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Chronic Subjective Dizziness – Depression Related Dizziness – Chronic Lack of Balance – Dizziness due to Medications
Chronic Subjective Dizziness
Dizziness is a vague sensation of imbalance, incoordination, motion, lightheadedness, or impaired spatial orientation. No specific sense of rotation, movement of objective lack of coordination are present.
What is Chronic Subjective Dizziness?
Chronic sensation of feeling dizzy is extremely common. This article will shed some light on the phenomenon of chronic subjective dizziness. This term circulates in neurological literature even though there is no official diagnostic entity with this name.
The key word in this term is “subjective”. This dizziness is called subjective because for an outside observer the person complaining of a dizzy sensation appears to be perfectly fine. There are no falls, no bumping into objects, no actual loss of balance, no vertigo, and no findings on neurological examination.
So, what are the symptoms of chronic subjective dizziness?
The most common complaints are dizziness, unsteadiness, constant sensation of rocking, which are worse while changing body position, walking or standing. These symptoms are persistent but vary in intensity through the day. Unsteadiness experienced by the patients is not visible to outside observers. Dizziness can be provoked by visual patterns, reading, computer screens or activities requiring visual attention. Any medical condition with symptoms of vertigo or a bout of anxiety would trigger deterioration of dizziness. People might experience these symptoms for years with periodic exacerbations and remissions.
It all starts after some event with symptoms of vertigo or dizziness. Benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, and panic attack are typical triggers of the vicious circle of chronic dizzy sensation.
Please note that chronic subjective dizziness phenomenon and chronic dizzy sensation in people with anxiety or depression are different entities. Dizziness related to depression will be described separately.
Cause of Chronic Subjective Dizziness
The proposed mechanism of chronic subjective dizziness is largely speculative. I’ll try to be brief.
The brain runs a sophisticated “software” that collects and processes all the information about current position, speed, and movement direction of all body parts individually and the body as a whole. A single human body “GPS” is much more complex than all the GPS systems in the world put together. Failure of one of the numerous sensors brings up some turmoil into the system (such as in benign vertigo). Normally, the brain adapts to such loss within days and the symptoms of vertigo go away. In chronic subjective dizziness the story is different.
In chronic subjective dizziness, the brain “program” that runs “GPS” function gets kind of stuck in a constant cycle of readaptation to new stimuli rather than adapting to the new reality. Any change in head position or movement knocks the “GPS”out of equilibrium generating the sense of imbalance and dizziness. The actual function of balance does not suffer, while the perception of imbalance persists.
The vast majority of people suffering chronic subjective dizziness have anxiety disorder. Subjective dizziness is not a part of anxiety phenomenon and is not produced by anxiety. This is very important!
My perception is that anxiety disorder somehow interferes with the normal process of the brain function recovery after disorders with symptoms of vertigo.
Treatment of Chronic Subjective Dizziness
Chronic subjective dizziness responds well to the treatment with antidepressants, whether they are SSRIs or SNRIs. Zoloft, Lexapro, Effexor are the examples.
I have my own view on the reasons for antidepressant’s effectiveness for chronic subjective dizziness. There is a possibility that removal of the anxiety factor allows the brain to recover.
The issue might be even more complex. It is a well-known fact that the use of SSRIs after a stroke improves recovery of neurological deficits. May be antidepressants somehow help with recovery after vertigo attacks as well. This is just a speculation, though.
Chronic Dizziness in Anxiety Disorder, Depression, and Sleep Apnea
Chronic poorly defined dizzy sensation and sensation of instability while walking are extremely common in anxiety and depression. These disorders are universally associated with poor sleep quality, difficulty falling asleep, staying asleep, and early awakenings.
Fatigue, lack of sense of refreshment, difficulty concentrating, daily headaches, and dizziness are the results of chronic sleep deprivation. In this case chronic dizzy sensation comes packaged together with the rest of the symptoms. Prior history of some vertiginous event is not essential. This phenomenon is different from chronic subjective dizziness caused by prior vertigo attack and poor adaptation of the brain to the vestibular system malfunction.
Sleep apnea produces similar phenomenon of chronic sleep deprivation caused by poor sleep quality due to disordered breathing while asleep. Symptoms of chronic sleep deprivation caused by sleep apnea are similar to sleep deprivation caused by anxiety or any other reason.
Napping does not improve the sense of well-being in sleep apnea and people with mood disorders are simply unable to nap.
In both disorders, treatment of the underlying conditions alleviate all the symptoms, including chronic dizzy sensation.
Dizziness due to Medications
Chronic Lack of Balance or Unsteadiness
Chronic poor balance is rarely caused by a single disease.
Balance is a challenging task. Think about it! We are walking on two flexible appendages and normally manage pretty well. In order to pull this task, we need to use a large portion of the brain processing power. Brain is connected to different parts of the body by multiple back feed loops. There are multiple systems involved in the balance control: vision, position sense from the muscles in the legs and neck, joints, info from the labyrinth, sense of touch, even hearing.
Data from multiple sources is collected, processed and constantly monitored while the body is moving around.
We may be doing relatively well if one or even two of the systems would fail. When multiple systems are not doing well or there are some issues with the information processing, the normal function of balance may be lost.
People suffering with diabetes usually develop polyneuropathy. As a result, nerves are able to conduct less data from the legs, which starves the brain of the necessary back feed input. Add poor vision or darkness and the balance is off.
Pain in the legs overloads spinal cord and limits its ability to carry position data to the brain. Diabetes and high blood pressure cause small blood vessel disease of the brain. It disrupts some connections and lowers the brain processing speed. Prior history of strokes also limits the amount of functional “hardware”.
Management of chronic loss of balance is not an easy task. Use of cane while ambulating provides the brain with some additional information about the body position in space and improves stability.
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