What is the cause of morning dizziness, exacerbated by position changes, in a 60-year-old female taking trazodone (at bedtime), sertraline, and gabapentin (600 milligrams three times a day, TID)?

Differential Diagnosis for 60-year-old Female with Dizziness

Single Most Likely Diagnosis

• Orthostatic Hypotension: The patient's symptoms of dizziness worsening in the morning and with position changes, along with the use of medications such as trazodone and gabapentin that can cause orthostatic hypotension, make this the most likely diagnosis. Trazodone, an antidepressant, and gabapentin, an anticonvulsant, can both contribute to hypotension, especially when standing up.

Other Likely Diagnoses

• Benign Paroxysmal Positional Vertigo (BPPV): Given the patient's dizziness with position changes, BPPV is a plausible diagnosis. It is a common cause of vertigo that is related to the movement of the head and is more prevalent in older adults.
• Vestibular Dysfunction: This could include conditions like labyrinthitis or vestibular neuritis, which can cause dizziness and vertigo, especially with changes in position.
• Medication Side Effects: Besides orthostatic hypotension, other side effects from the patient's medications, such as sertraline (an SSRI) and gabapentin, could contribute to dizziness.

Do Not Miss Diagnoses

• Cardiac Causes (e.g., Arrhythmias, Heart Block): Although less likely, cardiac issues can cause dizziness, especially with position changes or exertion. Missing a cardiac cause could be fatal.
• Stroke or Transient Ischemic Attack (TIA): Dizziness can be a symptom of a stroke or TIA, especially if accompanied by other neurological deficits. These are medical emergencies.
• Severe Anemia or Blood Loss: Significant blood loss or severe anemia can lead to orthostatic hypotension and dizziness. Identifying and treating the underlying cause is crucial.

Rare Diagnoses

• Multiple System Atrophy (MSA): A rare neurodegenerative disorder that can cause orthostatic hypotension, among other symptoms. It's less likely but should be considered if other diagnoses are ruled out and symptoms persist or worsen.
• Autoimmune Inner Ear Disease: A rare condition that can cause vertigo, hearing loss, and tinnitus. It would be considered if other vestibular causes are ruled out and there are additional symptoms suggestive of an autoimmune process.