Beta Blockers And Brain Fog

[summer]

Since starting a combination of BB and Florinef almost a year ago, I have had improvement in a number of ways, although I still have a long way to go. I am able to stay standing for longer periods, I do not get as nauseated, I am not as tachycardic and my episodes are less often. I would say the combination has helped a lot.

However, my brain fog has not changed. This is my most disabling symptom and is the thing that is holding me back in getting on with my life. I work as a nurse and can not do my job with out being fully alert all the time. It's very frustrating.

I read a study from 1998, from Vanderbilt, called "Raised Cerebral Vascular Resistance in Idiopathic Orthostatic Intolerance: Evidence for Sympathetic Vasoconstriction" It suggests that symptoms of hypoperfusion are caused by constriction of the cerebral vasculature. This includes "altered mentation". I have read in recent posts about constriction of the carotids, but this and other research would seem to suggest it is more than that - that infact, there is perhaps a sympathetic response in the entire vaculature of the brain.

When tested by my ANS specialist, he did a transcranial doppler which measured cerebral blood flow velocity. Mine decreased by close to 30% with upright position. According to the study I mentioned, normal controls dropped only 10%.

Here is my question. BB are known to cause vasoconstriction and according to my doc have worsened Raynaud's syndrome for me. Does anyone know if BB can have vasoconstrictive effects on the brain as well? Could BB make brain fog worse?

I know this is an old study and maybe some of you have more up to date info on cerebral vasoconstriction in POTS. I would love to know about it if you do.

Thanks,

Summer

[valliali]

i am on propranolol, which is a non-selective beta blocker, meaning it targets the beta receptors in the brain as well. i find that my brain fog is much worse on it. i do not know, however, that it is from cerebral constriction as much as it is from norepinephrine being blocked from the brain. it's a good question though. unfortunately, i find that the propranolol does the most for me, so i'm willing to take the brain fog to not have to deal with the multiple other symptoms it relieves a great deal. what a great choice though, huh. would i rather have heart problems or brain fog??? i'll go with brain fog. awesome.

Since starting a combination of BB and Florinef almost a year ago, I have had improvement in a number of ways, although I still have a long way to go. I am able to stay standing for longer periods, I do not get as nauseated, I am not as tachycardic and my episodes are less often. I would say the combination has helped a lot.

However, my brain fog has not changed. This is my most disabling symptom and is the thing that is holding me back in getting on with my life. I work as a nurse and can not do my job with out being fully alert all the time. It's very frustrating.

I read a study from 1998, from Vanderbilt, called "Raised Cerebral Vascular Resistance in Idiopathic Orthostatic Intolerance: Evidence for Sympathetic Vasoconstriction" It suggests that symptoms of hypoperfusion are caused by constriction of the cerebral vasculature. This includes "altered mentation". I have read in recent posts about constriction of the carotids, but this and other research would seem to suggest it is more than that - that infact, there is perhaps a sympathetic response in the entire vaculature of the brain.

When tested by my ANS specialist, he did a transcranial doppler which measured cerebral blood flow velocity. Mine decreased by close to 30% with upright position. According to the study I mentioned, normal controls dropped only 10%.

Here is my question. BB are known to cause vasoconstriction and according to my doc have worsened Raynaud's syndrome for me. Does anyone know if BB can have vasoconstrictive effects on the brain as well? Could BB make brain fog worse?

I know this is an old study and maybe some of you have more up to date info on cerebral vasoconstriction in POTS. I would love to know about it if you do.

Thanks,

Summer

[summer]

Wow. That's interesting. I was not aware of BBs being selective or non-selective. The BB that I am on is also non-selective. I guess I'll have to look into that more and see what the differences are. You're right! That's a terrible trade-off to have to make.

Thanks for the reply!

