Vertigo is not the same as dizziness or lightheadedness. It is “a sensation of motion or spinning ... often described as dizziness,” according to the U.S. National Library of Medicine. One cause of vertigo is ototoxicity—ear poisoning—that may result in permanent or temporary damage to the inner ear or acoustic nerve. According to Timothy C. Hain, M.D., Professor of Otolaryngology at Northwestern University Medical School, many antidepressants can impair balance, “but the mechanism of this effect is uncertain, and probably not due to ototoxicity.” Prescription antidepressants can cause or exacerbate tinnitus, but few will trigger vertigo.
Selective Serotonin Reuptake Inhibitors or SSRIs
Selective serotonin reuptake inhibitors such as escitalopram, or Lexapro; citalopram, or Celexa; and fluoxetine, or Prozac, do not cause vertigo. However, some SSRI antidepressants may impair balance or lead to dizziness, and others may cause tinnitus. In his article, “Ototoxic Medications Can Cause Tinnitus,” tinnitus expert Barry Keate, says “both the older, tricyclic, and the newer, SSRI, antidepressants have this capability.” The Physician’s Desk Reference lists Celexa, Luvox, Paxil, Prozac and Zoloft as the SSRI antidepressants that may cause tinnitus.
Abruptly stopping an SSRI may cause serious discontinuation symptoms, including dizziness. Even though paroxetine and fluvoxamine cause more discontinuation symptoms than sertraline, fluoxetine, and citalopram, these SSRIs do not actually cause vertigo. "Discontinuation symptoms have been reported less often for sertraline,” according to an article by Massachusetts Mental Health Center psychiatrist, Kara E. Ditto, M.D., M.P.H. However, a drug monograph published on Internet Mental Health, warns that vertigo can be an infrequent side effect of sertraline, commonly known as Zoloft.
Tricyclics, which include amitriptyline, or Elavil; imipramine, or Tofranil; and nortriptyline, among others, have been used to treat depression for many years. Vertigo is not a common or even infrequent side effect of most of these antidepressants. Clomipramine and amitriptyline are tricyclic antidepressants that may cause tinnitus and dizziness, and desipramine may cause dizziness when someone stands up abruptly, but none of these medications cause vertigo.
The newer depression drugs, called atypical antidepressants, work differently than SSRIs and tricyclics. Some target other neurotransmitters alone or in addition to serotonin; brain chemicals they affect include norepinephrine and dopamine. Although some of these antidepressants list dizziness as a side effect, most do not cause vertigo. Atypical antidepressants include venlafaxine, or Effexor; duloxetine, or Cymbalta; mirtazapine, or Remeron; trazodone, or Desyrel; nefazodone, or Serzone; and bupropion, or Wellbutrin.
Bupropion is the only atypical antidepressant that may trigger vertigo, but the occurrence of this side effect is rare. The Federal Drug Administration describes vertigo as an infrequent side effect of bupropion. People may also experience vertigo-like symptoms, such as dizziness, loss of balance and a feeling that the room is spinning, when taking bupropion. The drug interaction between bupropion and amatadine can also cause vertigo.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase inhibitors or MAOIs were the first type of antidepressant to be used and date back to the 1950s. MAOI antidepressants like phenelzine, or Nardil; tranylcypromine, or Parnate; isocarboxazid, or Marplan; and selegiline, or Emsam, can cause many side effects, including weakness, dizziness, headaches, tremor, nausea and lightheadedness, to name a few, but they do not cause vertigo.