS on the auditory area (ΔTHI = 6). In contrast, combined rTMS did not show any better improvement on THI (ΔTHI = 6.5) than the first rTMS on the auditory cortex (ΔTHI = 7) in patients without depression (BDI <10, n = 3) and patients with moderate to severe depression (BDI ≥16, n = 4).
    Acta oto-laryngologica 02/2013; 133(6). DOI:10.3109/00016489.2012.763181 · 0.99 Impact Factor
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    • "CBT for tinnitus shares many components with CBT for the treatment of depression (Greimel and Kroner-Herwig 2011). Several investigations have also addressed antidepressants for tinnitus (Baldo et al. 2006; Robinson 2007). Of these, two randomized double-blind placebo-controlled studies examined the effects of antidepressants in patients with tinnitus and comorbid depression (Sullivan et al. 1993; Zoger et al. 2006b). "
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    ABSTRACT: Depressive symptoms are common in individuals with tinnitus and may substantially aggravate their distress. The mechanisms, however, by which depression and tinnitus mutually interact are still not fully understood. Here we review neurobiological knowledge relevant for the interplay between depression and tinnitus. Neuroimaging studies confirm the existence of neural circuits that are activated both in depression and tinnitus. Studies of neuroendocrine function demonstrate alterations of the HPA-axis in depression and, more recently, in tinnitus. Studies addressing neurotransmission suggest that the dorsal cochlear nucleus that is typically hyperactive in tinnitus, is also involved in the control of attention and emotional responses via projections to the locus coeruleus, the reticular formation and the raphe nuclei. Impaired hippocampal neurogenesis has been documented in animals with tinnitus after noise trauma, as in animal models of depression. Finally, from investigations of human candidate genes, there is some evidence to suggest that variant BDNF may act as a common susceptibility factor in both disorders. These parallels in the pathophysiology of tinnitus and depression argue against comorbidity by chance and against depression as pure reaction on tinnitus. Instead, they stand for a complex interplay between tinnitus and depression. Implications for tinnitus treatment are discussed.
    The World Journal of Biological Psychiatry 05/2011; 12(7):489-500. DOI:10.3109/15622975.2011.575178 · 4.23 Impact Factor
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    • "Periauricular auscultation and palpation are helpful in identifying objective tinnitus (Crummer & Hassan, 2004; Folmer et al., 2004). Subjective tinnitus, however, cannot, by definition, be detected by anyone other than the patient (Baldo et al., 2008). Tympanometry may identify undetected middle ear effusions, changes in tympanic membrane stiffness caused by a patulous eustachian tube or myoclonus of palatal or stapedial muscle (Lockwood et al., 2002). "
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    ABSTRACT: About 10% of the population experiences tinnitus, a common and distressing symptom characterized by the perception of sound in the absence of external stimuli. There is, however, marked heterogeneity in etiology, perception, and extent of distress among those who experience tinnitus. Reactions to tinnitus vary from simple awareness to severe irritation; some people have difficulty in hearing because of the loudness of the noise. Severe tinnitus causes many, often psychological, symptoms (e.g., tension, frustration, impaired concentration, disrupted sleep). For some, tinnitus is temporary, for others it is longstanding. Although many people adjust successfully, others are disabled by tinnitus; approximately 5% experience persistent and severe symptoms affecting their lifestyle and significantly reducing their quality of life. Because tinnitus is poorly understood and no single therapeutic approach is effective for all patients, many patients are told that ''nothing can be done'' and they must ''learn to live with it.'' In spite of these challenges, there is remarkably little relevant nursing literature on tinnitus. This literature review was conducted to explore current knowledge of tinnitus, including prevalence, causes and diagnosis, and assessment. Its psychosocial effects and impact on individuals are considered. Implications for practice are discussed-demonstrating that understanding the full impact of the condition and identifying patients' needs are essential to effective care.
    Biological Research for Nursing 01/2011; 13(1):97-108. DOI:10.1177/1099800410382290 · 1.34 Impact Factor
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