Anxiety Associated with Vertigo

Summarized by Robert W. Griffith, MD
May 4, 2005

Introduction

A common form of dizziness is when you feel that you, or the room, is spinning or moving. This is called vertigo; sometimes it's accompanied by nausea, sweating, and even vomiting. There are many causes of vertigo, which have to be fully investigated to make sure the right treatment is recommended. Sometimes one of the more baffling causes is an underlying anxiety disorder.

Vertigo associated with anxiety is characterized by a variable duration of the episodes. Common tests for inner-ear disturbances are usually negative, whereas there are accompanying symptoms of anxiety; these may present as variations of panic attacks, generalized anxiety, or as an obsessive-compulsive disorder.

It should be remembered that vertigo itself is a distressing condition that can produce anxiety, even when the main cause is something else.

Treatment of nausea and vomiting

Drugs that are good for motion sickness are also often effective in vertigo-related nausea. They are unlikely to benefit one of the common types of vertigo, benign paroxysmal positional vertigo, where each episode only lasts for seconds. They may be used in anxiety-related vertigo if the episodes last more than a few minutes. Drugs commonly employed are meclazine (Avert^®), dimenhydrinate (Dramamine^®), and prochlorperazine (Compazine^®).

Anxiety symptoms and vertigo

Patients are likely to hyperventilate (over-breathing, with quick, deep breaths using the upper chest), which can be accompanied by apparent shortness of breath, a rapid pulse, chest pains, palpitations, and tingling feelings in the fingers and toes. Hyperventilation can result in fainting. Treatment begins with reassurance and removing any obvious external cause for panic or anxiety.

Vertigo sufferers who have anxiety or depression often have mild dysfunction of their inner ear (their vestibular apparatus). On the other hand, classical vertigo caused by clear-cut disease of the vestibular apparatus usually causes severe anxiety symptoms, and can be hard to distinguish from a primary anxiety disorder. This means anyone with vertigo needs to have a full work-up to make sure of the basic cause.

GABA (gamma-aminobutyric acid) is an inhibitor of vestibular action. Treatment often starts with so-called vestibular suppressants. Drugs used include GABA-like drugs or ones that enhances the action of GABA, e.g. the benzodiazepines (Valium^® or Ativan^®). If relief is short-lived, a class of drugs known as selective serotonin reuptake inhibitors (SSRIs) may be found to be more effective; they include fluoxetine (Prozac^®), paroxetine (Paxil^®), and sertraline (Zoloft^®). However, side effects, which include nausea, sedation, and dizziness, are especially intolerable for vertigo patients, so the starting dose must be low and only increased slowly.

Other drugs that are effective in anxiety states, such as antidepressants or venlafaxine (Effexor^®), can be tried, but they haven't been properly evaluated in anxiety associated with vertigo. Finally, cognitive behavioral therapy may be helpful in resistant cases.

If you have anxiety associated with vertigo

The most important step is to be fully evaluated for a possible disorder of the vestibular apparatus. This can be done by your family physician, but you may wish to consult an otorhinologist or a neurologist. There are well over 15 known causes of vertigo - 6 of them considered common - and nearly all will respond to the correct treatment.

Try to obtain a firm diagnosis of the cause and have it treated, rather than rushing into medication for symptoms that may or may not be relevant to the main disorder. And if you aren't getting adequate relief after a few weeks, consider getting another opinion.

Source

• Treatment of Vertigo. R. Schwarz, P. Longwell, Am Fam Physician, 2005, vol. 71, pp. 1115--1130

Related Links
I Get Dizzy!
Neurology Channel: vertigo
NIH: Dizziness and Vertigo

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.