Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 0 0 2026 09 13 1589 1589 Fahimeh Hajiabolhassan - Younes Lotfi - Mohmmadreza Khodaei Ardakani Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Enayatollah Bakhshi Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 2026 06 23 2026 08 26 Background and Aim: Major depressive disorder (MDD) is associated with dizziness, balance complaints, and abnormalities in vestibular processing. This study examined whether noisy galvanic vestibular stimulation (nGVS), virtual reality (VR)-based vestibular rehabilitation, or their combination, when added to stable pharmacotherapy, could influence depressive symptoms, dizziness-related disability, and vestibular function in women with moderate MDD. We hypothesized that the combined intervention would be associated with greater improvement than vestibular intervention or pharmacotherapy alone. Methods: This controlled quasi-experimental study included 52 women with moderate MDD. A separately recruited non-randomized control group (n=13) received pharmacotherapy alone. The 39 participants were randomly allocated to nGVS, VR, or nGVS+VR groups (n=13 each). nGVS consisted of three 20-minute sessions once weekly for three weeks. VR-based vestibular rehabilitation comprised eight 45-minute sessions twice weekly over four weeks. Pharmacotherapy remained unchanged during the intervention and follow-up periods. Assessments were performed at baseline, post-intervention, and one-month follow-up. Results: Depressive symptoms decreased more in the nGVS+VR and VR groups than in the control group post-intervention and in all vestibular intervention groups at follow-up. Between-group changes in dizziness-related disability were not statistically significant. Right lateral canal vestibulo-ocular reflex (VOR) gain showed greater improvement in the combined group compared with the control group. Conclusion: Vestibular-targeted interventions added to stable pharmacotherapy were associated with greater improvement in depressive symptoms. The combined intervention produced a selective improvement in right lateral VOR gain. These preliminary findings warrant further investigation but do not establish generalized vestibular recovery or superiority of the combined approach across all outcomes. https://avr.tums.ac.ir/index.php/avr/article/view/1589 https://avr.tums.ac.ir/index.php/avr/article/download/1589/703