[valliali]

hi summer,

at first, i took metropolol which only targets the receptors in the heart. it really really helped my tachycardia and heart arrythmias. i wanted to try the propronolol however because i wanted something to help the panic attacks and facial flushing (which it does wonders for). if you are looking for a beta blocker to primarily reduce your heart rate, a selective one like metropolol might be worth trying. it caused me no brain fog at all. yet, i know other people have very different stories with metropolol, but its likelihood of causing brain fog versus the propranolol is much much less.

[summer]

Thanks for the info. I'm definitely going to look into this more!

[iheartcats]

i am on propranolol, which is a non-selective beta blocker, meaning it targets the beta receptors in the brain as well. i find that my brain fog is much worse on it. i do not know, however, that it is from cerebral constriction as much as it is from norepinephrine being blocked from the brain. it's a good question though. unfortunately, i find that the propranolol does the most for me, so i'm willing to take the brain fog to not have to deal with the multiple other symptoms it relieves a great deal. what a great choice though, huh. would i rather have heart problems or brain fog??? i'll go with brain fog. awesome.

Since starting a combination of BB and Florinef almost a year ago, I have had improvement in a number of ways, although I still have a long way to go. I am able to stay standing for longer periods, I do not get as nauseated, I am not as tachycardic and my episodes are less often. I would say the combination has helped a lot.

However, my brain fog has not changed. This is my most disabling symptom and is the thing that is holding me back in getting on with my life. I work as a nurse and can not do my job with out being fully alert all the time. It's very frustrating.

I read a study from 1998, from Vanderbilt, called "Raised Cerebral Vascular Resistance in Idiopathic Orthostatic Intolerance: Evidence for Sympathetic Vasoconstriction" It suggests that symptoms of hypoperfusion are caused by constriction of the cerebral vasculature. This includes "altered mentation". I have read in recent posts about constriction of the carotids, but this and other research would seem to suggest it is more than that - that infact, there is perhaps a sympathetic response in the entire vaculature of the brain.

When tested by my ANS specialist, he did a transcranial doppler which measured cerebral blood flow velocity. Mine decreased by close to 30% with upright position. According to the study I mentioned, normal controls dropped only 10%.

Here is my question. BB are known to cause vasoconstriction and according to my doc have worsened Raynaud's syndrome for me. Does anyone know if BB can have vasoconstrictive effects on the brain as well? Could BB make brain fog worse?

I know this is an old study and maybe some of you have more up to date info on cerebral vasoconstriction in POTS. I would love to know about it if you do.

Thanks,

Summer

I am on Propranolol, too, and the positives outweigh the negatives. My brain fog doesn't seem that much worse (I take 20mg 2-3 times a day...what about you guys)? I would say maybe 5-10% worse, on average?

I read some side effects go away as your body adjusts, so maybe I'm adjusting to it.

Brain fog was never my worst POTS symptom, but still there. I used to have excellent memory. Now it's ok to good. Frustrating for me though. My memory was something I took for granted back in the day! I think overall it affects my short term memory. I take Ambien once in a while and it never affects my memory (does for some people, at least temporarily).

So I can see BBs probably bothering some a lot worse than others, especially because us POTS folks vary so much and medications can act differently.

[summer]

I am on Propranolol, too, and the positives outweigh the negatives. My brain fog doesn't seem that much worse (I take 20mg 2-3 times a day...what about you guys)? I would say maybe 5-10% worse, on average?

I read some side effects go away as your body adjusts, so maybe I'm adjusting to it.

Brain fog was never my worst POTS symptom, but still there. I used to have excellent memory. Now it's ok to good. Frustrating for me though. My memory was something I took for granted back in the day! I think overall it affects my short term memory. I take Ambien once in a while and it never affects my memory (does for some people, at least temporarily).

So I can see BBs probably bothering some a lot worse than others, especially because us POTS folks vary so much and medications can act differently.

Yes. You're right that we do all seem to react very differently to different meds. I guess it truely is a trial and error thing for us. Maybe I should try a different BB to see if I might have less brain fog.

