MdDS (Mal de debarquement Syndrome) treatments

Timothy C. Hain, MD • Page last modified: September 24, 2022

MdDS main page is hereMdDS calculatorBertec-GyrostimPTTMSOKN. •references.

Overview:

A review article about MdDS treatment can be found in Frontiers online (Canceri et al, 2018), and this might be a good place to start.

MdDS often ends by itself, typically within 4 months (median duration according to Cha et al, 2008). There are also some medications to suppress rocking or, in theory, to speed up resolution of the symptoms. Medication is reportedly the most effective(Cancieri et al, 2018), but there can be some "mild mood altering" side effects with the tranquilizer or antidepressants generally used.

If "waiting it out" doesn't work, and medication fails or is just not chosen, then some patients go for roll-adaptation/habituation -- the logistics are difficult however (see below).

This page mainly discusses medication treatments for MdDS (mal de debarquement syndrome). There are several other pages linked to above involving sometimes expensive devices with especial attention to the amount of evidence available to support their use. Of course, "lack of proof" is logically not at all the same as "proof of lack". So perhaps some of these treatments will eventually be shown to be effective for MdDS.

Medications:

Medications appeared to be the most effective treatments for MdDS in the Cancieri et al study (2018).

While the observation has been made that patients with MdDS generally feel better, and have less rocking on a variety of medications, to our knowledge, there have been no placebo controlled blinded studies of any medication in MdDS. In the author's first paper on MdDS (Hain et al, 1999), which was a survey study, it was observed that many medications were tried, but only a few were reported as useful (Klonopin and Amitriptyline). Subsequent literature remains at the anecdotal level.

Medications that may be recommended for MdDS (but have no formal evidence that they work) include:

A survey, carried out by Cancieri et al (2018), obtained responses to Survey monkey and Qualtrics questionnaires from 370 subjects, located throughout the world. They reported (from their online respondants of course), that "Benzodiazepine/Antidepressant use was the most commonly trialled treatment in both MT and SO groups, 64.7 and 67.3%, respectively, (Figure 1A, Table 2), followed by vitamin/mineral supplementation (47.9% and 51.0%). " They use MT to indicate motion triggered, and SO to indicate spontaneous onset. These subjects were not examined in person, and thus it might be difficult to exclude disorders such as BPPV, bilateral loss, or vestibular neuritis, that are identified with physical examination or tests.

The Bottom Line regarding medications for MdDS:

Our "executive summary" of the following long discussion -- there are just two medications seriously worth considering -- clonazepam, and venlafaxine

Clonazepam is a "suppressive" medication -- i.e. a "band aid", and probably doesn't speed up resolution. It is addictive - -a big problem. Venlafaxine is not a "suppressive" type drug, but it is a little psychoactive and may reduce anxiety. Our guess is that it does speed up resolution (but this is just a guess).

We think the best protocol is to use venlafaxine to attempt to speed up recovery, and use clonazepam or a similar drug when anticipating a relapse (such as taking a long trip). The reasoning for both is that one needs both a daily "prevention" type medication, and also it is probably important to avoid relapses, as with each relapse, there is a tendency for the duration of the symptoms to last longer (Cha, 2008). These ideas are just our opinion -- so far, studies are lacking.

With respect to all of the other medications discussed below, well it is good to keep an open mind, but we don't think one needs to try them all.

Details about medications in MdDS:

More detailed comments follow: The majority of the information here is either from mentions of a response in published papers, or the author's experience (more than 250 MdDS patients).

Medications that don't work for MdDS (athough no formal studies):

After MdDS has started, most medications that work for other forms of dizziness or motion sickness are ineffective. Conventional vestibular suppressants that affect anticholinergic pathways such as meclizine and transdermal scopolamine are not helpful in MdDS. (Hain, Hanna et al. 1999) Antivert (bonine, meclizine), dramamine, and scopolamine seem to be of little use. The author has tried out many other medications, and has also not found response to more unusual agents for dizziness such as betahistine, baclofen, or verapamil.

Medications to stop and procedures to consider stopping (no studies here either).

Anecdotes:

Periodically we get patients email us with positive information about unusual treatments. The author of this page does not endorse these treatments, but we welcome the input and will copy them as they come in here (unless this page gets overloaded).

5/15/2022: Psilocybin (a hallucinogen). An invidual who reported 2 bouts of MdDS wrote: "I did a macrodose of 4g over the weekend, and while it didn’t completely resolve the symptoms, it did reduce them by about 50% right away. I am planning to continue to microdose and monitor my symptoms, and if they don’t resolve in about a month, I might try another macrodose and report back. I am also a migraine sufferer, and microdosing psilocybin has also alleviated my migraines to a degree."

Research is needed !

There are many open questions concerning treatment of MdDS. Here are a few:

References