482. A NEW CHRONIC DIZZINESS DISEASE: PERSISTENT POSTURAL-PERCEPTUAL DIZZINESS (PPPD) AND VORTIOXETINE

Abstract Background Persistent Postural-Perceptual Dizziness (PPPD) is a new chronic dizziness disease that has been introduced by the Barany Society. We already reported Sertraline: SSRI (typical antidepressant) therapy was effective for patients with chronic dizziness and depression using utilized Dizziness Handicap Inventory (DHI) questionnaire and vestibular ocular reflex tests in rotation (VOR tests) at 2019 Neurootological and Equilibriometric Society (NES) in Tokyo and 2021 NES in Budapest. We also experienced SNRI or NaSSA (antidepressants) were effective for patients with PPPD. In particular, vortioxetine (Trinterix) is a new antidepressant (S-RIM: Serotonin Reuptake Inhibitor and Modulator) with less side effects and effective well. Aims & Objectives We therefore investigated the effectiveness of vortioxetine therapy for the patients with PPPD with depression. Method Out of 1900 patients (658 men, 1242 women) (mean age, 60.5 years) with dizziness. PPPD was revealed in 278 patients (14.6%) (82 men, 196 women, (mean age, 58.4 years). By the way, vortioxetine treatment performed 122 all depressive patients (with or without dizziness) (50 men, 72 women) and PPPD was revealed in 71 patients, of which 36 patients (average age 56.9 years) could be compared before and after therapy. Results Psychiatric comorbidity was revealed in 93.9% (261/278) with PPPD. This number was extremely high compared to 72.4% (1375/1900) of all dizziness diseases. The prevalence of comorbid mood disorders was high at 31% (81/261). DHI scores were improved (60.5→43.2→32.1, before→1M→2M). In VOR tests, DP% scores (vestibular function) were improved (10.87→7.63) in 13 cases. Discussion & Conclusions We reported the possibility that sertraline (SSRI) acts directly on the vestibular nervous system. These results of the present clinical research suggested that vortioxetine (S-RIM) might have some effects which improved the vestibular function in patients with dizziness and depression as well as sertraline (SSRI). It was expected that dizziness symptoms would improve by reducing anxiety. In order to reduce the side effects, it’s important to start with a lower first dose of like 0.25-0.5T (1T=10mg), gradually increase the dose like 1-2T, and continue for a long period of time (about 3-6M) until a sufficient effect is obtained.