The effects of sertraline on severe tinnitus suffering - A randomized, double-blind, placebo-controlled study
ABSTRACT 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.
- SourceAvailable from: Tobias Kleinjung
Article: Tinnitus and depression.[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 · 4.23 Impact Factor
Chapter: Fármacos en acúfenosAcúfeno como señal de malestar, Edited by López-González MA, Esteban-Ortega F, 01/2010: chapter Fármacos en acúfenos: pages 641-65; Publidipsa., ISBN: 978-84-692-3367-2
Article: Antidepressant therapy in tinnitus[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: Review the literature on the co-morbidity of depression and anxiety with tinnitus. Briefly consider proposed mechanisms by which antidepressants might be helpful for tinnitus, including treatment of co-morbid depression and anxiety and a more direct serotonergic mechanism of tinnitus. Survey the literature on antidepressants and tinnitus including tinnitus reported as a side effect of antidepressants (phenelzine, amitriptyline, protriptyline, doxepin, imipramine, fluoxetine, trazadone, bupropion, venlafaxine), tinnitus associated with withdrawal of antidepressants (venlafaxine and sertraline) and antidepressants as a treatment for tinnitus (case reports--fluoxetine and paroxetine, retrospective reviews--imipramine and selective serotonin reuptake inhibitors, single blind trials of amitriptyline and double blind placebo controlled trials of trimipramine, nortriptyline, paroxetine and sertraline). Provide suggestions on future directions, specifically replication of prior studies and a dose finding study of paroxetine for the treatment of tinnitus.Hearing Research 05/2007; 226(1-2):221-31. DOI:10.1016/j.heares.2006.08.004 · 2.85 Impact Factor