From the Research
Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) or escitalopram (Lexapro) are generally considered the best antidepressants for patients with Postural Orthostatic Tachycardia Syndrome (POTS). Starting with a low dose, such as 25mg of sertraline or 5mg of escitalopram daily, and gradually increasing as tolerated is recommended 1, 2. These medications are preferred because they typically have minimal impact on blood pressure and heart rate compared to other antidepressants.
Key Considerations
- Tricyclic antidepressants and SNRIs should generally be avoided in POTS patients as they can worsen orthostatic symptoms and tachycardia 3.
- Bupropion (Wellbutrin) should also be used cautiously as it may increase heart rate, although it may be useful in patients with syncope-predominant POTS 4.
- When initiating antidepressant therapy in POTS patients, it's essential to monitor orthostatic vital signs closely, ensure adequate hydration, and consider salt supplementation to help maintain blood volume 1, 2.
- The choice of antidepressant should be individualized based on the patient's specific symptoms, comorbidities, and previous medication responses, with close follow-up to assess both psychiatric improvement and impact on POTS symptoms.
Additional Factors
- A study from 2014 found that sertraline had a modest pressor effect in POTS patients, but this did not translate into a reduced heart rate or improved symptoms 5.
- Another study from 2020 found that bupropion was not associated with a statistically significant improvement in orthostatic vitals but showed a degree of improvement in syncope 4.
- The most recent and highest quality study from 2021 provides a comprehensive overview of the current understanding of POTS and best practices for clinical care, including the use of SSRIs as a preferred treatment option for depression in POTS patients 2.