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: 6.03). 02/2006; 9(4):CD003853. DOI: 10.1002/14651858.CD003853.pub2
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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- "Evidence from Cochrane Reviews shows that Ménière's disease patients may benefit from intratympanic gentamicin or steroid etiologic ther- apies[Phillips and Westerberg, 2011; Pullens and vanBenthem, 2011], but these may induce serious side effects: for example, intratympanic gentamicin is effective for treating vestibular complaints but is not effective for treating tinnitus and hearing loss, which is often worsened by the therapy in up to 25% of the treated population . All the etiologic and symptomatic treatments based on oral drug regimens evaluated in the Cochrane Reviews did not prove their effectiveness and may induce important adverse effects[Baldo et al., 2012;Burgess and Kundu, 2006;Hoekstra et al., 2011;James and Burton, 2001]. Interestingly, the evidence from Cochrane Reviews highlights several effective symptomatic treatments for tinnitus and vestibular complaints that are nonpharmacological: tinnitus retraining therapy, sound therapy (masking), CBT, and vestibular rehabilitation [Hillier and McDonnell , 2011;Hobson et al., 2010;Martinez-Devesa et al., 2010;Phillips and McFerran, 2010]. "
ABSTRACT: Ménière's disease is a disorder of the inner ear affecting hearing and balance to a varying degree. It is characterized by episodes of vertigo, low-pitched tinnitus, and hearing loss. There is currently no gold standard treatment for Ménière's disease. We conducted a systematic search of the Cochrane Database, as a high-quality source of evidence-based therapies, for reviews on the efficacy of etiological therapy or on Ménière's disease or its symptoms. Following recent positive experiences reported by other research teams, we decided to involve a patients' representative in the assessment and analysis of the evidence retrieved in the literature in order to achieve a more patient-centered evaluation of the therapies. Evidence confirms that an effective treatment of Ménière's disease is still missing, but recent discoveries on the microvascular etiology of Ménière's disease may be assimilated by new evidence-based therapeutic approaches. © 2015 S. Karger AG, Basel.
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- "As well, there was no evidence of a benefit in prescribing ADs for cases of sialorrhea related to neurological conditions (Amyotrophic lateral sclerosis (ALS), Parkinson’s disease), although prescription was sometimes recommended . Antidepressants were found to have no proof of benefit for cases of tinnitus . "
ABSTRACT: Background Antidepressants (ADs) are commonly prescribed in primary care and are mostly indicated for depression. According to the literature, they are now more frequently prescribed for health conditions other than psychiatric ones. Due to their many indications in a wide range of medical fields, assessing the appropriateness of AD prescription seems to be a challenge for GPs. The aim of this study was to review evidence from guidelines for antidepressant prescription for non-psychiatric conditions in Primary Care (PC) settings. Methods Data were retrieved from French, English and US guideline databases. Guidelines or reviews were eligible if keywords regarding 44 non-psychiatric conditions related to GPs’ prescription of ADs were encountered. After excluding psychiatric and non-primary care conditions, the guidelines were checked for keywords related to AD use. The latest updated version of the guidelines was kept. Recent data was searched in the Cochrane Database of Systematic Reviews and in PubMed for updated reviews and randomized control trials (RCTs). Results Seventy-eight documents were retrieved and were used to assess the level of evidence of a potential benefit to prescribing an AD. For 15 conditions, there was a consensus that prescribing an AD was beneficial. For 5 others, ADs were seen as potentially beneficial. No proof of benefit was found for 15 conditions and proof of no benefit was found for the last 9. There were higher levels of evidence for pain conditions, (neuropathic pain, diabetic painful neuropathy, central neuropathic pain, migraine, tension-type headaches, and fibromyalgia) incontinence and irritable bowel syndrome. There were difficulties in summarizing the data, due to a lack of information on the level of evidence, and due to variations in efficacy between and among the various classes of ADs. Conclusions Prescription of ADs was found to be beneficial for many non-psychiatric health conditions regularly encountered in PC settings. On the whole, the guidelines were heterogeneous, seemingly due to a lack of trials assessing the role of ADs in treatment strategies.
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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  . "
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).
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