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How Do I Counteract Adrenaline ?


DadOf2
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I was reading that Lecithin or Innositol both help for anxiety, but specifically, Acetylcholine is what counteracts Adrenaline.

Since Lecithin is a supplement that turns into Acetylcholine, I was thinking this might help with my constant state of Anxiety.

This Adrenaline stuff would probably account for the fact that Benzos such as Xanax and Klonopin don't help much to reduce my anxiety.

Thanks for all your help so far,

Dustin

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Best I can do is try and dissipate the adrenaline surge once it already enters my bloodstream. And to that extent things that seem to help reduce the duration include; laying down flat with my arms over my head, slow abdominal breathing, and if I am feeling tacky or anxious I take a tincture of Motherwort. I don't know why the Motherwort works, but for me it does better than kava and I never was able to tolerate benzos.

I have also practiced zen meditation for 10 years ... can't say it helps in a flare but it helps considerably between the flares so that my entire life is not one big vortex of anticipatory concerns.

Good luck finding things that work for you.

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Directly countering adrenaline impact is conventionally beta-blockade. I think a beta blocker like Propranolol is leaned toward, since it is non-selective and can block CNS activity (presumably what cascades into the anxiety). Probably you're already up on that side of things, but what Rama said about second beta blocker is interesting.

I know barbiturates have brief mention in POTS treatment (phenobarbitol). It requires even more care than benzos, but maybe it's a silver bullet? Would qualudes be another possibility. These may be "different" enough to not just be "stronger benzos" in their effect...

I happen to have lecithin in my "regime". Hard to say if it's doing much. I've tried choline biterate for brief periods of time (I don't know if eating these actually results in changes to the body where it counts). I can vaguely say it might have been mildly anxiety-relieving overall. So was piracetam (kind of a different axis, AMPA)... very very mildly anxiolytic.

Sleeping with head elevated was specifically helpful when I had a period of supine anxiety (maybe loosely like your situation but milder). I also felt like cortisol or some hormonal thing was in the picture. Certainly, be sure any conventional medical factors like endocrine disorders aren't in the picture.

For upping acetylcholine one can consider "reuptake" tampering things like Mestinon (or Tachy has mentioned Huperzine-A in the past).

Looking at acetylcholine from the other side, the receptors... one might unconventionally consider stuff there. Acetylcholine, IIRC, tends to activate muscarinic and nicotinic receptors. I happen to take a muscarinic agonist... but it's just targeted to my saliva glands! Maybe something down those lines might help counter specific sympathetic activity (by upping the parasymptathetic that opposes it)? However, I don't know if any of that comes up in the CNS... perhaps just the ANS peripheral stuff? Something nicotinic might enter the game there... but not sure. Does nicotine relax folks that aren't already on a nicotine cycle? Probably better not to start that cycle.

Other things might be options like from the an anticonvulsant and mood stabilizing genera, carbamazepine or something. Most traditional anti-depressants are also anxiety reducers. Some TCA or TeCAs might do that and also happen to have cholinergic action (perhaps opposite of what you want with lecethin, though). Buspirone is used instead of benzos by some... but takes time to work like most of these here. Neuroleptics can be considered, whether or not there is a thought disturbance to begin with.

SOMA (an opioid muscle relaxer) was very mildly anxiolytic for me... I think opioids can generally be so (again a doc must cautiously go off label here).

The NMDA axis is not often medically contemplated, but antagonists tend to up anxiety and agonists calm. Cycloserine might help, but that would be off-label or research trial sort of thing.

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Acetylcholine, IIRC, tends to activate muscarinic and nicotinic receptors.

Here is the language in Wikipedia (I put the part he is talking about in bold):

Receptors

Main article: Acetylcholine receptor

There are two main classes of acetylcholine receptor (AChR), nicotinic acetylcholine receptors (nAChR) and muscarinic acetylcholine receptors (mAChR). They are named for the ligands used to activate the receptors.

[edit] Nicotinic

Nicotinic AChRs are ionotropic receptors permeable to sodium, potassium, and chloride ions. They are stimulated by nicotine and acetylcholine. They are of two main types, muscle type and neuronal type. The former can be selectively blocked by curare and the latter by hexamethonium. The main location of nicotinic AChRs is on muscle end plates, autonomic ganglia (both sympathetic and parasympathetic), and in the CNS.[7]

from:

http://en.wikipedia.org/wiki/Acetylcholine

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I forgot to mention "alpha beta" blockers. I guess technically that is blocking more of the adrenaline. That could go either way... in the CNS realm though I'm not sure what that implies... alpha-agonists are semi-stimulating. Seems touchy but I think it's recommended for H-POTS???

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Guest tearose

Welcome dadof2...

I too have had to learn to deal with adrenaline since once it is there it needs to dissipate. I don't get anxious feelings as much as the racing heart, drop in bp and lack of mental clarity. Once I understood that this was a good corrective measure to get O2 to the brain I didn't concern myself with why it was happening,rather, how could I avoid it from happening or how to handle it when it does...

so, to avoid it, I use compression garments, stay hydrated and not overdo anything.

If I do somehow push the envelope and trigger the adrenaline dump... I need to: sit down, lay down or squat into a ball with my knees up to my chin. This will bring me back to homeostasis.

The after effects of the adrenaline dump for me is usually a spell of greater fatigue so I will then need a nap.

Also, like EM I have found amazing results from zazen/prayerful/meditation. I absolutely see how I can help balance my bp up and my hr down after contemplation.

