From the Guidelines
The management of Postural Orthostatic Tachycardia Syndrome (POTS) should prioritize treating autonomic imbalances and comorbid conditions, such as anxiety and depression, to improve overall functional status, as suggested by the emerging appreciation of autonomic imbalances in patients with cyclic vomiting syndrome 1. When managing POTS, it is essential to consider the presence of comorbid conditions, such as mood disorders, migraine, and seizure disorders, which are commonly associated with cyclic vomiting syndrome (CVS) 1.
- Key considerations for POTS management include:
- Addressing anxiety and depression, which can contribute to the development and exacerbation of POTS symptoms
- Implementing lifestyle modifications, such as increasing fluid and salt intake, avoiding triggers, and engaging in regular exercise
- Considering medication management, such as beta blockers, fludrocortisone, and midodrine, to help regulate heart rate and blood pressure
- Providing patients with education on how to manage their symptoms and improve their overall quality of life In the context of Post-Acute Withdrawal Syndrome (PAWS), a comprehensive approach combining medication, therapy, and lifestyle modifications is crucial, but the primary focus for POTS management should be on addressing autonomic imbalances and comorbid conditions, as highlighted in the recent study on cyclic vomiting syndrome 1.
- Additional strategies for PAWS management may include:
- Medications like SSRIs for mood symptoms and trazodone or low-dose mirtazapine for sleep disturbances
- Cognitive-behavioral therapy (CBT) to address negative thought patterns and develop coping strategies
- Support groups and lifestyle modifications, such as regular exercise, proper nutrition, and stress management techniques, to promote overall well-being and recovery.
From the Research
Management of Post-Acute Withdrawal Syndrome (PAWS)
- The management of PAWS is not well-defined, but studies suggest that medications acting on GABA and NMDA neurotransmitter systems may be employed to counterbalance the up-regulation of NMDA and the down-regulation of GABA 2.
- Gabapentinoids (gabapentin and pregabalin) and anticonvulsants (carbamazepine and oxcarbazepine) may be used to treat negative affect and sleep symptoms in PAWS 3.
- Acamprosate may also be used, but there are no controlled trials to support its efficacy 3.
- A comprehensive assessment of medication history, duration of the withdrawal syndrome, and its various somatic, affective, sleep, and cognitive symptoms is necessary for proper recognition and detection of PAWS 4.
Management of Postural Orthostatic Tachycardia Syndrome (POTS)
- There are no research papers provided to assist in answering this question.
Tapering of Medications to Mitigate Withdrawal Symptoms
- Tapering of SSRI treatment over a period of months and down to doses much lower than minimum therapeutic doses may reduce withdrawal symptoms 5.
- Hyperbolic tapering of SSRIs may reduce their effect on serotonin transporter inhibition in a linear manner, minimizing withdrawal symptoms 5.
- A simple scale of Gorski's warning signs for relapse may be used to predict subsequent relapses in individuals with alcohol problems 6.