treatment for PPPD

PPPD, also known as Persistent Postural Perceptual Dizziness, is a condition that causes chronic dizziness in patients. Persistent Postural Perceptual Dizziness symptoms include dizziness that occurs without any specific cause, & general unsteadiness that is otherwise unexplainable through any other neuro-otological disorders & reasons. Persistent Postural Perceptual Dizziness symptoms can be triggered by any pre-existing vestibular illnesses whether diagnosed or undiagnosed, &/or psychological stress. Early signs of PPPD disease include showing an obsessive-compulsive personality, & a mental illness diagnosis such as mild depression & anxiety.

However, even though Persistent Postural Perceptual Dizziness presents with symptoms similar to a psychiatric illness, it is primarily a neuro-otological disorder with certain additional behavioral elements. Further medical researches into Persistent Postural Perceptual Dizziness & its Symptoms led medical experts to interesting findings. They found out that Persistent Postural Perceptual Dizziness symptoms also included those of non-vertiginous dizziness & general unsteadiness. These could either be triggered or worsened by external environmental stimuli & performing tasks that require a certain level of concentration such as reading, writing, & computer programming.

PPPD disease can also present as space-motion discomfort, along with symptoms of visual vertigo overlapping those of Peripheral Vertigo & Chronic Subjective Dizziness.

We’ll read more about PPPD disease, Persistent Postural Perceptual Dizziness symptoms, PPPD treatment, & PPPD vertigo medicine in the following paragraphs.

What is Persistent Postural Perceptual Dizziness?

Persistent Postural Perceptual Dizziness is a condition characterized by chronic dizziness resulting from vestibular disorders. Patients often show a range of behavioral symptoms including obsessive-compulsive disorder, mild depression, & display a rise in general anxiety levels. Two renowned German neurologists, Thomas Brandt & Marianne Dieterich first explained Phobic Postural Vertigo & Dizziness as a condition of postural non-vertiginous dizziness with recurrent dizzy episodes. Medical researchers around the world have performed scientific studies on the concept of Persistent Postural Perceptual Dizziness & have termed it a combination of Chronic Subjective Dizziness (CSD) & PPV. This gave the condition its collective name, the Persistent Postural Perceptual Dizziness or PPPD disease

Persistent Postural Perceptual Dizziness Symptoms

One of the most common Persistent Postural Perceptual Dizziness symptoms are recurrent feelings of rocking & swaying, general unsteadiness, and dizziness without Vertigo that lasts longer than 3 months. Another common Persistent Postural Perceptual Dizziness symptom is the daily occurence of each of the above-mentioned symptoms.

Persistent Postural Perceptual Dizziness Symptoms also worsen with:

  • Sitting or standing in an upright posture,
  • Any head or body motions,
  • Constant exposure to complex & motion-rich environments

PPPD disease also typically starts with an episode of acute Vertigo, unsteadiness, dizziness, & loss of balance including:

  • A central or peripheral Vestibular disorder, for eg., BPPV, Vestibular Neuritis, Meniere’s Disease, & stroke.
  • Vestibular Migraine,
  • Panic attacks that occur along with dizziness,
  • Mild to traumatic brain injury, whether through a concussion or whiplash
  • Dysautonomia, a disease of the autonomic nervous system

It’s also important to distinguish Persistent Perceptive Postural Dizziness symptoms from other medical problems like dysrhythmias, & certain drug reactions that could present as acute episodes of Vertigo, unsteadiness, & dizziness problems. In most cases, PPPD disease starts with a physical trigger, although it might not be immediately visible at the time. Patients also show mild depression & anxiety, although these are often PPV symptoms.

The most common & striking Persistent Perceptive Postural Dizziness Symptom is the patients’ psychological inability to face their triggers. Most PPPD disease patients feel as if they will be in terrible danger if they step into situations that happen to trigger their symptoms. This psychological aspect of symptoms is noteworthy in PPPD disease, more so than any other types of Vertigo.

PPPD Treatment

Medical researchers have arrived at a detailed PPPD Vertigo Treatment based plan on a patient’s individual symptoms, medical history, & specific Persistent Perceptive Postural Dizziness symptoms. Treatment for PPPD includes PPPD vertigo medicines, PPPD treatment therapies, & vestibular rehabilitation exercises to help the patient get relief from their symptoms.

PPPD Vertigo Medicines

Your healthcare provider might prescribe SSRIs (Selective Serotonin Reuptake Inhibitors) & SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) to help you with the Chronic Dizziness aspects of PPPD disease. PPPD Vertigo treatment with SSRIs & SNRIs is highly successful most of the time. Patients who are prescribed SSRIs for PPPD treatment show about 70-80% decline in their primary Persistent Perceptive Postural Dizziness symptoms. They also show improvement in recurrent dizziness, anxiety, & depression.

However, it is important to continue this treatment for PPPD treatment for at least a year to produce the desired effect. It is also important to know that benzodiazepines & other vestibular suppressants are not effective for PPPD treatment.

Vestibular Balance Rehabilitation Therapy

Vestibular Balance rehabilitation Therapy helps in PPPD treatment by making the patients more habituated to their triggers & desensitizing them to PPPD symptoms. Since most cases of PPPD Vertigo are triggered or worsened by external motion stimuli, treatment for PPPD is targeted at helping the patients get accustomed to external motion stimuli & other PPPD symptoms.

Medical researchers believe that the efficiency of Vestibular Balance Rehabilitation Therapies as PPPD treatment is about 60-80%. This figure also largely depends on each patient’s individual symptoms & medical history. VRT helps increase the mobility & daily functioning of PPPD Vertigo patients by a significant amount. It also helps in reducing the anxiety & depression of PPPD Vertigo patients, & helps them become more independent in their daily lives. Patients need to continue Vestibular Balance Rehabilitation Therapy for PPPD Vertigo treatment for at least 3-6 months to see maximum results.


Psychotherapy & related counseling can also help in the early stages of PPPD vertigo treatment, but not if the patient has fully developed long-standing PPPD disease. Research also showed that Cognitive Behavioral Therapy (CBT) also helps reduce recurrent dizziness in patients with PPPD symptoms.

However, this relief almost immediately subsides once the therapy finishes.  Recent researches conducted to assess the efficacy of CBT in PPPD Vertigo treatment concluded that patients show signs of relief from dizziness & related psychological distresses in just 3 sessions. But for this to happen, the therapy should start within 8 weeks from when the patient first experiences PPPD symptoms.

Research & studies have also shown that in patients who experience debilitating anxiety, the likelihood of developing PPPD Vertigo is respectively:

  • 60% in those who have clinically significant anxiety,
  • 45% in those who have clinically significant depression, &
  • 25% in patients who have neither.

Anxiety medications & therapies that reduce general anxiety levels in patients can also help in treating their recurrent dizziness & unsteadiness. Balance exercises and PPPD exercises are also noted for helping PPPD disease patients get used to external stimulation due to any kind of motion and complex sensory environments.

Vestibular rehabilitation therapy consists of a set of customised PPPD exercises according to the patient’s needs. It includes a variety of eye movements & head & body exercises to optimize vestibular compensation from the Persistent Perceptive Postural Dizziness symptoms.

NeuroEquilibrium range of clinics has developed an effective line of treatment using virtual reality technology to reduce visual vertigo symptoms in PPPD disease patients. Persistent Perceptive Postural Dizziness patients have shown to benefit greatly from this treatment module.