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Antidepressants for patients with tinnitus

Antidepressants for patients with tinnitus (Review)
Baldo P, Doree C, Molin P, McFerran D, Cecco S
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library2012, Issue 9 Antidepressants for patients with tinnitus (Review)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Review]
Antidepressants for patients with tinnitus
Paolo Baldo1, Carolyn Doree2, Paola Molin3, Don McFerran4, Sara Cecco5 1Pharmacy Unit, Drug Information Centre, CRO Aviano - Centro di Riferimento Oncologico IRCCS, Aviano (PN), Italy. 2SystematicReview Initiative, NHS Blood and Transplant, Oxford, UK. 3Multidisciplinary Territorial Handicap Team, Local Medical Authority“Bassa Friulana”, Latisana (Udine), Italy. 4ENT Department, Essex County Hospital, Colchester Hospital University NHS FoundationTrust, Colchester, UK. 5Pharmacy Unit, Drug Information Centre, CRO Aviano - Centro di Riferimento Oncologico IRCCS, Aviano(PN), Italy Contact address: Paolo Baldo, Pharmacy Unit, Drug Information Centre, CRO Aviano - Centro di Riferimento Oncologico IRCCS,Via Franco Gallini, 2, Aviano (PN), Friuli-Venezia-Giulia, 33081, Italy. .
Editorial group: Cochrane Ear, Nose and Throat Disorders Group.
Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 9, 2012.
Review content assessed as up-to-date: 5 January 2012.
Citation: Baldo P, Doree C, Molin P, McFerran D, Cecco S. Antidepressants for patients with tinnitus. Cochrane Database of Systematic
Reviews
2012, Issue 9. Art. No.: CD003853. DOI: 10.1002/14651858.CD003853.pub3.
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
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 withchronic 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 tinnituseffect 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 andunpublished 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 authorsfor further information.
Antidepressants for patients with tinnitus (Review)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Main results
Six trials involving 610 patients were included. Trial quality was generally low. Four of the trials looked at the effect of tricyclicantidepressants 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 SSRIdrug reached the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequateoutcome measures, large drop-out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety anddepression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effectsmay have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any ofthe validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higherdoses of the drug. This observation merits further investigation. In the trial investigating trazodone, the results showed an improvementin tinnitus intensity and in quality of life after treatment, but in neither case reached statistical significance. Reports of side effectsincluding sedation, sexual dysfunction and dry mouth were common.
Authors’ conclusions
There is as yet insufficient evidence to say that antidepressant drug therapy improves tinnitus.
P L A I N L A N G U A G E S U M M A R Y
Antidepressants for patients with tinnitus
Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation, and it is frequently associatedwith 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. Thesestudies 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 studiesshowed benefit of paroxetine or trazodone in the treatment of tinnitus. Side effects, though relatively minor, were common in all groupsof antidepressants. Further research is required.
Antidepressants for patients with tinnitus (Review)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Curriculum Vitae AMIR A. KHALIQ, PhD, MBBS, MSc, MSHS BUSINESS ADDRESS Department of Health Administration & Policy College of Public Health, Room 349 The University of Oklahoma Health Science Center 801 N.E. 13th Street, Oklahoma City, OK 73104-5072 Phone: (405) 271-2115 Extension 5 E-mail: amir-khaliq@ouhsc.edu EDUCATION PhD PROFESSIONAL EXPERIENCE TENU

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