Comparison of the Effectiveness of Vestibular Rehabilitation and Venlafaxine in the Treatment of Patients with Persistent Postural-Perceptual Dizziness, a Randomized Clinical Trial

Abstract

Background: This study aimed to investigate the efficacy of venlafaxine as a first-line treatment for patients with persistent postural-perceptual dizziness (PPPD) and compare the superiority of vestibulo-ocular rehabilitation versus venlafaxine in PPPD patients. Methods: A randomized clinical trial was conducted on sixty patients (31 males, 29 female) with a mean age of 43 ± 9.9 years, diagnosed with PPPD by Bárány criteria at Al-Zahra Hospital in Isfahan, Iran, from September 2023 to March 2024. Patients were randomly divided into two groups of 30 people each. One group received vestibulo-ocular reflex rehabilitation once a week for six weeks, and the other group received venlafaxine 37.5 mg daily for six weeks. Dizziness severity was measured pre/post-intervention using the Dizziness Handicap Inventory (DHI). Findings: In the vestibular-ocular rehabilitation group, the mean DHI score before intervention was 46.33 ± 13.65, which reduced to 28.26 ± 12.64 after intervention. In the medical treatment group, the mean DHI score was 47.86 ± 13.57, which dropped to 28.13 ± 10.58 after treatment. Both groups showed significant reductions in DHI scores after treatment (P < 0.001), with no superiority between treatments (P > 0.05). Conclusion: Venlafaxine can be used as a first-line treatment for patients with PPPD. No superiority was found for vestibular-ocular rehabilitation over venlafaxine in treating PPPD. © 2025, Isfahan University of Medical Sciences(IUMS). All rights reserved.