Many people experience dizziness or imbalance at some point in life. Usually, the cause is identified — such as an ear infection, low blood pressure, or a medication side effect — and treatment brings relief. But some patients continue to feel unsteady even after ENT and neurology tests are normal. This ongoing problem is often described as treatment-resistant imbalance.

🤔 What is Treatment-Resistant Imbalance?

Treatment-resistant imbalance refers to persistent dizziness, unsteadiness, or a rocking/spinning sensation that does not respond to usual medical treatments. In many cases, this condition overlaps with what specialists call Persistent Postural–Perceptual Dizziness (PPPD).

Patients often describe:

• A constant sense of imbalance or swaying rather than sharp vertigo.

• Worsening symptoms in crowded places, supermarkets, or while watching moving traffic.

• Fluctuations with stress, anxiety, or fatigue.

• Vague bodily complaints that don’t match any clear disease.

🧠 The Mind–Body Connection

Research shows that anxiety disorders, OCD, and somatic symptom disorders often co-exist with treatment-resistant imbalance. The balance system in the brain becomes overly sensitive, and even normal movements can trigger a sense of dizziness.

Polypharmacy (taking many medications together) can also worsen imbalance through sedation, blood pressure fluctuations, or drug interactions.

✅ How is it Managed?

1. Reassurance & Education

   • The symptoms are real, but not dangerous. Understanding the condition reduces fear and secondary anxiety.

2. Medication Review

   • Simplifying prescriptions, reducing sedatives, and focusing on one effective antidepressant (such as an SSRI) can help.

3. Vestibular Rehabilitation Therapy (VRT)

   • Exercises like the Brandt–Daroff and Cawthorne–Cooksey maneuvers retrain the balance system.

4. Psychological Support

   • Cognitive Behavioural Therapy (CBT) or Exposure–Response Prevention (ERP) helps patients manage anxiety and reduce hyperfocus on body sensations.

5. Gradual Re-exposure

   • Encouraging walking, balance tasks, and daily activities instead of avoiding movement helps retrain the brain.

⚠️ When to Seek Urgent Help

Not all dizziness is harmless. Seek immediate medical attention if imbalance is associated with:

• Sudden severe headache

• Chest pain or palpitations

• Weakness or numbness in limbs

• Slurred speech or loss of consciousness

💡 Key Takeaway

Treatment-resistant imbalance is not “all in the mind.” It is a real, functional condition where the brain’s balance system remains hyperactive. The best results come from a combination of streamlined medication, vestibular rehabilitation, and psychological support — not from endlessly adding more drugs.

👨‍⚕️ Consult for Treatment-Resistant Imbalance

I’m Dr. Srinivas Rajkumar T, Consultant Psychiatrist at Apollo Clinic, Velachery, Chennai.
If you are struggling with persistent dizziness, imbalance, or related psychiatric concerns, you can book a consultation at Apollo Clinic.

📞 Contact: 8595155808