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"unusual Tiredness" And "drowsy" = Yuck

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Along with the POTS, I've been dealing with depression and anxiety for years and years. With my recent health problems, both have gotten worse.

For the past few months, I've been experienced something that I can only describe as sudden bouts of acute malaise. Not just tiredness, but tiredness plus. It's a feeling of yuck. That's why I describe it as malaise.

When I realized that my heart rate was increasing when I stood, described this to my doctor, then my cardiologist, and my cardiologist said it sounded like POTS. I was relieved to finally have a diagnosis other than anxiety, because, with these physical symptoms that are beyond the symptoms I've come to recognize of anxiety, I was getting pretty frustrated with not getting any answers that met with my own knowledge of my body. Something was going on beyond anxiety.

Anyhoot, it turns out there hasn't really been a change in treatment. I'm still on the beta blocker that I was prescribed in the ER a few months ago, and I've been told to load up on fluids and salt.

Now, I'm not frustrated that I'm not being given different/more treatment, as my treatment seems to be along the same lines as everyone else here.

My problem is that my treatment doesn't seem to be helping all that much, and might be making it worse?

I've noticed that every morning about two hours after I take my morning line-up of Aciphex (for the GERD), Metoprolol (for the tachy) and Zoloft (for the depression/anxiety), I feel so tired, worn-out, lazy, etc. Some days I end up giving in and taking something like a 2 - 4 hour nap. Since starting the Zoloft, I think, so far as the depression goes, I've actually started to feel worse. I find myself thinking "What's the point? What's the purpose of life, anyway?" a lot. Not suicidal, just feeling a little lost and inconsequential, lacking substance, maybe? I recently left my job as a teacher due to the stress/fatigue, so that has something to do with it also. I need to be doing something of consequence to feel fulfilled, and I feel very unfulfilled and meaningless lately.

I want to feel productive/alive/energetic again.

I fully intend on discussing these issues with my doctor(s), but I wanted to ask ya'll...

Has anybody else experienced these symptoms (malaise, sleepy, worn out) from their treatment? (I think I've read some who have.) How did you handle it?



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Yes, I can commiserate with you on a couple levels. I too have had problems with anxiety, and within the last 3 years depression from just feeling like crap all the time. In fact, my anxiety has gotten wrose since I'm so anxious about my health. Every doctor/ER visit I've had have diagnosed me as having anxiety/panic attacks. But like you I noticed that my heart would race every time standing up, and was convinced that anxiety was not the cause of this. I then found out about POTS after researching my symptoms, and brought in some literature to my last PCP. He ordered a TTT for me, which did confirm rise of >30bpm when tilted upright, and slight drop in bp. But he also explained that even if I had POTS (he couldn't make a formal diagnosis), all he could do was treat symptoms. Indeed, I am anxious, and he could definately notice that. He said if someone came in exhibiting my symptoms, he would have them on an SSRI and benzo. I've been on both before, and on them the orthostatic tachy was not as noticeable. In fact, it took coming off the meds to really notice and get a hold on what was really happening with my hr. And yes, it is very troublesome to get someone who will listen and open their minds to the thought of there being something else going on instead of just anxiety/depression. My dad and stepmom are still convinced I am just anxious all the time. They did hear the results of the TTT test, but apparently it didn't sink in.

Anyway, after trying to go without meds and not seeing any light at the end of the tunnel for 4 months, I decided to go back on them (Cymbalta and Klonopin was what I was prescribed). I have to say, though, that I did feel better being on the meds. I think I mostly contribute that to the Cymbalta, as I eventually weaned of klonopin entirely). In fact, I felt so good that I decided that I would try to go off meds again, this time weaning more slowly, and try to handle my symptoms with natual supplements/herbs. Well, in hindsight that was a big mistake, because as soon as I was at a low dose of Cymbalta, I began to have problems, even more so than the first time I went off of it. Mainly issues with hr surges out of the blue, just sitting and "relaxing", and of course were more severe when upright. The first one scared me so much I ended up in the ER. Again, handed info on anxiety, told to resume my meds, and sent home.

