Pots And Aggression

[vemee]

Has any one who has been on a norepinephrine reuptake inhibitor ever had trouble with extreme irritability or anxiety when you get off it or lower your dose past a certain point? After my pots became severe I noticed I would have extreme reactions to getting off cymbalta or effexor when in the past I did not have that reaction.

[Shimoda]

YES, very much so, with Effexor. I have flipped out when I mess with it.

More importantly, I take a morning and a night dose. Before I take my second pill, when the first one has basically worn off, I have gotten so enraged I've been near violence. I feel terrible at night because of the extreme irritability, and my family isn't very understanding in that regard.

Don't know what that means though, science wise.

[vemee]

norepinephrine and aggression This article is a summary for a longer paper but it does a good job showing the effects of raising and lowering norepinephrine levels. Basically any major change in levels causes irritation and possibly violence. There is a lot more study that needs to be done in this area but I think physicians and psychiatrists need to start using serum norepinephrine levels in guiding the use of these medicines instead of guessing and going by how the patient feels. Pots people have altered norepinephrine levels to begin with and the doctors need to take this into account.

[janiedelite]

This is interesting. According to the article, POTS patients (who have fluctuating norepinephrine levels with orthostatic changes) would be likely to have problems with aggression and violence. When I'm upright too long, I can feel the changes in my body (palpitations, short of breath, etc.) but I can tell when I need to lie down because I get SUPER GRUMPY! My hubby used to get frustrated when this happens, but as soon as I lay down I'm "happy wife" again! My norepi levels lying was 250 and standing was 1089. Grumpiness for me means it's time to lie down!!!

[vemee]

I went to Vanderbilt and NIH in the same year, both places took my supine norepinephrine levels and Vanderbilt also took my standing levels. At Vanderbilt my supine levels were around 457 and standing levels were over 2000. The Vanderbilt test was done while off all drugs and on a controlled diet. A few months later I went to NIH to be evaluated for a pheochromocytoma and my supine level was around 585. This was taken while I was on cymbalta. I was negative for a pheo. On return I asked my doctor to talk to Dr. Raj at Vanderbilt about finding a way to reduce my norepinephrine levels. He suggested I get off the cymbalta and start a small dose of clonidine. I checked with the psychiatrist and he agreed as long as I switch over to lexapro to catch any depression. I went through the pits and was so irritable my wife took me to the emergency room to have my medications evaluated. After waiting 4 hours on a cot in the er ( I had agreed to a voluntary commitment) I got fed up and told them to either take me upstairs or produce a detainment order, it they did neither I was leaving. Nothing was done until I tried to leave then they quickly moved me upstairs after being tazered. I was declared bipolar and heavily medicated with haldol. No one would listen that I was having a reaction to the stopping of cymbalta. The above article backs me up but since I am just a patient no one listens. In fact one person more or less told me I didn't have the ability to question a doctor's diagnosis.

Stopping the cymbalta would have taken the norepinephrine levels down to where they were at Vanderbilt and taking clonidine reduced them even further so they took a big fall and I honestly believe that was the reason I acted the way I did especially since it is out of character for me to be hostile.

When my pots got severe I was on cymbalta, I got off of it when I started having pins and needles feeling over my body. At that time getting off was a breeze but two years later when I had to get off of everything again I became very irritable. Something changed biochemically when pots became severe, I don't know it it all has to do with norepinephrine or if there are other factors involved.

[ramakentesh]

Im pretty sure most doctors wouldnt be surprised that POTS patients get grumpy when they stand due to the excess sympathetic activity - which also means excess epinephrine and more importantly in POTS norepinephrine.

I remember reading somewhere that a guy got off a murder charge because he had pheot-blah-blah-toma (I cant remember how to spell it - tumur on adrenal gland) because he proved that when it was activated and his blood was saturated with high levels of epinephrine he could not control his anger.

I get grumpy when ive stood too long - When i lie down for 10 minutes i feel much better, Nowdays its one of my warning signs.