***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Although there is increasing awareness that depression can add significantly to the disability associated with chronic medical illness , it is not clear whether all of the impact of psychosocial factors upon medical disability are mediated by or moderated by depression . It has not been determined whether treating depression alone is an adequate strategy for addressing psychosocial magnification of medical disability . We analyzed data collected at initiation of a treatment trial from 92 subjects with chronic severe tinnitus to assess the role of coping , and 49 subject-spouse pairs to assess the role of marital interaction  in  tinnitus-related role dysfunction . Three multiple regression models were developed . After accounting for gender , tinnitus loudness , and depressive severity among the 92 subjects , greater role dysfunction was associated appraisal of tinnitus as salient , and less role dysfunction with coping through avoidance or seeking social support . Marital interaction was assessed from patient and spouse perspectives . In the patient-rated set , less marital cohesion was associated with greater tinnitus-related role dysfunction . In the spouse-rated set , more punishing responses to subject illness behavior were associated with greater tinnitus-related role dysfunction . In each case the disabling effect was greater in the face of high levels of subject depression . This study provides evidence for the oft-stated analogy between chronic tinnitus and chronic pain , and provides justification for a similar multimodal treatment strategy . Reducing depression is an important means to reduce medical disability but should be supplemented by clinical attention to appraisal of the illness , modes of coping with the illness , and spousal response to the illness Patients disabled by tinnitus show a high prevalence of major depression . Furthermore , tinnitus produces patterns of disability similar to those produced by major depression . To explore further this link between tinnitus and depression , and to investigate the efficacy of treating depression in the treatment of tinnitus , a single-blind , placebo-washout , nonr and omized pilot study of the tricyclic antidepressant nortriptyline ( hydrochloride ) was undertaken in disabled tinnitus patients who also met diagnostic criteria for major depression . Nineteen patients began the study , two responded to placebo  , and two dropped out prior to completion . Fourteen considered their tinnitus improved , and 12 chose to continue taking nortriptyline after the study . Depression severity decreased , on the average , by 65 % ( p<.0001 ) . Tinnitus loudness measured by audiometric matching decreased by a mean of 10 dB or 50 % ( p<.02 ) . Self-reports of tinnitus loudness and severity , somatic and psychologic symptoms , and psychosocial dysfunction all showed significant improvement with treatment . These results suggest that what initially appears to be an irreversible otologic disability in these patients may be in large part a reversible psychiatric disability OBJECTIVE To determine whether the antidepressant , nortriptyline , is effective for treatment of depression , tinnitus-related disability , and tinnitus symptoms in patients with severe chronic tinnitus . DESIGN A 12-week , double-blind , r and omized 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 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 . 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 
    Output:
    
There was no evidence that Gingko biloba was effective in patients with a primary complaint of tinnitus .
The practical clinical significance of this is unclear .
The incidence of side effects was low .
The limited evidence does not demonstrate that Ginkgo biloba is effective for tinnitus when this is the primary complaint