Brexpiprazole augmentation in antidepressant therapy for persistent postural-perceptual dizziness (PPPD): A case report

To report a case of refractory dizziness associated with persistent postural-perceptual dizziness (PPPD) effectively treated with adjunctive brexpiprazole. A 62-year-old female presented with one year of persistent dizziness 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 amitriptyline and lorazepam showed slight improvement. Subsequently, brexpiprazole was introduced. Subjective dizziness improved significantly within two weeks of adding brexpiprazole (0.5mg/day). NPQ (Nigata PPPD questionaries) scores improved from 27 to 15, and psychological symptoms showed marked relief. Also, stabilometric parameters are unchanged as well. Brexpiprazole demonstrated efficacy in managing refractory dizziness by addressing comorbid psychological factors, underscoring the importance of neuropsychiatric approaches in PPPD management.