Between 20-50% of individuals who suffer from vertigo suffer from a psychiatric condition, the most common being anxiety and depression.¹ But the relationship between vertigo and anxiety is complex and reciprocal. 

Both vertigo and anxiety can be managed and treated through therapy and medication. 

Let’s take a closer look.

What is vertigo?

Vertigo is a symptom of other conditions that can manifest as:

• Dizziness or loss of balance (making it harder to walk or stand)
• Nausea and sickness

Vertigo ranges from mild (when it is hardly noticeable) to severe, where it can feel as though the environment is spinning around you. It can come on suddenly and last a few seconds to several hours, days or months. In more severe cases, vertigo can make everyday life very challenging.

There are two types of vertigo: 

• Peripheral vertigo originates in the inner ear or vestibular nerve (the nerve located in the inner ear that sends signals to the brain).  The most common type of peripheral vertigo is benign paroxysmal positional vertigo (BPPV), where the signals sent to the brain become disrupted.  The movements of the head trigger it
• Central vertigo – originating from the brain and central nervous system, for example, multiple sclerosis and vestibular neuritis

For more information on the causes, symptoms, and treatment options for vertigo, please see this article from the Klarity Health Library: click here.

Anxiety symptoms

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe. When these feelings of worry are persistent and start impacting everyday life, anxiety can develop. Anxiety is a symptom of several conditions, including generalised anxiety disorder (GAD), panic disorder, phobia, post-traumatic stress disorder (PTSD), and social anxiety disorder, among others.

The 5 main symptoms of GAD used to diagnose the condition are:

• Excessive anxiety occurs for a minimum of 6 months and on more days than not
• Difficulty in controlling worry
• Three or more psychological or physical symptoms
• Social impairment
• Effects that are not related to medication or another medical condition
• Effects that are not better explained by another mental health condition

For more information on the diagnostic criteria for and types of anxiety, please see this article from the Klarity Health Library: click here.

Vertigo and anxiety – the connection

Chronic anxiety has a particular effect on the body that releases stress hormones into the bloodstream, including one called cortisol. These stress hormones can have an adverse effect on the vestibular system, which controls our sensory perception of balance and spatial orientation, positioning and movement of our head. However, studies that link vertigo, anxiety and our ability to regulate stress hormones such as cortisol are still in their infancy.³

In addition, the underlying neural circuitry linking vertigo and anxiety is unclear but does appear to relate to the vestibular nervous system.¹

A retrospective study found that individuals with anxiety, especially females and those with co-morbid diseases (such as cerebrovascular disease), are 2.17 times more likely to develop the most common form of vertigo, BPPV.²  

A large prospective study using the UK Biobank found that patients who received an inpatient diagnosis of peripheral vertigo had an increased risk of developing anxiety and depression in the two years following hospitalisation.³

In another on vertigo, anxiety was more common in patients with two other forms of vertigo – migrainous vertigo and Menière disease, compared to BPPV.⁴ This also notes that patients with conditions alongside these two forms of vertigo, for example, hearing disorders, are more likely to suffer from anxiety and depression. 

One cross-sectional study looked specifically at the relationship between coronavirus-related anxiety, health anxiety and anxiety in vertigo patients. The COVID-19 pandemic increased the rate and severity of vertigo in patients. During COVID-19 patients with vertigo suffered more anxiety.⁵

As previously noted, the relationship between vertigo and anxiety is both complex and reciprocal. The interrelationship has been widely studied and shown that patients with anxiety (and depression) presented with more severe symptoms of vertigo and that the psychiatric condition could itself greatly exacerbate vertigo.¹ Other studies have shown that mental problems can aggravate vestibular disorders in which vertigo and dizziness are symptoms – such as episodic and chronic vestibular syndrome (EVS and CVS, respectively).¹

Prevention 

Healthcare practitioners must be aware of the heightened risk of anxiety and depression in patients experiencing vertigo, and screen for these conditions upon presentation.⁶ This will help ensure the right treatment and support is received as early as possible. 