I'm still wondering about cerebral vasoconstriction. Is this the reason for decreased cerebral oxygenation in POTS? Is this why we have symptoms of hypoperfusion even with a stable BP? Has anyone else ever heard this?

[sue1234]

summer,

I was thinking, just thinking here, that there might be less perfusion to the brain as we stand because a percentage of the blood volume is pooling due to gravitation, and then all the POTS overdrive kicks in but can't seem to perfuse the brain as it would in a lying down situation. Like I said, just thinking!

[summer]

Hi Sue,

I think that you're right that the "POTS overdrive" while standing has something to do with it.

In the study I mentioned at the beginning of the thread, the researchers were suggesting that, in POTS, the adrenaline released while standing actually causes the blood vessels in the brain to constrict, so that even though the BP should be enough to supply adequate blood to the brain, the constriction of the vessels in the brain prevent enough blood from getting to the cells. This results in symptoms of low perfusion (ie. lightheadedness, brain fog, visual changes, etc.). The study I read was from 1998 and I'm not sure if this theory is still current. I think it would explain a lot.

I am also wondering if that vasoconstriction could be made worse by BBs which seem to make vasoconstriction worse in other areas of the body.

[ramakentesh]

Betablockers can help in that they obviously reduce the excessive sympathetic overactivity that is suggested to be the cause of the excessive vasoconstriction of the carotids and whole brain (which may account for migraine aura type visual disturbances), but they will also reduce your standing blood pressure and as firewatcher demonstrated to reduce the bioavailability of nitric oxide (which is a natural - and seems increasingly likely to be the main vasodilator in the body).

perhaps you could consider some sort of supplements such as vitamin C in large doses or something that improves the bioavailability of nitric oxide.

You should be aware that other more recent studies suggest that the excessive vasoconstriction in some (low flow) POTS patients is caused by reduced nitric oxide due to either elevated levels of angiotensin II or low grade whole-body inflammation leading to high levels of C-reactive protein which also decreases nitric oxide levels.

Good luck,

For me, licorice or anything that can increase blood pressure will help this symptom to some degree, or atlesat increase energy. The best thing for me though was a beer! But dont run out and start drinking on my account because ive yet to find any reason for this ( other than alcohol increasing NE reuptake in acute intoxication).

[summer]

Thank you so much for your post. That is really helpful info. I do have a lot of visual symptoms - snow, floaters, stars along with my brain fog - and migraines. Looks like I've got some homework to do!

[ramakentesh]

yeah i have the same. The two angles to look into are NET transporter deficiency - leading to excess sympo-excitation or the work of Dr Julian Stewart on Low Flow POTS. Both of these models for POTS could result in what you are describing.

Some info that you might find interesting can be found at:

http://www.nymc.edu/fhp/centers/syncope/ci...ots_and_CFS.htm

[ramakentesh]

yeah i have the same. The two angles to look into are NET transporter deficiency - leading to excess sympo-excitation or the work of Dr Julian Stewart on Low Flow POTS. Both of these models for POTS could result in what you are describing.

Some info that you might find interesting can be found at:

http://www.nymc.edu/fhp/centers/syncope/ci...ots_and_CFS.htm

[flop]

Selective vs non-selective beta-blockers. It isn't quite as easy as heart and brain. In fact it is to do with what type of beta-receptors are blocked by the medication.

Selective beta-blockers target the beta-1 receptors

Non-selective beta-blockers target both beta-1 and beta-2 receptors.

quote from Wikipedia

Pharmacology

There are three known types of beta receptor, designated β1, β2 and β3. β1-Adrenergic receptors are located mainly in the heart and in the kidneys. β2-Adrenergic receptors are located mainly in the lungs, gastrointestinal tract, liver, uterus, vascular smooth muscle, and skeletal muscle. β3-receptors are located in fat cells.

Examples of beta-blockers include: acebutolol, bisoprolol, esmolol, propranolol, atenolol, labetalol, carvedilol, metoprolol, and nebivolol.

