Effects of antidepressants on persistent postural-Perceptual Dizziness(PPPD)

The diagnostic criteria for Persistent Postural-Perceptual Dizziness(PPPD)was defined by the Committee for the Classification of Vestibular Disorders of the Barany Society, and published in the Journal of Vestibular Research in 2017. PPPD is characterized by chronic vestibular syndrome persisting for ＞3 months, that is typically preceded by acute vestibular disorders. Antidepressant medication, vestibular rehabilitation, and cognitive behavioral therapy have been reported to be useful for the treatment of PPPD. In this study, we evaluated the efficacy of pharmacotherapy with antidepressants in 90 patients diagnosed as having PPPD. A selective serotonin reuptake inhibitor(SSRI)(escitalopram, 10-20 mg/day), serotonin and noradrenaline reuptake inhibitor(SNRI)(venlafaxine, 75mg/day), and noradrenergic and specific serotonergic antidepressant(NaSSA)(mirtazapine, 15mg/day)were used in this study. Antidepressant therapy led to improvement of the Dizziness Handicap Inventory(DHI)score, suggesting that it was effective for reducing the dizziness in patients with PPPD. On the other hand, in the non-treated group, consisting of patients who, for some reason, could not receive medication, there was no significant improvement in dizziness during the approximately 1-year follow-up period, suggesting the usefulness of therapeutic intervention for PPPD. While antidepressant drug therapy was shown to be effective, the incidence of adverse effects was high for all the drug classes, and the treatment continuation rate tended to decrease as the incidence of adverse effects increased, suggesting that appropriate control of adverse effects is important to achieve better treatment efficacy.