Chronic dizziness and anxiety: Effect of course of illness on treatment outcome

Objective: To investigate the hypothesis that the efficacy of selective serotonin reuptake inhibitors (SSRIs) for chronic subjective dizziness (CSD) and anxiety depends on the longitudinal pattern of the patients' symptoms. Design: Prospective cohort study. Setting: Tertiary care, multidisciplinary, balance center. Patients: Eighty-eight consecutive patients treated with an SSRI for CSD and anxiety between 1998 and 2003. All patients were referred for evaluation of unremitting dizziness. They entered SSRI treatment after comprehensive neurotologic and psychiatric evaluations revealed a syndrome of CSD with accompanying anxiety. Patients were separated into 3 groups according to their longitudinal patterns of illness: (1) otogenic, defined as primary neurotologic conditions triggering secondary anxiety disorders; (2) psychogenic, defined as anxiety disorders alone causing dizziness; and (3) interactive, defined neurotologic conditions exacerbating preexisting anxiety. Interventions: Patients with CSD were treated with an SSRI according to an established protocol for at least 8 weeks or until they proved intolerant to medication. Main Outcome Measures: Changes in dizziness and anxiety as measured by the Clinical Global Impressions-Improvement scale. Results: Patients with the otogenic and psychogenic patterns of illness had a more complete response to SSRI treatment than did patients in the interactive group (P<.01). Rates of SSRI intolerance were similar for all 3 groups. Conclusions: Selective serotonin reuptake inhibitors are effective for patients with CSD and anxiety. However, patients with clinically significant anxiety predating neurotologic illness may require more intensive interventions.