Best regards,

tearose

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Hey Dadof2,

If I recall correctly from another post, you tried SSRI's (anti-depressants with NO luck) and gave up on those. Right? Anxiety was also a major symptom for my teen son when dysautonomia struck. It was so shocking as he was a typical laid-back skateboarder type. He had never had any unusual symptoms of anxiety before. His ped at Johns Hopkins was very quick to point out to us that the anxiety was very much the result of his dysautonomia, NOT a sign of emotional weakness. Please understand this. It is physiological, not psychological- DON'T LET ANYONE TELL YOU OTHERWISE!

An SSRI (in part) was the answer for my son, BUT he also had an awful response to it initially. I think you did too. Mack's doctors guessed that he was so low in serotonin that his body very much overreacted to it. Mack started with a small dose and worked his way up to a more therapeutic level. He took his antidepressant at night, because within 10-15 mins of swallowing the pill, he was pretty much incapacitated. He HAD to lie down in a dark room and basically just fell asleep as he was unable to function. He got an awful headache, felt very lightheaded, thought he was going to vomit, felt very shaky, was unable to tolerate light, etc. He stuck with it and after a week or so, he stopped having any reaction to the pill AND (miracle of miracles) the adrenaline surges/anxiety was gone.

Don't totally give up on the idea of an SSRI yet. They help with adrenaline surges and help balance the autonomic nervous system. Consider giving that another try.

I know this is frustrating. The onset is the worst. Once you have a med/lifestyle regimen worked out- things will get a lot better. Hang on there!

Julie

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Erik--I had read up on the nicotinic and muscarinic receptors a few months ago, as I almost quit sweating in response to heat. I saw that those are the receptors at sweat glands. I didn't understand it too well, but does it basically imply that I might be low in acetylcholine to stimulate the sweat gland receptors? What would make someone low in acetylcholine?

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I'm not sure. If the problem is in one sort of body function, one receptor type (the sweat related one), it seems to imply something more specific than a generalized acetylcholine shortage. It seems a generalized acetylcholine shortage ought to show up with many separate symptoms since that neurotransmitter is active all over the place (and will mess some key things... generally in the parasympathetic side of things, though sweat glands ironically are a rare exception on the sympathetic side using acetylcholine).

Certainly some meds have so called "anti-cholinergic" side effects so check if something is suppressing or blocking acetylcholine somewhere accidentally on you as an explanation. I suppose specific troubles like neuropathy of the nerves to the sweat glands, or auto-immune attack against the sweat gland receptors (like can happen to the salivary receptors in Sjogrens... not sure if sweat glands are prone to that), or whatever else might be a possibility? Or something is otherwise "modulating" or antagonizing those receptors? I'm certainly no neurologist, just speculator and spectator!

I don't know if there are documented deficiency conditions, like poor absorption, dietary shortage, missing enzyme or whatever. There is mention of potential benefit from supplementation. I don't know how plausible the claims are or what quantities would be involved.

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Problem is that the anxiety is possibly but not definitively being caused by your body trying to correct the abnormal circulatory demands of POTS through release of adrenaline - whether they be inappropriate vasoconstriction, inappropriate baroreflex sensitivity or the other mechanisms.

So the only way to improve them in theory is to improve POTS with really nothing has been proven to do.

non-selective beta blockers like inderal work ok for this. I found kava helpful but on either you may find your dizziness is worse. But when i was that bad I took on the jitteriness first and then took on the dizziness once that had improved.

As I was saying for some reason the anxiety like symptom seems more common in males. No idea why just going on what people have told me about their own situation.

Gaba agents didnt work on mine either when it was bad.

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This will sound strange, but sometimes, pushing, like when you have a bm, helps reset my system too. Just a few minutes ago I started have a really bad rush because I was talking on the phone too long and I tend to walk around while I'm on the phone without realizing it, and I moved around a bit too much and talking at the same time (bad combination), so I tried the vaso manuever and it really did reset my system. This does't always work, but it's worth trying when you have a adrenaline surge.

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"Valsalva Manoeuvres in the Dark"... weren't they big in the 80's? Does listening to them help? :)

I forgot to mention "alpha beta" blockers. I guess technically that is blocking more of the adrenaline. That could go either way... in the CNS realm though I'm not sure what that implies... alpha-agonists are semi-stimulating. Seems touchy but I think it's recommended for H-POTS???

Also forgot Clonidine. Probably should have been up there with beta and alpha-beta blockers in terms of being "direct" opposition. It tricks the body into thinking there is more adrenaline/noradrenaline present than there is, hopefully making it reduce production. This relates to the "adrenaline surge" dumped into the blood... may or may not relate to anxiety trigger chemically and probably not with sympathetic vs. parasympathetic balance (that is the neural side of ANS regulation, rather than the hormonal side of things). It's on various lists for POTS, especially H-POTS.

Wise to counteract something by preventing it's release in the first place... As Mack's Mom points out the ultimate/ideal way to do that is skew the darn ANS back into a better balanced realm (rather than just fighting each specific bad signal it puts out). It doesn't happen for everyone, and as she says it can be rough, but the SSRI & SNRI side of POTS treatments can sometimes work that magic. Many to choose from, some could be more tolerable than others and difficulty starting them is not too uncommon, dysautonomia or not.

Please keep us posted. I certainly hope something can get you relief.

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  • 2 years later...

RE: Erik's mention of barbiturates,

I have a donnatal (phenobarbital & belladonna alkaloid) script for when my abdominal pain gets out of control. It definitely makes all of my symptoms feel better because it settles the adrenaline surges and feels like it does help reset my body. BUT, I take it sparingly...maybe once a month (more if I need it a 2-3 days in a row if the GI tract won't settle) because it is easy to build up a tolerance and it is easy to get addicted. I haven't come across another non-addictive drug option that has the same mechanism. I think for me, it would be a "silver bullet" for controlling my symptoms if it existed.

Katie

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