β-Receptor antagonism

Stimulation of β1 receptors by epinephrine induces a positive chronotropic and inotropic effect on the heart and increases cardiac conduction velocity and automaticity. Stimulation of β1 receptors on the kidney causes renin release. Stimulation of β2 receptors induces smooth muscle relaxation, induces tremor in skeletal muscle, and increases glycogenolysis in the liver and skeletal muscle. Stimulation of β3 receptors induces lipolysis.

Beta blockers inhibit these normal epinephrine-mediated sympathetic actions, but have minimal effect on resting subjects. That is, they reduce the effect of excitement/physical exertion on heart rate and force of contraction, dilation of blood vessels and opening of bronchi, and also reduce tremor and breakdown of glycogen.

It is therefore expected that non-selective beta blockers have an antihypertensive effect. The antihypertensive mechanism appears to involve reduction in cardiac output (due to negative chronotropic and inotropic effects), reduction in renin release from the kidneys, and a central nervous system effect to reduce sympathetic activity (for those β-blockers that do cross the blood-brain barrier, e.g. Propranolol).

Antianginal effects result from negative chronotropic and inotropic effects, which decrease cardiac workload and oxygen demand. Negative chronotropic properties of beta blockers allow the lifesaving property of Heart rate control. Beta blockers are readily titrated to optimal rate control in many pathologic states.

The antiarrhythmic effects of beta blockers arise from sympathetic nervous system blockade – resulting in depression of sinus node function and atrioventricular node conduction, and prolonged atrial refractory periods. Sotalol, in particular, has additional antiarrhythmic properties and prolongs action potential duration through potassium channel blockade.

Blockade of the sympathetic nervous system on renin release leads to reduced aldosterone via the renin angiotensin aldosterone system with a resultant decrease in blood pressure due to decreased sodium and water retention.

Flop

[ramakentesh]

Oh yeah - some patients with POTS have hypocapnia when standing which can result in anxiety and cerebral vasoconstriction as well.

[summer]

Selective vs non-selective beta-blockers. It isn't quite as easy as heart and brain. In fact it is to do with what type of beta-receptors are blocked by the medication.

Selective beta-blockers target the beta-1 receptors

Non-selective beta-blockers target both beta-1 and beta-2 receptors.

Flop

Thanks Flop,

That helps. I wonder how our doctors decide which BB they will perscribe for those of us with POTS. I wonder if one type is perscribed more often than another.

Summer

[summer]

Oh yeah - some patients with POTS have hypocapnia when standing which can result in anxiety and cerebral vasoconstriction as well.

My ANS doctor mentioned this but said that I was not hyperventilating during the tilt (they were measuring that too), so he did not think that was the reason for my decreased cerebral oxygenation. Your posts have been really helpful! I have started to do some reading about low flow POTS - it's sounding a lot like me. Do you know if people with low flow POTS have more cognitive difficulties?

Thanks for all your help.

Summer

[ramakentesh]

Apparently they arent really discernable by symptoms. Hypocapnia may be a problem for me but id just be guessing.

All the theories are still fairly conjectural at the moment from what I can fathom.

[TopHatKat]

Hi Summer,

I am on the BB metropolol and it causes me to have lots of brain fog, some days being worse then others. I am a college student, so I am I can sympathize with your situation. If you find anything that helps you out, PLEASE let me know.

~Katherine

[summer]

Hi Summer,

I am on the BB metropolol and it causes me to have lots of brain fog, some days being worse then others. I am a college student, so I am I can sympathize with your situation. If you find anything that helps you out, PLEASE let me know.

~Katherine

Hi Katherine,

Sorry this is causing problems for you too. If I figure out something that works better for me, I'll be posting it!!! Good luck with school. Some people have said that the brainfog tends to be worse at the beginning of POTS and that it can improve over the first few years, I'm still hoping for that!

summer