From the Guidelines
Your POTS symptoms may worsen after anxiety episodes because anxiety activates your sympathetic nervous system, which can exacerbate POTS symptoms the following day. When you experience anxiety, your body releases stress hormones like adrenaline and cortisol, which increase heart rate and blood pressure 1. For POTS patients, whose autonomic nervous system already struggles with blood pressure and heart rate regulation, this additional stress can deplete your body's resources and lead to worse symptoms the next day. This post-anxiety POTS flare often includes increased heart rate, dizziness, fatigue, and brain fog.
Key Considerations
- Anxiety can trigger a hyperadrenergic state, which is a proposed pathophysiology of POTS 1
- POTS is frequently associated with deconditioning, recent infections, chronic fatigue syndrome, joint hypermobility syndrome, and a spectrum of non-specific symptoms such as headache and chest pain 1
- Orthostatic intolerance, which includes POTS, is characterized by symptoms that develop upon standing and are relieved by sitting or lying down 1
Management Strategies
- Anti-anxiety medications like SSRIs (such as sertraline 25-100mg daily) or benzodiazepines (like lorazepam 0.5-1mg as needed) may be considered to manage anxiety and POTS symptoms 1
- Non-medication approaches include practicing daily relaxation techniques like deep breathing or meditation, maintaining consistent hydration with 2-3 liters of water daily with added electrolytes, wearing compression garments, and following a regular sleep schedule
- Beta-blockers (like propranolol 10-40mg) may be helpful for managing both anxiety and POTS symptoms, but should only be used under medical supervision 1
Important Notes
- The pathophysiology of POTS is debated and likely heterogeneous, and may involve deconditioning, immune-mediated processes, excessive venous pooling, and a hyperadrenergic state 1
- The European guidelines draw direct attention to the evolution of evidence over time and its impact on the strength of recommendations 1
From the Research
POTS Symptoms and Anxiety
- POTS symptoms can be exacerbated by anxiety, as patients with POTS often experience situational anxiety that can reduce their activity level and impede functional recovery 2.
- Anxiety sensitivity, particularly with regards to cardiac symptoms, is increased in patients with POTS, which can contribute to worsening symptoms 3.
- The relationship between anxiety and POTS symptoms is complex, and psychological interventions may aid in recovery and facilitate uptake and adherence to other treatment modalities 3.
Pathophysiologic Mechanisms
- POTS is a heterogeneous condition with multiple pathophysiologic mechanisms, including peripheral denervation, hypovolemia, deconditioning, and hyperadrenergic state 4.
- Psychologic mechanisms, such as somatic hypervigilance, are also involved in a significant proportion of patients with POTS 4.
- These mechanisms can interact with each other and with anxiety to exacerbate POTS symptoms.
Cognitive Function and POTS
- Cognitive function is impaired in patients with POTS, particularly in the domains of attention and short-term memory 3, 5.
- Daily function is greatly impacted by cognitive symptoms resulting from POTS, and patients have developed strategies to overcome these challenges 5.
- The cognitive impact of POTS on daily function is an important consideration for treatment and management of the condition.
Treatment and Management
- Treatment of POTS typically involves a combination of pharmacologic and nonpharmacologic interventions, including beta-receptor antagonists, vasoconstrictors, and postural training 4.
- Psychological interventions, such as cognitive behavioral therapy, may also be beneficial in managing POTS symptoms and improving quality of life 2, 3.
- A comprehensive treatment plan that addresses the complex pathophysiologic mechanisms and cognitive symptoms of POTS is essential for effective management of the condition.