Tandospirone for antidepressant-intolerant persistent postural-perceptual dizziness: A case series based on an otolaryngology–psychiatry collaborative care model
Year: 2026
Type: article
Study design: Case Report
Abstract: Introduction: Persistent postural-perceptual dizziness is typically managed with serotonergic antidepressants; however, treatment continuation is frequently hindered by adverse effects. Pharmacological alternatives for patients with antidepressant intolerance remain poorly defined. Here, we present a case series examining the potential therapeutic utility of tandospirone, a partial agonist of the 5-hydroxytryptamine 1A receptor, in this clinical context. Case Series: Three female patients (aged 64–80 years) diagnosed with persistent postural-perceptual dizziness in accordance with the Bárány Society criteria experienced persistent dizziness and were unable to tolerate antidepressant therapy because of grade 2 adverse events, including gastrointestinal disturbances. Tandospirone was introduced as an alternative treatment and was titrated based on individual tolerability. All patients exhibited meaningful clinical improvement, characterized by reductions in Niigata persistent postural-perceptual dizziness Questionnaire scores and stabilization of posturographic parameters. Symptomatic relief was maintained for up to 12 months without any notable adverse effects. Conclusion: Tandospirone may be a clinically valuable alternative for patients with antidepressant-intolerant persistent postural-perceptual dizziness. Although the contributions of spontaneous remission and vestibular rehabilitation cannot be excluded entirely, the extended duration of symptoms preceding tandospirone initiation renders natural recovery less probable. Prospective investigations are warranted to further elucidate its efficacy and safety profile.
Institution: Sapporo Medical University
Language: English
Subfield: Neurology
Field: Neuroscience
Domain: Life Sciences
Open Access status: gold
OpenAlex ID: W7213774759