12/23/2009 - Articles

Anxiety Associated with Vertigo

By: Robert W. Griffith, MD

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Anxiety can cause vertigo, and vertigo can cause anxiety. It can be difficult to separate one from the other, but a review published in the journal American Family Physician is quite helpful. Here's a summary of some relevant points.

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

Created on: 05/03/2005
Reviewed on: 12/23/2009

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Anonymous wrote 2 years 29 weeks ago

Very nice site!

Anonymous wrote 2 years 32 weeks ago

This has been a tricky one for me. I've had minor bouts with anxiety in the past, like most of us have, but have never had any dizziness associated with it.

Recently however, I've started to experience extreme dizziness. After a few days of dealing with this I ended up become anxious and even had a panic attack due to it. Dealing with one is hard enough but dealing with two is that much tougher.

What helped me was to focus on getting my anxiety under control first. I made sure to not focus on worrying thoughts and to instead focus on being happy and involving myself in conversations. I find that if you allow anxiety and negative thoughts to overcome you, you feed into it. I realize that some people may require medication as well. As of now, I have never needed this ... instead, I just need to work at getting myself back to the right state of mind.

Once I had my anxiety back under control I realized that the dizziness was occurring during moments when I had no anxiety at all. Even after the dizziness I had no anxiety. This definitely told me that the dizziness was being caused by vertigo or something else. I can now communicate this to my Doctor to make sure that he find the real cause of the dizziness instead of assuming its related to anxiety.

Anonymous wrote 2 years 31 weeks ago

Your experience was very helpful, it allowed me to be most aware of what you alll are experiencing.Recently my dad has been suffereing veritgo and he is not himself anymore. He is afraid to be alone, he gets anxious, and cant eat.He has lost 25lbs. All due to this vertigo. I was trying to have an understadning of what he may be exeperiencing, because he is not explaining it to me well. He has been to the doctors and all f his blood and cat scan state that he is healthy. So im just confused and need to be educated on what exactly is going on. I pray for you both.thanks again for sharing tips.

veronyke wrote 2 years 36 weeks ago

Thanks for article ,i guess you are right.The doctors usually try to identify the cause of the Vertigo in order to cut off the list some of the serious conditions which have as a primary symptom the dizziness such as stroke, tumor, hemorrhage or cardiovascular disease. The diagnosis process includes a physical and neurological examination, imaging tests and also blood tests.