A Cochrane review [Abstract] 1 included 6 studies with 610 patients. Four studies were on tricyclic antidepressants (n=405), one on paroxetine, a selective serotonin reuptake inhibitor (SSRI; n=120) and one on trazodone (n=85). Only the paroxetine trial met the highest quality standard. 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. With paroxetine, there was no overall improvement in any of the validated outcome measures but there was possible benefit for a subgroup that received higher doses of the drug. 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. Side effects including sedation, sexual dysfunction and dry mouth were common.
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment, more than 20% of follow-up), inconsistency (heterogeneity in evaluation methods and outcomes) and imprecise results (failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression).
Primary/Secondary Keywords