Treatment of anxiety and depression-related vertigo and dizziness with SSRIs and SNRIs

Abstract

Recently, vertigo or dizziness has been linked to abnormal serotonin regulation in the hippocampus. According to the DSM-VI and ICD-10, vertigo or dizziness is a common symptom of anxiety disorder, somatoform disorder, and depression. In today's stressful society, we are now observing record increases in the number of patients with depression. Because of this increase, otolaryngologists are now encountering an increasing number of patients with depression-related dizziness or vertigo. We treated 41 patients with depression-related vertigo or dizziness with a selective serotonin reuptake inhibitor (SSRI: paroxetine or fluvoxamine) or a selective norepinephrine reuptake inhibitor (SNRI: milnacipran). We graded the effects of treatment according to three levels: outstanding, effective, or not effective. Besides dizziness, the chief complaints of patients we treated were problems with sleep, headache, heavy headedness, shoulder stiffness, and loss of motivation. Drug effectiveness or the overall recovery rate was defined as the ratio of the number of patients showing outstanding and effective improvements to the total number of patients treated with a particular drug. The overall recovery rate for patients treated with paroxetine was 82% (14/17), for patients treated with fluvoxamine it was 90% (10/11), and for patients treated with milnacipran it was 62% (8/13). Side effects were observed in 22% (9/41) of the patients. Symptoms disappeared in about 2 weeks after drug treatment began. SSRIs and SNRIs are now the drugs-of-choice for treating anxiety- or depression-related vertigo because they are associated with fewer adverse effects than traditional antidepressants. Moreover, when compared to tranquilizers, SSRIs and SNRIs tend to be less habit-forming. As an adjunct to psychological counseling, dizziness associated with psychiatric disorders can also be treated in otolaryngological outpatient clinics with relevant drugs. To effectively treat these dizzy patients, collaboration between the patients' otolaryngologists and psychiatrists or psychological counselors is also important.