Psychiatric aspects on clinical evaluation and treatment of tinnitus

Abstract: Background: The relationship between tinnitus and psychiatric disorders is a matter of controversy and there are few studies on antidepressants and psychotherapy in the treatment of tinnitus. Aims: To determine the prevalence of psychiatric diagnoses and to investigate the screening performance of the Hospital Anxiety and Depression Scale (HAD Scale) in a consecutive series of tinnitus patients. To elucidate the clinical significance of the severity of tinnitus and to study the benefits of antidepressants and psychotherapy in the treatment of severe refractory tinnitus. Subjects and Methods: Only patients without socially disabling hearing loss were included. One study group consisted of 82 consecutive patients and two other groups (n = 76, n = 68) were deemed by screening to be at high risk for severe and disabling tinnitus. The severity of tinnitus was assessed by clinical gradings, using the Tinnitus Severity Questionnaire (TSQ) and VAS-scales for annoyance and loudness. DSM criteria were used to identify psychiatric disorders, and the HAD Scale, the Comprehensive Psychopathological Rating Scale (CPRS-S-A) and the Hamilton rating scales (HAM-D, HAM-A) were used to assess the severity of anxiety and depression. Patients were randomly assigned to 16 weeks of double-blind treatment with placebo (n=38) or sertralin (n=38). Thirty-seven patients received group psychotherapy in 8 one-hour sessions over a 3 month period. Changes in the severity of symptoms were the primary outcome. Results: Lifetime depressive and anxiety disorders were recorded in 62% and 45% of the cases, respectively. The HAD Scale was better at detecting depression than anxiety disorders. Significant correlations were found between the severity of tinnitus and the severity of depression and anxiety. Sertraline showed to be more effective than placebo (p=0.024) in decreasing reported tinnitus severity according to the TSQ, and perceived tinnitus loudness (p=0.014). Comparisons between the group psychotherapy and placebo groups revealed no benefits at the end of the intervention period. However, at follow-up 3 months later a significant improvement in anxiety (p<0.01) was recorded for the psychotherapy group. Conclusions: There is a close association between tinnitus and psychiatric disorders. The HAD Scale is a handy and useful instrument for screening for psychiatric disorders, especially depression, in tinnitus patients. The severity of tinnitus is associated with psychiatric disorders, as well as with the severity of anxiety and depression in tinnitus patients. Sertraline is more effective than placebo in the treatment of severe refractory tinnitus. Group psychotherapy does not reduce tinnitus but might be beneficial in terms of anxiety reduction.