Evaluating the effect of antidepressants for persistent postural-perceptual dizziness: A systematic review

BackgroundPersistent postural-perceptual dizziness (PPPD) is a functional neurological disorder characterized by chronic, non-spinning dizziness exacerbated by motion, visual stimulation, or upright posture. Although antidepressants are commonly prescribed for PPPD, their efficacy and tolerability have not been well established.ObjectiveTo evaluate the available evidence on antidepressant use in PPPD, with a focus on clinical outcomes.MethodsA systematic search of Embase, APA PsycINFO, and MEDLINE was conducted via the Ovid platform for any studies on antidepressant use in PPPD (or related symptoms under prior diagnostic terms) published before May 8, 2025.ResultsThirteen studies met inclusion criteria, comprising two randomized controlled trials (RCTs), seven open-label trials, and four observational or retrospective studies including a total of 807 participants. Four studies enrolled participants with a PPPD diagnosis, while others included participants with symptoms mirroring PPPD or precursor terms for the disorder. Specific antidepressant regimens varied greatly. Across studies, antidepressants were generally associated with reductions in both dizziness and psychiatric symptoms. Reported treatment response rates ranged from 55% to 84%. However, up to 25% of participants were unable to tolerate treatment. Reported adverse events included gastrointestinal symptoms, sedation or fatigue, sexual adverse effects, and headache.ConclusionsCurrent evidence regarding the use of antidepressants for the treatment of PPPD and precursor chronic dizziness disorders is limited by low-quality studies, heterogeneous designs, and inconsistent diagnostic criteria. The available evidence suggests antidepressants may be effective for PPPD; however, high-quality, randomized placebo-controlled trials are urgently needed to clarify the efficacy and tolerability of antidepressants for PPPD.