Enabling the patient to gain a better understanding of vertigo can reduce the psychological distress associated with the experience.³

Management and treatment 

Studies suggest that the psychological aspects of suffering from vestibular dysfunction can have an impact on the development of psychiatric conditions like anxiety in patients with vertigo.⁵ It is therefore recommended that mood is monitored in the long-term as part of clinical practice, alongside physical factors.^1,3 

Utilising a multidisciplinary approach with different medical specialists (such as Ear Nose Throat or ENT specialists, psychiatrists, and psychologists) could also be effective.⁷

Counsel patients with vertigo suffering from anxiety.⁷ Cognitive behavioural therapy (CBT) and psychological guidance are helpful.^1,5 A 3-session CBT intervention induces considerable improvements in dizziness symptoms.⁶ The use of CBT for a particular vestibular disorder, persistent postural perceptual dizziness (PPPD) – which can lead to vertigo – saw significant reductions in anxiety and dizziness over 6 months.  

Vestibular rehabilitation (sometimes referred to as vestibular rehabilitation therapy or VRT) is a treatment programme in which exercises address issues with balance and dizziness. One of the goals of VRT is to improve vertigo (as well as to improve gaze postural stability and overall daily functioning).⁸ In vertigo patients with anxiety, VRT can be used as a behavioural intervention or alongside other psychiatric treatments when severe.⁸ VRT has also been combined with CBT in some research, with promising results for the treatment of dizziness and anxiety symptoms.⁹

Medications manage and treat vertigo and anxiety. For vertigo alone, antihistamines, benzodiazepines and anti-cholinergic drugs (collectively known as vestibular suppressants) are treatment recommendations. Where vertigo and anxiety co-occur drugs, called selective serotonin reuptake inhibitors (SSRIs)  manage both conditions.^10,

However, it’s important to note that many factors can affect the management and recovery of these conditions, including:⁸

• Medications taken
• When treatment began, and its duration and intensity
• Symptom severity
• Age
• Symptoms of anxiety or depression, which can impact recovery 

FAQs

What triggers vertigo?

Vertigo occurs due to different conditions related to the inner ear. Common triggers of peripheral vertigo include benign paroxysmal positional vertigo (BPPV), head injury, and medications which affect the inner ear. Common triggers of central vertigo include medications, multiple sclerosis, stroke, neurovascular disease, tumours, and vestibular migraine.

How do you make vertigo go away?

Lie down rapidly on the affected side and hold for three minutes. Rotate your head 90 degrees towards the sky or ceiling and hold for three minutes. Rotate your body to face the sky or ceiling and turn your head to the unaffected side. Rotate the head to now face the sky or ceiling. Return to an upright seated position. This is known as the Zuma Maneuver.¹¹

How long does vertigo last? 

Vertigo can last from between a few seconds to minutes and hours. In severe cases, it can last for several days or even months. 

How long does dizziness from anxiety last? 

When anxiety is acute and severe, dizziness may last for seconds to minutes. With chronic anxiety, dizziness may be intermittent, coming and going and lasting for minutes to hours. 

What does anxiety vertigo feel like?

Anxiety accompanies dizziness which is a sense that the surrounding is spinning around, or a sense of swaying or light-headedness. 

How do you stop vertigo from anxiety?

Try breathing slowly and deeply, sip water, and close your eyes for a few minutes. 

Does anxiety medication stop dizziness? 

Medication is not always needed, but anti-anxiety medications can be used to help with dizziness. SSRIs are for anxiety and vertigo symptoms. 

What happens if vertigo is left untreated?

Vertigo worsens if the underlying condition is undiagnosed or untreated. Peripheral vertigo is generally not considered life-threatening, but central vertigo can be dangerous. Leaving vertigo untreated can lead to long-term health problems or worsening of symptoms. 

When should I consult a medical professional?

Speak to your GP or healthcare practitioner if you experience:

• Vertigo that comes on suddenly
• Vertigo that does not resolve on its own
• Recurrent episodes of vertigo
• Vertigo that impacts on your day-to-day life

Seek emergency medical attention if you experience vertigo or extreme dizziness along with chest pain or a sudden, severe headache. 

Please consult your GP or healthcare practitioner for advice about anxiety symptoms. 

Summary

Vertigo is a sense of spinning or dizziness. It is related to vestibular system dysfunction in the inner ear. Anxiety and depression are the most commonly co-occurring psychiatric conditions with vertigo. The relationship between anxiety and vertigo is well established, but it is complex and reciprocal. 

Management and treatment options for anxiety and vertigo include vestibular rehabilitation therapy, cognitive behavioural therapy, and the use of SSRI medication.