A prospective trial of sertraline for chronic subjective dizziness.
OBJECTIVE
The authors previously reported that selective serotonin reuptake inhibitors (SSRIs) reduce chronic subjective dizziness in patients with and without psychiatric illnesses. To extend those preliminary findings and test the hypothesis that SSRIs may offer a novel treatment for chronic subjective dizziness, the authors conducted a prospective study of sertraline in patients with dizziness for more than 6 months, in the absence of active physical neurotologic illness.


METHODS
Sixteen-week, prospective, open-label, flexible-dose clinical trial.


METHODS
Twenty-four patients with subjective dizziness for more than 6 months and no active physical neurotologic illness were studied. Eighteen patients had major anxiety disorders. Six had minor frustration or worry that did not warrant a psychiatric diagnosis. Sertraline was administered at a daily dose of 25 mg, which was increased to a maximum daily dose of 200 mg. Dizziness, functional impairment, and psychological distress were measured using the Dizziness Handicap Inventory (DHI) and Brief Symptom Inventory-53 (BSI-53). Treatment outcomes were analyzed using repeated-measures multivariate analyses of variance, with last observations carried forward.


RESULTS
Three patients were excluded from data analysis for disqualifying medical conditions, one for protocol violations. Fifteen (75%) patients completed treatment. Five (25%) withdrew for adverse effects or lack of efficacy. The median daily dose of sertraline was 100 mg. Sertraline significantly reduced scores on all three DHI subscales and the BSI-53. Eleven of 15 (73%) patients who completed treatment had a positive response, including 8 of 11 (73%) with major anxiety disorders and 3 of 4 (75%) with no psychopathological conditions. Six patients enjoyed a full remission of symptoms.


CONCLUSIONS
Sertraline significantly reduced chronic subjective dizziness in patients without active physical neurotologic illness, including those with and without psychiatric comorbidity.
Staab
Jeffrey P
JP
Department of Psychiatry, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA. jeffrey.staab@uphs.upenn.edu
Ruckenstein
Michael J
MJ
Amsterdam
Jay D
JD
D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology; D002908:Chronic Disease; D004244:Dizziness / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use*; D013001:Somatoform Disorders / Q000188:drug therapy* / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline