Antidepressants for patients with tinnitus

 

Abstract

Background

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2006.

Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic 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 tinnitus effect 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(CENTRAL); PubMed; EMBASE; Psycinfo; CINAHL; Web of Science; BIOSIS; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 22 October 2008.

Selection criteria

Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus.

Data collection and analysis

The studies retrieved were critically appraised and data extracted independently by two authors. Where necessary study authors were contacted for further information.

Main results

Six trials involving 610 patients were included. Four of these trials looked at the effect of tricyclic antidepressants 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 SSRI drug reached the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop-out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. In the trial investigating trazodone, the results showed an improvement in tinnitus intensity and in quality of life after treatment, but in neither case reached statistical significance. Reports of side effects including sedation, sexual dysfunction and dry mouth were common.

Authors' conclusions

There is as yet insufficient evidence to say that antidepressant drug therapy improves tinnitus.

 

Plain language summary

Antidepressants for patients with tinnitus

Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation, and is frequently associated with depression or depressive symptoms. Six studies 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 in the treatment of tinnitus. Side effects, though relatively minor, were common in all groups of antidepressants. Further research is required.

 

摘要

背景

用抗憂鬱藥治療耳鳴

.當沒有聲音刺激時卻感覺聲音或噪音的存在稱為耳鳴，它曾被人與慢性疼痛比較，而且也許與憂鬱與壓抑症狀有關，會影響到生活品質與工作能力。曾有人用抗憂鬱藥物來治療無論是否有憂鬱症的耳鳴病患

目標

評估抗憂鬱藥治療耳鳴的效果，並查明其效果是來自直接耳鳴減輕的作用，還是來自於治療病患同時有憂鬱狀態的間接作用

搜尋策略

搜尋了the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 1, 2006); MEDLINE (January 1951 to 2006); EMBASE (1974 to 2006), CINAHL (to 2006), PSYCINFO (to 2006), LILACS (to 2006), and Cambridge Scientific Abstracts。最近的搜尋日期為2006年3月

選擇標準

隨機對照臨床研究，比較抗憂鬱藥與安慰劑對耳鳴病患的效果

資料收集與分析

兩位作者各自摘選並嚴格評價所檢索的研究。聯繫被挑選研究的作者以得更多訊息

主要結論

收集了5個研究含525位病人。其中4個研究(共含405位病患)著眼在三環抗憂鬱劑(tricyclic antidepressants)對耳鳴的效果。1個研究(含120位病患)探討selective serotonin reuptake inhibitor (SSRI)的效果。用其他種類抗憂鬱劑治療耳鳴的研究中並沒有符合挑選標準。收集的研究中，只有SSRI藥物的試驗符合最高品質等級的評價，其他研究皆無達到最高品質等級，是由於不充足的結果評量、大量病人退出試驗率、或並沒有把耳鳴的治療效果與憂鬱焦慮症狀的效果分開等等的原因。所有評估三環抗憂鬱劑的研究顯示耳鳴有輕微的改善，但這些效果可能來自方法學上的誤差。探討SSRI的研究中，根據其試驗設計的有效結果標準，發現在整體上並無改善，但在用高劑量的病患群中也許有些效益。這個觀察值得更進一步的探討研究。報告的副作用常見的有鎮定、性功能障礙、及乾口症

作者結論

沒有足夠的證據顯示抗憂鬱藥可改善耳鳴

翻譯人

本摘要由國泰綜合醫院方德詠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

抗憂鬱藥治療耳鳴:沒有聲音刺激時卻感覺聲音或噪音的存在稱為耳鳴，它常與憂鬱及壓抑症狀有關。5個研究符合此篇評論的收集標準，4個評估三環抗憂鬱劑(amitriptyline, nortriptyline and trimipramine)對耳鳴的治療，這些研究沒有足夠證據顯示這類藥劑對耳鳴的功效；1個研究評估paroxetine(一種 selective serotonin reuptake inhibitor抗憂鬱劑)，顯示其對耳鳴無整體上的效益。這兩類抗憂鬱藥物的副作用雖然不嚴重，卻很常見。需要更多的研究