Can transcranial magnetic stimulation (TMS), a treatment that has been approved for patients with major depression, have a positive effect on tinnitus sufferers? That is what a team of researchers from Loyola University Medical Center in Proviso, IL, is studying. (See FastLinks.) “Tinnitus could be for a number of reasons,” said Murali Rao, MD, the chair of the department of psychiatry and behavioral neurosciences at Loyola University Chicago Stritch School of Medicine, in Maywood, IL. “Once all has been done to rule out the common causes of tinnitus, such as blood vessel problems and anything to do with the nervous system, we then look at the chronic tinnitus sufferers where no cause or remedy has been found. There has been a close association between psychological disorders like anxiety and depression and tinnitus.”
Earlier studies suggest that TMS treatment may be beneficial for tinnitus patients, and the Loyola study is the first to examine patients who suffer from tinnitus and depression. “TMS has an effect on the neurocircuitry of the brain,” Dr. Rao said. “It's a way of modulating the connectivity within the brain, and we use that for treatment of depression. What we are trying to find out is how much the treatment has an effect on depression, and we will see what happens with tinnitus at the same time.”
A patient has a magnetic coil placed next to the left side of the head during TMS treatment. The coil sends short pulses of magnetic fields to the surface of the brain, and these currents stimulate brain cells, which, in turn, affect mood-regulatory circuits in the brain, resulting in beneficial effects for depressed patients. The treatment lasts around 40 minutes, and is done on an outpatient basis; patients can immediately resume normal activities afterwards.
Researchers are still in the process of enrolling patients, but Dr. Rao said he recognized the difficulty of finding patients with tinnitus and depression. The study will enroll up to 20 individuals and each patient will receive five treatments a week for six weeks. Looking ahead, Dr. Rao said it may be possible to use the same technique to study patients with tinnitus and no depression, if the study demonstrates an effect on tinnitus.
This research comes on the heels of a Swedish study of 6,215 working adults surveyed in 2008 and 2010 that reported higher levels of depression symptoms in those with severe tinnitus. (PLoS ONE 2012;7:e37733.) Tinnitus severity was rated from one to four, and a depression symptom score was gathered from six items from the Hopkins Symptom Checklist. A strong association was found between changes in tinnitus score and tinnitus severity rating compared with changes in depression symptom ratings. Those with a decrease in depressive symptoms during the period also reported a decrease in rates of tinnitus and tinnitus severity.
“It is clear from our study that changes in depression and tinnitus scores are associated with each other and may be due to comorbidity,” wrote the study authors, who were led by Sylvie Hébert, PhD, of the Centre for Research on Brain, Language and Music at the University of Montreal. “This study suggests that depressive symptoms should be assessed in tinnitus patients and vice versa. Future studies are needed to assess possible clinical relevance on an individual level.”
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