About the tiredness issue, I remember shortly after my first POTS episode (aka "Panic attack"), my cardiologist suggested a beta blocker, nadalol, which I took for a while. It was prescribed mainly for bp fluctuations. Anyway, while on that I was really tired all the time, and ended up going off cause my bp showed normal levels when measured at home. I was then referred to a psychiatrist, who had me on high dose Klonopin (8mg/day) and Zoloft (100mg). I was noticeably tired taking those as well. Later switched from Zoloft to Cymbalta (60mg)...tired and yawning all the time. It was not until I weaned my klonopin way down and dropped my cymbalta to 30mg that I was not yawning and tired all the time.

So, it could just be the meds making you tired. Being tired is common with Beta-blockers and SSRIs. Perhaps it is a dosage issue (may I ask what mg Zoloft you are on)? I remember a number of years ago before being "POTSy" I was on almost all the SSRIs and they all made me feel tired and I had to nap like every day, and I was on a low dose. It is evident that Cymbalta does, at least for me, mitigate my symptoms and I don't feel the need to nap during the day, but then again I seem to need like 11 hours of sleep.


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Yeah, it can be frustrating that so many of the meds that MAY help us, are used for so many different things. So, although your treatment hasn't changed it seems in line with what many of us take or have tried. But, this does not mean that it is necessarily the best fit for you. I would try to find a dr. well versed in dysautonomia to help you find the right treatment combo.

The meds I have taken have definitly made me feel like that, sometimes it gets better, and sometimes it doesn't. Drs. tend to tell me to give it a month or so.

If the Zoloft is new and these side effects started with the Zoloft, you may find it beneficial to try a different medication. I tried Celexa and it made me have bouts of manic type moods and some really depressed type moods that is not at all anything I had ever experienced before, it was a rollercoaster ride, and I really needed to get off of it. So, the drs. put me on Zoloft.

Hope that helps and you find relief soon!

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  • 2 weeks later...

Thanks for the replies. I'm learning that fatigue is just part and parcel of the whole thing, though sometimes the meds contribute.

As for me, I've started taking my low dose of Metoprolol at night, and I've started taking my low dose of Zoloft (25mg) at night as well.

I can't afford to see my psychiatrist for now, so that's another reason why I've decreased the dose, and why I haven't yet switched to Wellbutrin as he ordered the last time I was there. (Can't afford psychiatrist, can't afford psych meds either! wark! :) )

For now, I'm feeling okay, just learning how to cope with this tiresome (in more ways than one) disability.

Thanks again,


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I may be totally off base, but with the fatigue you describe, it it possible you might have some type of sleep disorder?

I was diagnosed with sleep apnea in the spring. I still have ans issues bigtime, but my fatigue and mood are loads better with cpap treatment. A number of people here have apnea, even if they don't fit the stereotype. I didn't think they'd find anything on my sleep study--but lo and behold I have apnea. and the gerat news is that apnea really is treatable. I rarely need a nap. I can get by on fewer hours in bed, because the qulaity of my sleep is so much better. (In other words, breathing is good for you. )

and there are many people misdiagnosed as depressed, when really they are suffering the effects of sleep deprivation. I still have bad autonomic spells premenstrually, but my mood and spirits are pretty decent.

The way my ans doctor put it, treating apnea might not make your ans normal, but leaving it untreated will make everything worse. In the end, I think it's getting easier to get sleep studies ordered and paid for, because in the end it reduces health costs.

Just a random thought.

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Guest tearose

Hm, I too have tiredness but I don't have apnea so I can't treat that. I do have non-restorative sleep and they think the ANS misfires but they don't know how to treat this since this field is still new

I wake up with such low bp and weakness that it takes me several hours to go from wake up to fully dressed and ready to start my day. It takes me about four hours. And this is an average. I am not depressed and not on medication. I am just a total rag doll for several hours. I have to live like this because there are no alternatives. I have medication allergies. sensitivities and contraindications so I do all behavior modification things.

Yes, fatigue and inconsistant energy or low stamina and hollow bones or whatever you call it, IS part of living with POTS from my experience.

best regards,


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