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Serotonin Reuptake Inhibitors for Dizziness With Psychiatric Symptoms
Jeffrey P. Staab, MD, MS;
Michael J. Ruckenstein, MD;
David Solomon, MD, PhD;
Neil T. Shepard, PhD
Arch Otolaryngol Head Neck Surg. 2002;128:554-560.
Objective To investigate the efficacy and tolerability of selective serotonin
reuptake inhibitors (SSRIs) for the treatment of patients with dizziness and
major or minor psychiatric symptoms, with or without neurotologic illnesses.
Design Review of 60 consecutive cases of patients with dizziness who were treated
with an SSRI for at least 20 weeks during the 30-month period from July 1998
to December 2000.
Setting Tertiary care, multidisciplinary referral center.
Patients Sixty men and women, aged 13 to 81 years, with (1) psychogenic dizziness,
(2) dizziness due to a neurotologic condition, as well as significant psychiatric
symptoms, or (3) idiopathic dizziness.
Interventions Open-label treatment with an SSRI titrated to 1 of 3 end points: optimal
clinical benefit, intolerable adverse effects, or no therapeutic response.
Main Outcome Measure Change in dizziness and psychiatric symptoms measured by the 7-point,
clinician-rated, Clinical Global Impressions-Improvement Scale.
Results Thirty-eight (63%) of 60 patients in the intent-to-treat sample and
32 (84%) of 38 patients who completed treatment improved substantially. The
response rates did not differ between patients with major psychiatric disorders
and those with lesser psychiatric symptoms. Patients whose only diagnosis
was a psychiatric disorder and those with coexisting peripheral vestibular
conditions or migraine headaches fared better than patients with central nervous
system deficits. Before being treated with an SSRI, two thirds of the study
patients took meclizine hydrochloride and/or benzodiazepines, with minimal
benefit.
Conclusions Treatment with SSRIs relieved dizziness in patients with major or minor
psychiatric symptoms, including those with peripheral vestibular conditions
and migraine headaches. Patients fared far better with SSRI treatment than
with treatment with vestibular suppressants or benzodiazepines.
From the Departments of Psychiatry (Dr Staab), Otorhinolaryngology–Head
and Neck Surgery (Drs Staab, Ruckenstein, Solomon, and Shepard), and Neurology
(Dr Solomon) and the Balance Center (Drs Staab, Ruckenstein, Solomon, and
Shepard), University of Pennsylvania Health System, Philadelphia. Dr Staab
receives research funding from Pfizer Inc and GlaxoSmithKline, and is a consultant
to Eli Lilly and Company and Forest Laboratories, Inc.
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