Aripiprazole as second-line pharmacotherapy for a heterogeneous cohort of refractory functional dizziness disorders: a pilot preliminary retrospective study

By
Fumiyuki Goto
Koichiro Wasano
June 3, 2026
0 min

Frontiers In Neurology

Overview

This preliminary retrospective analysis evaluated aripiprazole as a second-line treatment for refractory functional dizziness disorders, including PPPD. The study found a 75% response rate, indicating potential efficacy in patients who did not respond to first-line serotonergic agents.

Background

Persistent postural-perceptual dizziness (PPPD) is a prevalent chronic vestibular disorder affecting a significant portion of patients with chronic dizziness. First-line treatments, primarily serotonergic antidepressants, have a response rate of only 60-65%, leaving many patients with unresolved symptoms. This highlights the need for alternative therapeutic options, such as aripiprazole, which may address underlying dopaminergic dysregulation.

Data Highlights

Outcome Measure	Response Rate
CGI-I Improvement	75.0%

Key Findings

75% of patients showed improvement on the CGI-I scale after aripiprazole treatment.
Four patients did not respond to treatment, and one discontinued due to extrapyramidal side effects.
Improvements were noted in Dizziness Handicap Inventory (DHI) and Niigata PPPD Questionnaire (NPQ) scores among evaluable patients.
No significant changes were observed in foam posturography results.
Aripiprazole's multimodal mechanism may target symptoms inadequately addressed by serotonergic agents.

Clinical Implications

Aripiprazole may be a viable second-line treatment option for patients with refractory functional dizziness disorders, particularly those with PPPD. Clinicians should consider its use in patients who do not respond adequately to first-line serotonergic therapies, while monitoring for potential side effects.

Conclusion

The findings suggest that aripiprazole may offer a promising alternative for managing refractory functional dizziness disorders. Further prospective studies are needed to validate these preliminary results.