Abstract
We have observed some severe cases of Meniere's disease with continuous or recurrent vertigo attacks. There are many factors that can make vertigo patents difficult to manage. One of the most important factors is neurotic depression. The most prominent symptom of neurotic depression is sleep disturbance, especially waking up many times at night. When you diagnose a vertigo patient as having neurotic depression, I recommend prescribing the antidepressant amitriptyline (10 mg at night). If this is not effective, you may use a dose of 20 mg to 75 mg. The case of symptoms such as vertigo or general fatigue, you may prescribe maprotiline (10 mg after breakfast); if this not effective, increase the dose to 30 mg every morning, afternoon, and night. If the case is especially severe, change maprotiline to dosulepin (75 mg). In the most severe cases try lofepramine (30 mg to 90 mg).
If the patients are not in a depressive state, or take an overdose of the antidepressant, they often have nightmares or have resting tremors in their hands. When you observe such symptoms, stop the antidepressant therapy immediately.
