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Case Series
Tandospirone for antidepressant-intolerant persistent postural-perceptual dizziness: A case series based on an otolaryngology–psychiatry collaborative care model
1 Assistant Professor, Department of Otolaryngology– Head and Neck Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
2 Assistant Professor, Department of Neuropsychiatry, Sapporo Medical University, Sapporo, Hokkaido, Japan
3 Attending Physician, Department of Otolaryngology–Head and Neck Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
4 Professor, Department of Neuropsychiatry, Sapporo Medical University, Sapporo, Hokkaido, Japan
5 Professor, Department of Otolaryngology–Head and Neck Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
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Sumito Jitsukawa
MD, PhD, Department of Otolaryngology–Head and Neck Surgery, Sapporo Medical University, South 1, West 17, Chuo-ku, Sapporo, Hokkaido 060-8556,
Japan
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Article ID: 100022Z18SJ2026
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Jitsukawa S, Kashiwagi T, Iwakiri A, Kawanishi C, Takano K. Tandospirone for antidepressant-intolerant persistent postural-perceptual dizziness: A case series based on an otolaryngology–psychiatry collaborative care model. J Case Rep Images Otolaryngol 2026;5(2):5–10.ABSTRACT
Introduction: Persistent postural-perceptual dizziness is typically managed with serotonergic antidepressants; however, treatment continuation is frequently hindered by adverse effects. Pharmacological alternatives for patients with antidepressant intolerance remain poorly defined. Here, we present a case series examining the potential therapeutic utility of tandospirone, a partial agonist of the 5-hydroxytryptamine 1A receptor, in this clinical context.
Case Series: Three female patients (aged 64–80 years) diagnosed with persistent postural-perceptual dizziness in accordance with the Bárány Society criteria experienced persistent dizziness and were unable to tolerate antidepressant therapy because of grade 2 adverse events, including gastrointestinal disturbances. Tandospirone was introduced as an alternative treatment and was titrated based on individual tolerability. All patients exhibited meaningful clinical improvement, characterized by reductions in Niigata persistent postural-perceptual dizziness Questionnaire scores and stabilization of posturographic parameters. Symptomatic relief was maintained for up to 12 months without any notable adverse effects.
Conclusion: Tandospirone may be a clinically valuable alternative for patients with antidepressant-intolerant persistent postural-perceptual dizziness. Although the contributions of spontaneous remission and vestibular rehabilitation cannot be excluded entirely, the extended duration of symptoms preceding tandospirone initiation renders natural recovery less probable. Prospective investigations are warranted to further elucidate its efficacy and safety profile.
Keywords: Antidepressant intolerance, Collaborative care, Persistent postural-perceptual dizziness, Tandospirone
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Acknowledgments
We would like to thank all staff members of the Department of Otolaryngology–Head and Neck Surgery and Department of Neuropsychiatry at Sapporo Medical University. We would like to thank Editage (www.editage.jp) for English language editing.
Declaration of Generative AI and AI-assisted technologies in the manuscript preparation processWe used ChatGPT (version 5.2, GPT-5.2 model; OpenAI, San Francisco, CA, USA) for English language editing and proofreading of the manuscript. The AI tool was utilized to check grammar, spelling, and stylistic clarity in the main text.
Author ContributionsSumito Jitsukawa - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tomonori Kashiwagi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ayaka Iwakiri - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Chiaki Kawanishi - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Kenichi Takano - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Sumito Jitsukawa et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
