Cognitive Behavior Therapy as Augmentation for Sertraline in Treating Patients with Persistent Postural-Perceptual Dizziness

Abstract

Background Persistent postural-perceptual dizziness (PPPD) is a common vestibular disorder. This study was conducted to assess whether the addition of cognitive behavior therapy (CBT) could significantly improve the efficacy and acceptability of sertraline in treating PPPD. Methods PPPD patients were recruited and randomly assigned to control and experiment groups. Patients in both groups received sertraline 50–200 mg/day, and only patients in the experiment group received CBT (twice a week, one hour per time). The treatment was continued for eight weeks. At baseline, week 2, week 4, and week 8, the 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were used to assess the self-perceived handicapping effects caused by PPPD, anxiety, and depressive symptoms, respectively. The dose of sertraline used and the adverse events in both groups were recorded and analyzed. Results In total, 91 PPPD patients were randomly assigned to the control group (n = 45) and experiment group (n = 46). After eight weeks of treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. But compared to the control group, the experiment group had significantly lower average DHI score, HDRS score, and HARS score at weeks 4 and 8. Moreover, the dose of sertraline used in the experiment group was significantly lower than that in the control group, and adverse events occurred more frequently in the control group than in the experiment group (48.9% versus 26.1%, p = 0.025). Conclusion These results demonstrated that the addition of CBT could significantly improve the efficacy and acceptability of sertraline in treating PPPD and reduce the dose of sertraline used.

Persistent Postural-Perceptual Dizziness

“…45 Since the publication of the diagnostic criteria for PPPD, one randomized, prospective, but unblinded study compared treatment with sertraline (a SSRI) alone (N ¼ 45) versus sertraline plus cognitive behavior psychotherapy (N ¼ 46). 50 Patients who received combination therapy had significantly greater improvement after 4 and 8 weeks of treatment despite using a lower dose of medication than those who received sertraline alone. Patients in the sertraline-only arm achieved results that were comparable (slightly better) to those in a smaller (N ¼ 20) prospective, unblinded study of sertraline for chronic subjective dizziness that was completed 14 years earlier.…”

“…No large-scale, randomized, controlled trials of any treatments for PPPD have been done. However, several uncontrolled medication trials 8,41-45 and a few modest-sized controlled investigations of vestibular rehabilitation and psychotherapy [46][47][48][49] were completed on patients with chronic subjective dizziness and phobic postural vertigo, followed by one prospective study of medication versus medication plus psychotherapy 50 and one retrospective study of vestibular rehabilitation 51 for PPPD. Regarding medications, from 2002 to 2007 one large case series (N ¼ 60) 8 and four open-label prospective trials (N ¼ 5-60) 8,41-43 were published describing the use of selective serotonin reuptake inhibitors (SSRIs) in patients with chronic subjective dizziness 8 or PPPD-like chronic dizziness.…”

Persistent postural-perceptual dizziness: current approaches to diagnosis and treatment

“…Пациента информируют о характере его заболевания, что позволяет ему преодолеть страх перед возможным тяжелым органическим заболеванием. Эффективна когнитивно-поведенческая терапия, которая направлена на коррекцию мыслительных искажений тревожно-депрессивной природы [1,4,7,[9][10][11][12][13][14][15]23]. Методика психической десенсибилизации способствует изменению избегающего поведения: пациент должен сознательно стремиться побороть страх перед головокружением, целенаправленно посещая места, которые провоцируют головокружение [4,7,23].…”

“…В результате происходит редукция патологических реакций вестибулярной системы, формируются новые операционные модели поддержания устойчивости [4]. Большую роль также играет самостоятельное регулярное выполнение пациентами упражнений для тренировки равновесия, поскольку они дают уверенность в своих силах и способствуют редукции патологических реакций [4,7,15,23].…”

“…З а к л ю ч е н и е Таким образом, выделение ПППГ в отдельную нозологическую форму с четко очерченными диагностическими критериями позволяет улучшить диагностику данного заболевания. Наиболее эффективен комплексный подход к лечению ПППГ -использование когнитивно-поведенческой терапии, медикаментозного лечения и вестибулярной реабилитации [2,4,7,[9][10][11][12][13][14][15]23]. В многочисленных исследованиях показаны высокая эффективность и безопасность Та-накана® у пациентов с головокружением различного генеза, а также сопутствующими эмоционально-аффективными расстройствами [25][26][27][28][29][30].…”