Can serotonin help restore balance? Exploring the role of SSRIs and SNRIs in vestibular disorders
Feeling dizzy or unsteady is more than a fleeting nuisance - it can deeply affect quality of life. For many people with chronic balance disorders, traditional treatments such as vestibular rehabilitation or medication aimed at the inner ear offer only partial relief. New research suggests that a familiar class of medications - those used to treat depression and anxiety - may also play a surprising role in improving balance.
A recent review published in Audiology Research (Teggi et al., 2025) highlights growing evidence that serotonin, a chemical best known for regulating mood, also influences the vestibular system - the inner ear network that controls balance and spatial orientation.
Serotonin’s hidden role in balance
Serotonin (or 5-HT) acts throughout the body, affecting mood, sleep, appetite, and even heart rhythm. What is less known is that serotonin receptors are also found in the inner ear and vestibular nuclei of the brainstem. This discovery suggests that serotonin does not only shape emotions and might also help the brain interpret balance signals. When serotonin levels fluctuate, as they often do in anxiety or depression, balance perception may be affected and symptoms of dizziness and vertigo may arise especially in patients diagnosed with Persistent Postural Perceptual Dizziness, Mal de Debarquement Syndrome, Meniere’s Disease, or Vestibular Migraine.
Why antidepressants might help
The review examined over 40 studies exploring the use of SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin–Norepinephrine Reuptake Inhibitors) in vestibular conditions such as:
Persistent Postural Perceptual Dizziness (PPPD): A chronic sense of dizziness or unsteadiness
Vestibular Migraine (VM): Vertigo episodes linked to migraine activity.
Menière’s Disease (MD): Spontaneous vertigo episodes lasting hours with hearing loss, ear fullness, and tinnitus.
In PPPD, SSRIs and SNRIs consistently improved dizziness symptoms, especially when combined with vestibular rehabilitation and cognitive behavioral therapy. In vestibular migraine, the SNRI venlafaxine reduced vertigo attacks as effectively as traditional migraine preventives like propranolol, with the added benefit of improving mood. Similarly, SSRIs such as sertraline and escitalopram were found to reduce vertigo spells in Menière’s disease, particularly when anxiety was also present.
The mind–ear connection
These findings reinforce a crucial idea: the vestibular and emotional systems are closely linked. The same brain areas that process fear, stress, and anxiety, such as the amygdala and insula, also communicate with the vestibular nuclei. When anxiety heightens, serotonin levels increase and this may intensify balance symptoms, creating a feedback loop. SSRIs and SNRIs may help “reset” this loop by stabilizing serotonin levels in both mood and balance pathways.
A promising but evolving frontier
Although these medications are still considered off-label for dizziness, the evidence so far is promising. They are generally safe, well-tolerated in patients of all ages, and may offer meaningful relief, especially when used alongside active rehabilitation and therapy. The next step, according to the authors, is to conduct larger placebo-controlled trials to better define their role in vestibular care.
In short, what we once thought of as “just an antidepressant” may also be a tool to help patients regain both emotional and physical balance.
Talk to your doctor before considering any medication.
-
Teggi R, Caldirola D, Neri G, Cangiano I, Viola P, Chiarella G. The Presence of Serotonin in the Vestibular System: Supporting the Use of SSRIs/SNRIs in the Treatment of Vestibular Disorders—A Narrative Review. Audiology Research. 2025;15(6):148. [link]
Neurotransmitters in the vestibular system. In: Handbook of Clinical Neurology. Vol 137. Elsevier; 2016:41-55. [link]
Balaban CD, Thayer JF. Neurological bases for balance–anxiety links. Journal of Anxiety Disorders. 2001;15(1-2):53-79. [link]