Abstract
Based on our recent papers (Horii A et al. Otol Neurotol 2004, Horii A et al., J Vestibular Res 2007), we discussed the psychiatric involvement in patients with vertigo and dizziness. Seventy percent of patients with chronic dizziness showed a high score in the Hospital Anxiety and Depression Scale (HADS), suggesting that many dizzy patients have comorbid psychiatric disorders. Fluvoxamine, one of the selective serotonin reuptake inhibitors (SSRIs), administered at a dose of 200mg per day was effective for subjective handicaps due to dizziness in patients with or without neuro-otologic illnesses, owing to its actions on both the comorbid anxiety and depressive disorder. More aggressive psychiatric treatment, such as administration of higher doses, may be the next step of treatment for non-responders without neuro-otologic diseases, because these patients have been shown to suffer from more severe psychiatric illnesses. In contrast, other types of drugs that are known to help recovery of the vestibular function are recommended for neuro-otologic diseases in patients without clinically significant anxiety or depression and non-responders to fluvoxamine. The main causes of dizziness in patients without physical neuro-otologic findings were psychiatric disorders. Bidirectional relationships between vertigo/dizziness and psychiatric disorders could be explained by the anatomical connections between the brainstem and limbic system, including the amygdala.
