A case of refractory dizziness effectively treated with the addition of aripiprazole to antidepressant therapy

To report a case of refractory dizziness associated with persistent postural-perceptual dizziness (PPPD) effectively treated with adjunctive aripiprazole. A 41-year-old male presented with three months of persistent dizziness and aural fullness unresponsive to standard treatments for Ménière's disease. Comprehensive evaluations, including audiometry, vestibular function tests, and stabilometry, were normal. Based on clinical criteria, PPPD with comorbid anxiety and depression was diagnosed. Initial treatment with vortioxetine and clonazepam showed no improvement. Subsequently, aripiprazole was introduced. Subjective dizziness improved significantly within two weeks of adding aripiprazole (1.5 mg/day). Upon increasing the dose to 3 mg/day, Dizziness Handicap Inventory scores improved from 58 to 18, and psychological symptoms showed marked relief. However, stabilometric parameters remained unchanged. Aripiprazole demonstrated efficacy in managing refractory dizziness by addressing comorbid psychological factors, underscoring the importance of neuropsychiatric approaches in PPPD management.