The relationship between tinnitus and anxiety and depressive disorders has been frequently alluded to, but there are few studies on antidepressants in the treatment of tinnitus, and the efficacy of sertraline on severe refractory tinnitus has not been reported.
Consecutive tinnitus patients (n = 76) considered to be at high risk for severe and disabling tinnitus according to a recently developed screening procedure were randomly assigned to 16 weeks of double-blind treatment with placebo (n = 38) or sertraline (n = 38) at a fixed dose (25 mg/d on the first week and 50 mg/d on the following 15 weeks). Between-group comparisons of Tinnitus Severity Questionnaire scores over 16 weeks were made as the primary outcome measure. Secondary outcomes of tinnitus loudness and tinnitus annoyance were also measured using a visual analogue scale. Severity of depressive and anxiety symptoms was evaluated using the Hamilton rating scales (Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, interview-based ratings) and the Comprehensive Psychopathological Rating Scale (self-ratings).
The intention-to-treat analysis showed sertraline to be more effective than placebo (P = 0.024) in decreasing reported tinnitus severity according to the Tinnitus Severity Questionnaire at 16 weeks' follow-up. There was also more improvement (P = 0.014) in perceived tinnitus loudness. There were significant correlations between reduction of tinnitus according to the Tinnitus Severity Questionnaire over 16 weeks and improvements in depressive (r = 0.42-0.46) and anxiety symptoms (r = 0.34-0.42). Sertraline was well tolerated after a somewhat high (17%) dropout rate within the first 2 weeks.
Sertraline is more effective than placebo in the treatment of severe refractory tinnitus.
"The tricyclic nortriptyline signifi cantly reduced depression scores, tinnitus disability scores, and tinnitus loudness relative to placebo (Sullivan et al., 1993). The serotonin reuptake inhibitor sertraline, in turn, was signifi cantly more effective than placebo in reducing tinnitus severity (Zoger et al. 2006b). In both studies , the reduction in tinnitus-related disability scores correlated highly with the reduction in depression scores, suggesting that antidepressants elicit clinical improvements in depressed tinnitus patients, but that this is mainly due to the antidepressant effect of the drug. "
[Show abstract][Hide abstract] 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 · 4.18 Impact Factor
"Sertraline was found to be more effective than placebo for severe refractory tinnitus cases63 although its discontinuation was associated with tinnitus onset.64 Other SSRIs (eg, paroxetine) provided no significant improvement for nondepressed patients65 or even exacerbated tinnitus (eg, fluoxetine).66 "
[Show abstract][Hide abstract] ABSTRACT: Subjective tinnitus is a frequent, impairing condition, which may also cause neurotransmitter imbalance at the cochlea. Psychopharmacologic agents, although not being the first-line treatment for tinnitus, may modulate cochlear neurotransmission, thereby influencing the subjective tinnitus experience.
A comprehensive review of MEDLINE literature (from January 1990-January 2010) was performed searching for: "tinnitus", major classes of psychopharmacological agents, and psychiatric disorders. The most relevant clinical evidence is reported briefly along with a concise description of the main neurotransmitters purported to be involved in tinnitus, in order to provide the reader with a rational evaluation of tinnitus therapy with psychopharmacological agents.
Although strong methodological issues limit the reliability of the current results, a broad number of psychopharmacological agents have already been considered for tinnitus, both as candidate triggers or potential therapies.
Selected psychopharmacological drugs may play a role in the clinical management of this disorder. While the rational use of these agents for the treatment of tinnitus should not be overlooked, research should be undertaken on their neuromodulating actions at the cochlea.
"El mismo estudio apunta la posibilidad de que en un subgrupo de pacientes que recibió una dosis más alta de paroxetina (50 mg/día), sí se aprecie una cierta mejoría en algunas de las medidas. La sertralina también ha sido estudiada en un ensayo clínico [Zoger et al., 2006], encontrando una mejoría significativa frente a placebo en la severidad de los acúfenos medida con el TSQ y en su intensidad, apreciando también como la mejoría en el TSQ se correlaciona con una mejoría en los parámetros de ansiedad y depresión. "
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