Serum neurotransmitter imbalances in benign paroxysmal positional vertigo: correlations with anxiety, depression, and...

This study aims to investigate the associations between serum neurotransmitter levels (dopamine, epinephrine, norepinephrine) and psychological/sleep comorbidities in patients with benign paroxysmal positional vertigo (BPPV), elucidating the neurobiological mechanisms underlying their interplay.

A prospective cross-sectional study enrolled 310 BPPV patients and 300 age- and gender-matched healthy controls. Psychological status was assessed using the Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and Pittsburgh Sleep Quality Index (PSQI). Serum neurotransmitters were quantified via high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Spearman's correlation analysis evaluated relationships between neurotransmitters, psychological/sleep scores, and functional disability (Dizziness Handicap Inventory, DHI).

Benign paroxysmal positional vertigo patients exhibited significantly higher HAMA, HAMD, and PSQI scores compared to controls (all p < 0.0001). Serum dopamine (p = 0.0048), epinephrine (p < 0.0001), and norepinephrine levels (p < 0.0001) were significantly decreased in BPPV patients. Correlation analysis revealed that lower epinephrine and norepinephrine levels were strongly associated with greater physical impairment (r = -0.658 and -0.694, respectively, both p < 0.0001) and more severe depressive symptoms (epinephrine vs. HAMD: r = -0.704, p < 0.0001). A strong positive correlation existed between DHI and HAMA (r = 0.701, p < 0.0001), indicating shared influences on functional disability and anxiety.

Benign paroxysmal positional vertigo is associated with monoaminergic neurotransmitter deficits, which correlate with heightened anxiety, depression, and physical impairment. These findings highlight neurotransmitter imbalances as key mediators of the bidirectional relationship between vestibular dysfunction and psychological disturbances, supporting the need for integrated assessments of neurochemical and emotional parameters in BPPV management.