Sullivan M, Katon W, Russo J, Dobie R, Sakai C
Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle.
Arch Intern Med. 1993 Oct 11;153(19):2251-9.
To determine whether the antidepressant, nortriptyline, is effective for treatment of depression, tinnitus-related disability, and tinnitus symptoms in patients with severe chronic tinnitus.
A 12-week, double-blind, randomized controlled trial.
A university otolaryngology clinic.
Ninety-two subjects with severe chronic tinnitus: 38 with current major depression and 54 with depressive symptoms and significant tinnitus-related disability.
Nortriptyline (maintained at 50 to 150 mg/mL for 6 weeks) or placebo.
Hamilton Depression Rating Scale, Tinnitus Disability Measures, and Audiometric Measures.
Nortriptyline was superior to placebo by multivariate analysis of covariance for depression (10.6 vs 14.3 final Hamilton Depression score), for tinnitus-related 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 frequency]). 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.
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.
确定抗抑郁药去甲替林对重度慢性耳鸣患者的抑郁症、耳鸣相关残疾及耳鸣症状的治疗是否有效。
一项为期12周的双盲随机对照试验。
一所大学的耳鼻喉科诊所。
92例重度慢性耳鸣患者，其中38例患有当前重度抑郁症，54例有抑郁症状且存在明显的耳鸣相关残疾。
去甲替林（维持剂量为50至150毫克/毫升，持续6周）或安慰剂。
汉密尔顿抑郁量表、耳鸣残疾评定量表及听力测定指标。
通过协方差多变量分析，去甲替林在治疗抑郁症（最终汉密尔顿抑郁评分分别为10.6和14.3）、耳鸣相关残疾（最终MPI耳鸣干扰评分分别为1.8和2.4）及耳鸣响度（最终响度匹配分别为13.6和20.0分贝[耳鸣频率最差耳]）方面优于安慰剂。当分别考虑重度抑郁症组和抑郁症状组时，去甲替林在这些相同指标上也优于安慰剂，但差异未达到统计学显著性。
抗抑郁药去甲替林可减轻与重度慢性耳鸣相关的抑郁、功能残疾及耳鸣响度。耳部起源看似不可逆的残疾，部分可能是精神起源的可逆性残疾。
