Selective serotonin reuptake inhibitor (SSRI) and vestibular function

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are well-known to be effective in patients with dizziness and depression. However, there are only few papers about the effects of SSRIs on vestibular function in these patients. We therefore performed vestibulo-ocular reflex in rotation (VOR tests) and administered the Dizziness Handicap Inventory (DHI) questionnaire to patients with dizziness before and after SSRI therapy. Of the 716 patients with dizziness at our psychiatric hospital, 86 had depression; of these 86 patients with coexistent dizziness and depression, we selected 7 patients (1 men, 6 women) (mean age, 56.87 years) who fulfilled the following conditions for this study; 1) regular treatment including anti-vertiginous drugs, physical therapy, minor tranquilizers and/or sleep medications were ineffective, 2) the diseases were not in the acute phase, 3) no antidepressants had been prescribed, and 4) willing to sign the consent form approved by the ethics committee in University of Yamaguchi for participation in this study. The VOR tests were performed using video-oculography (Nystamo 21 type 2, IRN 2, Morita Manufacturing corporation, Tokyo). After about 4 weeks of additional SSRI (sertraline) treatment, the DHI scores improved significantly (57.4 31.8). In the VOR tests, the DP% (vestibular function) improved significantly (26.6 9.46). Herein, we report the case of a 44-year-old woman with dizziness and depression who showed marked improvement with SSRI therapy. In regard to basic research, Dr. Shimogori of our group used a guinea pig model to examine how SSRI (sertraline) affects the vestibular system. From this clinical research, we believe that SSRIs could possibly affect the vestibular system directly by the activation of cyclic AMPresponsive element blinding protein-brain-derived neurotrophic factor (CREB-BDNF) system signaling.

Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness: A retrospective pilot study

“…Moreover, vanillin in Gastrodia Tuber, ginsenosides in ginseng, and atractylenolide III in Atractylodes Rhizome have antidepressant effects[ 59 , 64 , 65 ], which can prevent worsening of PPPD symptoms[ 1 ]. Hesperidin in Citrus unshiu peel, atractylenolide III in Atractylodes rhizome, and ginsenosides in ginseng activate cyclic AMP response element binding protein (CREB)/the brain-derived neurotrophic factor (BDNF) pathway in the hippocampus[ 59 , 64 , 65 ], similar to the pharmacological actions of SSRIs/SSNIs on serotonergic neurotransmission (5-HT-CRF pathway)[ 66 , 67 ], which increases ghrelin signaling and activates the BDNF/trkB/CREB pathway in the cerebral cortex and vestibular nucleus[ 68 ]. Thus, in PPPD patients, HBT is hypothesized to have an anti-diuretic effect in the inner ear, consistent with strategy 1, while CREB-BDNF activation in the hippocampus, cerebral cortex, and vestibular nucleus has the same action as SSRIs/SSNIs, which has therapeutic effects in PPPD[ 55 , 69 ], and is consistent with strategies 2 and 3.…”