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I'm starting to feel dizzy as I progress through the healing process

I'm not sure if this is because my psychiatrist put me on Aripiprazole so I stopped taking it. I read a lot about bad side effects of this medication. Is my dizziness something that I won't be able to recover from after stopping the medication?

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Division Director PM&R

Answer transcribed from Brightway's interview with Dr. Thomas Franz:

The rehabilitation team that she's working with now, particularly a cognitive therapist or a psychologist, can be very useful in that; sometimes even the occupational therapist or speech therapist who deals with cognitive issues. If a person is remaining in post-traumatic amnesia, then the goals are going to be more basic: interacting with people, greeting with them, perhaps doing some common tasks like sharing a meal would be all one would hope. You're not going to plan an event, for example, with someone who can't retain the information and patients you know who are in post-traumatic amnesia. 

One of the hallmarks will be that they won't know that you were there yesterday. Every moment is like they just woke up, so doing a lot of complex elaborate things that really recall upon their memory will just be frustrating to the individual or to the person who's expecting perhaps a greater interaction. The rehabilitation team really ought to be able to guide you in that. If they're in a rehabilitation center, often there are activities to help with that. Now, of course, social distancing and Covid have changed the landscape of those kinds of events, unfortunately. Hopefully, we'll be getting back to that in a more realistic way soon and they may be able to help the individual interact via Zoom or some other video interface if not able to have an in-person visitation at this point. 

Once they move past the post-traumatic amnesia, I think the biggest issue really depends on the person's behavioral deficits. If somebody has lost all their filters, which I think is a term most people are familiar with, they say things that pop into their head without thinking about them or they act on every impulse that occurs to them, then a lot of the interaction will be working with them in simple interactions trying to redirect them to what's appropriate and then advancing to more complex social interactions as they improve. That would be something that the family would practice with the rehabilitation team and then continue to work with the individual in that regard. For some people, it's a period of time where they're really going through a phase. For other folks, unfortunately, where the behavioral deficits are more long-term, this can be a lifelong process.

Division Director PM&R

Answer transcribed from Brightway's interview with Dr. Thomas Franz:

Certainly, our Aripiprazole which used to be sold under the brand name Abilify can cause some dizziness. However, it's not a common side effect and there are patients who have dizziness just as a consequence of their brain injury. Either the inner ear itself which just sits right below the brain is damaged or the mechanisms within the brain that coordinate all the sensory information that help us remain balanced is damaged. And so it could be from the brain injury, it could be the medication, it could be the medication interacting with the brain injury. I would discuss it with the physician who prescribed it. if the dizziness either came on immediately after starting the medication and wasn't a problem prior to that or if it became  

worse after starting the medication, I would suspect that it's at least partially to blame. 

There are other medications in that category that can be prescribed that may have a better side effect profile for the person. There's no reason to think that if you have a side effect from a medication like Aripiprazole that it would persist long after stopping it. If they weaned it or stopped it depending on what kind of dose the person is on there's no reason to think the side effects wouldn't go away. There are some very rare side effects from all medicines in this class which are called dopamine antagonists where people get movement disorders. Although we have treatments now, those can be lifelong but dizziness itself is not something that should be a permanent condition.

If eliminating the medicine doesn't get rid of the dizziness, then there should be an evaluation both by a rehabilitation professional either a physical therapist or physiatrist, or even by a very specialized kind of ear doctor called a neuro otologist, which are ear, nose, and throat physicians that have had additional training in neurologic disorders and understand about damage to the inner ear the portion that has to do with balance in addition to the portion that has to do with hearing. And again, persistent dizziness problems, particularly if they can't be attributed to a particular medication or other problem, should be further evaluated.

This is something that a vestibular therapist might also be able to help out with. Depending on the severity of the symptoms, I may have the person start with vestibular therapy. There will be a certain amount of evaluation that's done but also there will be treatment to try and retrain the balance reflexes. Now, patients do have to be cautious and understand that part of what will be done in a balanced therapy is they will put you in situations where you feel off-balance or do exercises to challenge your sense of balance. Many patients don't expect that and then they become fearful and don't want to do the therapy. The point is to actually retrain your body to respond to that off-balance feeling and have proper reflexes to help you in in a situation where the ground or levels or surface may not be level or it may be very challenging to balance or visual inputs may be confusing. It's a very useful therapy but I always make sure that I explain to the patient what the purpose is or they may be put off by it which is unfortunate.