Postural Orthostatic Tachycardia Syndrome, or POTS, is a condition that affects the autonomic nervous system, which controls the 'automatic' functions of the body such as heart rate, blood pressure, digestion, and body temperature. When you have POTS, standing up can cause an abnormal increase in heart rate, alongside a variety of other symptoms.
Understanding POTS and its connection to mental health is crucial for both patients and their loved ones. This understanding can enhance patient care, foster supportive relationships, and guide effective strategies for managing symptoms.
POTS is characterized by a sustained heart rate increase of more than 30 beats per minute upon standing, without a drop in blood pressure. Symptoms can include fatigue, 'brain fog' or concentration difficulties, gastrointestinal dysfunction, and orthostatic intolerance symptoms like dizziness, lightheadedness, palpitations, reduced exercise tolerance, and chest pain.
In POTS, pro-inflammatory cytokines (proteins that can influence the behavior of cells) trigger increased sympathetic activity, which can cause chronic immune activation. Interestingly, POTS is often linked with autoimmune disorders, where the body's immune system mistakenly attacks its own cells.
POTS and Mental Health: The Connection
One subtype of POTS, known as 'hyperadrenergic,' is associated with elevated levels of catecholamines. Catecholamines are chemicals produced by your adrenal glands that act as neurotransmitters, or chemical messengers. They include adrenaline (also known as epinephrine), noradrenaline (norepinephrine), and dopamine, and play a crucial role in your body's response to stress.
In the hyperadrenergic subtype of POTS, there is an excess of these catecholamines, particularly norepinephrine. This can cause symptoms such as palpitations, lightheadedness, dizziness, shortness of breath, and sometimes nausea, diarrhea, headache, and fainting. It can also lead to chronic fatigue, confusion, and anxiety.
Because these symptoms can resemble those of anxiety and panic disorders, POTS can often be misdiagnosed as a psychiatric illness. This overlap underlines the importance of comprehensive evaluation and diagnosis.
Tracking Your Health: Heart Rate Variability (HRV) and POTS
As we move towards more personalized healthcare, technology can play an instrumental role. For instance, wearable technology like the Oura ring can measure and track heart rate variability (HRV), which is the variation in time between successive heartbeats. HRV is a biomarker of autonomic health and is typically reduced in POTS, indicating higher sympathetic activity and lower parasympathetic activity.
Keeping track of your HRV can help you understand how your body responds to stress and recovery, and can be an important tool in managing POTS and its impact on your mental health. Biofeedback is another tool that can help increase HRV.
Diagnosis and Treatment
Accurate diagnosis of POTS can be achieved through a variety of tests, including tilt testing, active standing test, Valsalva maneuver, deep breathing test, Holter EKG, and 24-hour ambulatory blood pressure monitoring.
Treatment for POTS is typically multi-faceted and personalized to the individual's needs, with options spanning lifestyle modifications, physical therapy, and pharmaceutical interventions.
Let's delve into some of the pharmaceutical treatments and the research surrounding them:
Beta-blockers - Medications like propranolol can control palpitations and have been found to improve exercise capacity in patients with POTS 11.
SSRIs and SNRIs - Several studies have found these classes of antidepressants to be effective in treating POTS. However, a slow titration may be needed, as activation of norepinephrine and dopamine can aggravate POTS symptoms 22.
Midodrine - This alpha adrenoceptor agonist doesn't carry some of the side effects of beta blockers, such as fatigue and further aggravation of POTS 22.
Fludrocortisone - Used for plasma volume expansion and possible sensitization of the peripheral adrenergic receptors to catecholamines 22.
Low dose naltrexone - An emerging option showing promise in reducing symptoms. It increases endorphins, which bind to regulatory T cells, reducing cytokine and antibody production 33.
IVIG - Intravenous immunoglobulin therapy may be considered, particularly for those with concurrent conditions like urticaria or mast cell activation syndrome 33.'
The Gut-POTS Connection: Unveiling the Role of Small Intestinal Bacterial Overgrowth (SIBO)
Recent studies have revealed an intriguing connection between gut health and POTS. One study found that patients with POTS were more likely to test positive for small intestinal bacterial overgrowth (SIBO) using a lactulose breath test 44. Treating SIBO with appropriate antibiotics, combined with dietary adjustments, led to improved symptoms of both POTS and SIBO.
This suggests that assessing gut health can play a vital role in managing POTS, supporting the importance of a holistic, integrative approach to treatment.
Managing POTS and Mental Health: The Path Forward
Understanding the connection between POTS and mental health can empower you to manage your health more effectively and advocate for your needs. Remember, you are not alone in this journey. With the right information, support, and treatment, you can navigate the challenges of POTS and lead a fulfilling life.
Always consult with your healthcare provider for personalized advice and treatment options.
Our team at Driftless Integrative Psychiatry is dedicated to empowering you on your health journey, providing personalized, integrative psychiatry services designed to cater to your unique needs. If you're dealing with symptoms that might indicate POTS or if you've already been diagnosed and are seeking holistic treatment options, we're here to help.
Take the first step towards reclaiming your health today. Visit our website to schedule a consultation and learn how we can support you on your path to wellness.
Vernino, S. et al. POTS: State of science and Clinical care from a 2019 NIH Expert Consensus Meeting, Part 1. 2021.
Arnold, A. C., Ng, J., & Raj, S. R. (2018). Postural tachycardia syndrome – Diagnosis, physiology, and prognosis. Autonomic Neuroscience, 215, 3–11.
Smith, P., & Blanshard, K. (2018). Low dose naltrexone: An option to consider in Postural Orthostatic Tachycardia Syndrome. BMJ Case Reports, 2018, bcr-2017-221405.
Weinstock, L. B., Klutke, C. G., & Lin, H. C. (2018). Small intestinal bacterial overgrowth in patients with interstitial cystitis and gastrointestinal symptoms. Digestive Diseases and Sciences, 53(5), 1241–1244.