Is antidepressant gaining recognition in the treatment of Meniere’s disease?

Meniere's disease (MD) remains a challenging inner ear disorder with multifaceted symptomatology, including vertigo, tinnitus, fluctuating hearing loss, and often neuropsychiatric comorbidities such as anxiety and depression, complicating both diagnosis and management.Despite advancements over the last several decades, the pathophysiology of MD is not fully elucidated, and existing treatments primarily aim to reduce vertigo episodes, often neglecting other symptom domains, including hearing loss and tinnitus.The wide variability in the symptomatology, affecting population and diagnostic measures, makes the diagnosis process difficult.With the recent classification, MD has been grouped into five types, which may reduce the complexities of diagnosing the disease, but all the treatment options available focus on reducing the vertigo episodes, leaving behind the other symptoms.It was believed that the rupture of the membranous labyrinth is responsible for the vertigo episodes.The distortion of the endolymphatic duct with inadequate drainage causes endolymphatic hydrops, and its rupture alters the chemical milieu of endolymph and perilymph, substantiated by the presence of scars.Recent studies show that the sudden shift of endolymph to the pars superior is the reason for vertigo attacks rather than the recurrent membrane breaks. [1]urthermore, the neuroimaging studies found that endolymphatic hydrops is not absolutely to MDs but is also noted in subjects of vestibular migraine, isolated sensory neural hearing loss and in healthy volunteers. [2]MD also shares its pathophysiology with vestibular migraine, another disease of the inner ear.Trials also point to the immunological basis of the disease pathology.Those patients diagnosed with MD also have an autoimmune pathology. [3]Trials with allergic desensitisation in patients with MD show a positive response.The immunological profile also shows variations in the levels of cytokines and biomarkers in various clinical trials.However, the major hindrance to the clinical trials of MD is the placebo effect, which affects the outcome and validity of any trial.This paves the way for so many treatment options without specificity.Current standard therapies, such as diuretics, vestibular suppressants, betahistine and invasive procedures, while offering some vertigo control, have variable efficacy and do not address the broader symptom burden associated with MD.Moreover, the overlap in clinical features with vestibular migraine and emerging evidence suggesting an immunological basis of MD highlight the need for alternative, multifactorial therapeutic strategies.Antidepressants-particularly selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)-have shown promise not only as treatments for vestibular migraine but https://ijpp.com