Association Between the Adverse Effects and Therapeutic Outcomes of Pharmacological Treatment for Persistent Postural-Perceptual Dizziness

Persistent Postural-Perceptual Dizziness (PPPD) is a leading cause of chronic dizziness, and antidepressant therapy, vestibular rehabilitation, and cognitive-behavioral therapy have been reported as effective treatments. However, side effects associated with antidepressant therapy could reduce treatment adherence. This study was aimed at evaluating the side effects and treatment outcomes of antidepressant therapy for PPPD. We enrolled a total of 21 patients who visited our Department of Otorhinolaryngology between May 2022 and September 2024, were diagnosed as having PPPD according to the 2017 Bárány Society criteria, and received antidepressant therapy for at least three months. Treatment efficacy was assessed using the Niigata PPPD Questionnaire (NPQ), with a reduction by 13 points or more considered as representing significant improvement. Adverse effects were classified according to the CTCAE Ver5, with severe adverse effects defined as those that necessitated discontinuation of the same medication. Severe adverse effects were observed in 5 of the 21 patients (23.8%), consisting primarily of gastrointestinal symptoms, along with akathisia and muscle stiffness. Patients who experienced severe adverse effects exhibited significantly higher NPQ scores prior to treatment initiation, particularly for items related to standing, motion, and visual stimulation. However, despite experiencing adverse effects, all five patients showed symptomatic improvement of the dizziness after six months of continued treatment. The results suggest that patients with higher NPQ scores prior to treatment are more likely to experience adverse effects, but that symptom improvement can still be achieved with continued treatment. Effective communication with patients about potential side effects before initiating antidepressant therapy may enhance treatment adherence. Further studies are warranted to validate these findings and improve the treatment strategies for PPPD.