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Effects on Depression, Disability, and Tinnitus Symptoms

Mark Sullivan, MD, PhD; Wayne Katon, MD; Joan Russo, PhD; Robert Dobie, MD; Connie Sakai, MSPA

Arch Intern Med. 1993;153(19):2251-2259.

Abstract
Objective
To determine whether the antidepressant, nortriptyline, is effective for treatment of depression, tinnitusrelated disability, and tinnitus symptoms in patients with severe chronic tinnitus.

Design
A 12-week, double-blind, randomized controlled trial.

Setting
A university otolaryngology clinic.

Patients
Ninety-two subjects with severe chronic tinnitus: 38 with current major depression and 54 with depressive symptoms and significant tinnitus-related disability.

Intervention
Nortriptyline (maintained at 50 to 150 mg/mL for 6 weeks) or placebo.

Main Outcome Measures
Hamilton Depression Rating Scale, Tinnitus Disability Measures, and Audiometric Measures.

Results
Nortriptyline was superior to placebo by multivariate analysis of covariance for depression (10.6 vs 14.3 final Hamilton Depression score), for tinnitusrelated disability (1.8 vs 2.4 final MPI Tinnitus Interference), and tinnitus loudness (13.6 vs 20.0 dB final loudness match [in worst ear at tinnitus fequency]). When major depression and depressive symptoms groups were considered separately, nortriptyline was superior to placebo on these same measures but differences did not achieve statistical significance.

Conclusions
The antidepressant nortriptyline decreases depression, functional disability, and tinnitus loudness associated with severe chronic tinnitus. What appears to be irreversible disability of otologic origin may, in part, be reversible disability of psychiatric origin.

(Arch Intern Med. 1993;153:2251-2259)

Author Affiliations
From the Department of Psychiatry and Behavioral Sciences, RP-10, University of Washington Medical School, Seattle (Drs Sullivan, Katon, and Russo); and Department of Otolaryngology, University of Texas Health Sciences Center, San Antonio (Dr Dobie and Ms Sakai).

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