Can an anxiety attack present as vertigo (dizziness)?

From the Guidelines

Yes, anxiety attacks can definitely present as dizziness, as evidenced by the fact that anxiety or panic disorder is listed as a potential cause of chronic vestibular syndrome, which includes symptoms of dizziness, in the clinical practice guideline for benign paroxysmal positional vertigo 1. Dizziness is actually one of the common physical symptoms experienced during anxiety attacks, along with rapid heartbeat, shortness of breath, sweating, and trembling. This occurs because anxiety triggers your body's fight-or-flight response, releasing stress hormones like adrenaline that can affect your inner ear and balance mechanisms. The hyperventilation that often accompanies anxiety can also reduce carbon dioxide levels in your blood, leading to lightheadedness and dizziness.

Some key points to consider when evaluating dizziness as a symptom of anxiety include:

• The temporal pattern of the dizziness, with anxiety-related dizziness often being episodic and triggered by specific situations or stimuli
• The presence of other symptoms of anxiety, such as rapid heartbeat, shortness of breath, and sweating
• The absence of other potential causes of dizziness, such as inner ear problems or neurological disorders

If you experience anxiety-related dizziness, techniques like deep breathing (inhaling slowly through your nose for 4 counts, holding for 1, and exhaling through your mouth for 6 counts), grounding exercises (identifying 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste), and staying hydrated can help manage these symptoms. For persistent or severe anxiety with dizziness, medications like SSRIs (such as sertraline 50-200mg daily or escitalopram 10-20mg daily) or benzodiazepines (like lorazepam 0.5-2mg as needed, though these should only be used short-term due to dependency risk) might be prescribed by a healthcare provider alongside cognitive behavioral therapy, as supported by the evidence on the effectiveness of these treatments for anxiety disorders 1.

From the FDA Drug Label

These symptoms must not be secondary to another psychiatric disorder or caused by some organic factor. Anxiety associated with depression is responsive to alprazolam tablets. Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: (1) palpitations, pounding heart, or accelerated heart rate; (2) sweating; (3) trembling or shaking; (4) sensations of shortness of breath or smothering; (5) feeling of choking; (6) chest pain or discomfort; (7) nausea or abdominal distress; (8) feeling dizzy, unsteady, lightheaded, or faint; (9) derealization (feelings of unreality) or depersonalization (being detached from oneself); (10) fear of losing control; (11) fear of dying; (12) paresthesias (numbness or tingling sensations); (13) chills or hot flushes

Anxiety Attack Symptoms:

• Feeling dizzy, unsteady, lightheaded, or faint is one of the symptoms of a panic attack.
• Dizziness or light-headedness is also listed as a symptom of generalized anxiety disorder.
• Therefore, yes, an anxiety attack can present as dizziness 2.

From the Research

Anxiety Attack Symptoms

• Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness 3
• Dizziness is a common symptom encountered by all physicians and is frequently linked to anxiety disorders 4
• Anxiety disorders involve dysfunction in brain circuits that respond to danger, and can manifest as excessive fear and anxiety or avoidance of perceived threats 5

Relationship Between Dizziness and Anxiety

• Rates of panic disorder are elevated to 5 to 15 times the general population rates among patients presenting for evaluation and treatment of dizziness 6
• Panic patients frequently experience significant dizziness and often demonstrate evidence of vestibular dysfunction 6
• There are three main explanatory models for the association between panic disorder and vestibular dysfunction: the psychosomatic model, the somatopsychic model, and the network alarm theory 6

Treatment of Anxiety Disorders

• First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release 3
• Selective serotonin reuptake inhibitors are good candidates for future treatment studies of patients with vestibular symptoms and panic disorder 6
• In adults with generalized anxiety disorder, SSRIs and SNRIs represent the first-line psychopharmacologic treatment 7