basktbal22 Posted September 29, 2010 Report Share Posted September 29, 2010 I had an appointment with an endocrinologist who is somewhat knowledgeable on POTS (and my case). To my surprise, this doctor prescribed effexor, an SNRI (antidepressant) that works on both serotonin and norepinephrine receptors. He claimed that thbis drug might help me with POTS symptoms and flushing, of all things (there are documented cases of it helping 'hot flushes', and the doctor said he had even prescribed it for idiopathic flushing and it had helped patients in the past). The thing is, my serotonin and norepinephrine levels (blood/serum) are already elevated! It seems counter-intuitive for me to use this medication, if it is going to make these levels 'worse'. I discussed this with the doctor and he said he was prescribing it more for its ability to 're-regulate' the autonomic nervous system. Any thoughts? I should mention that my blood pressure is fairly stable, thus I do not have 'orthostatic hypotension', but rather just POTS. Also, I have read past posts on SSRI/SNRI's, and they seem to be hit-or-miss.Has anyone had luck with SNRI's? If so, what type of POTS do you have (ie. does your blood pressure drop? Do you have high norepinephrine? Hyperadrenergic?) I am quite confused, because in the article, "The postural tachycardiasyndrome: When to consider it in adolescents" by Blair Grubb (http://www.dynakids.org/Documents/pots_article3.pdf), effexor (venlafaxine) is used in both 'Partial Dysautonomic' and 'Hyperadrenergic' POTS. Wouldn't an SNRI harm a patient with hyperadrenergic symptoms (as the norepinephrine is high already)? Utterly confused... Quote Link to comment Share on other sites More sharing options...
firewatcher Posted September 29, 2010 Report Share Posted September 29, 2010 My endocrinologist also prescribed a SNRI for me (Pritiq.) It seemed to be the wrong thing to do, so I called my doc at Vanderbilt. He said that for me a SNRI was absolutely counterindicated: I was NOT to take it, so I didn't. I am in the hyper-adrenergic POTS group and have orthostatic hypertension. However, Dr. Grubb apparently uses these in hyper-POTS without problems. I think it will be an individual response, like everything else. What works for one, will not work for another. If you decide to take it, just be careful and listen to your body! Quote Link to comment Share on other sites More sharing options...
Ashelton80 Posted September 29, 2010 Report Share Posted September 29, 2010 I have POTS and do not have a bp drop. Am extremely hyper adrenergic by symptoms as I have never actually had the blood levels drawn. Before I knew I had POTS one of the first meds I tried was Zoloft. It is an ssri and is a little different than an snri. I took it for two days and knew right away that is was the wrong med for me. It made my symptoms increase 10 fold and was probably two of the worse days I have ever had. If you want to try I think if it effects you as negatively as it did me, you will know very quickly. I actually had alot of paradoxical reactions to the drug too. It is supposed to make you drowsy and I was up for 48 hours after I took those two doses. I would just weigh the pros and cons as those medicines are no joke. Why they hand them out like candy I will never understand. Quote Link to comment Share on other sites More sharing options...
pat57 Posted September 30, 2010 Report Share Posted September 30, 2010 well I have OH and NCS not POTS. An SNRI has been extremely helpful. I felt great , I did know my heartwas beating faster. For me this was great- it prevented the OH. However would you believe I ended upwith tachycardia. my dose became an AM only and reduced to half on the lowest dose snri available.I take one dose of 75mg bupropion. This is half of the lowest therapeutic dose of an SNRI. Frommy point of view - or experience - it causes tachycardia. Quote Link to comment Share on other sites More sharing options...
friday7 Posted September 30, 2010 Report Share Posted September 30, 2010 I had an appointment with an endocrinologist who is somewhat knowledgeable on POTS (and my case). To my surprise, this doctor prescribed effexor, an SNRI (antidepressant) that works on both serotonin and norepinephrine receptors. He claimed that thbis drug might help me with POTS symptoms and flushing, of all things (there are documented cases of it helping 'hot flushes', and the doctor said he had even prescribed it for idiopathic flushing and it had helped patients in the past). The thing is, my serotonin and norepinephrine levels (blood/serum) are already elevated! It seems counter-intuitive for me to use this medication, if it is going to make these levels 'worse'. I discussed this with the doctor and he said he was prescribing it more for its ability to 're-regulate' the autonomic nervous system. Any thoughts? I should mention that my blood pressure is fairly stable, thus I do not have 'orthostatic hypotension', but rather just POTS. Also, I have read past posts on SSRI/SNRI's, and they seem to be hit-or-miss.Has anyone had luck with SNRI's? If so, what type of POTS do you have (ie. does your blood pressure drop? Do you have high norepinephrine? Hyperadrenergic?) I am quite confused, because in the article, "The postural tachycardiasyndrome: When to consider it in adolescents" by Blair Grubb (http://www.dynakids.org/Documents/pots_article3.pdf), effexor (venlafaxine) is used in both 'Partial Dysautonomic' and 'Hyperadrenergic' POTS. Wouldn't an SNRI harm a patient with hyperadrenergic symptoms (as the norepinephrine is high already)? Utterly confused...If you're my serotonin and norepinephrine levels (blood/serum) are already elevated what does he say about Serotonin Syndrome? I mean I know this is usually caused by taking several drugs that increase serotonin. But I'd want to make sure that if your levels are already high that you wouldn't wind up with Serotonin Syndrome.My personal experience with this drug was bad but I have trouble with my BP and must take salt tablets to keep my BP up. If You've never had trouble with low sodium levels it might be okay on that count. ALhtough I would still watch your salt levels and BP. As it can lower your sodium levels.I'd talk about this with more with the doctor before going ahead with it. If you did go head with taking it,Id make sure to ask about Serotonin Syndrome, and keep track of your sodium levels and BP. Quote Link to comment Share on other sites More sharing options...
dianne.fraser Posted September 30, 2010 Report Share Posted September 30, 2010 My doctor trialled me with Pristiq last year. I only took two doses - it was like having a chemical lobotomy. I sat in my car, unable to work out how to drive it.... It took months to recover. I'd proceed with caution. With best wishesDianne Quote Link to comment Share on other sites More sharing options...
basktbal22 Posted September 30, 2010 Author Report Share Posted September 30, 2010 Thanks all for the responses. At this point in time, I have decided not to try the drug.It just doesn't make sense as to why he wanted me to try this. My serotonin is already high, as serotonin syndrome was mentioned in another post, my blood pressure is slightly elevated and stable, and my norepinephrine levels are also high. From my understanding, an SNRI would just make my serotonin and norepi levels even higher. I can't believe this doctor suggested this. If anybody has any insight as to why it could be beneficial, let me know. I have heard that SNRI's can help re-regulate the autonomic nervous system. Quote Link to comment Share on other sites More sharing options...
pat57 Posted September 30, 2010 Report Share Posted September 30, 2010 neurpinephrine effects either the sympathetic or para sympathetic system have you looked it up on Wiki?neuropnephrine is a Catecholamine, whatever that does might be important for you.why don't you try it and see? You can always get off it. Quote Link to comment Share on other sites More sharing options...
Ashelton80 Posted October 1, 2010 Report Share Posted October 1, 2010 My doctor trialled me with Pristiq last year. I only took two doses - it was like having a chemical lobotomy. I sat in my car, unable to work out how to drive it.... It took months to recover. I'd proceed with caution. With best wishesDianneWow Dianne, that sounds really scary!!! It was a nightmare for me as well. I told my husband I had never felt mentally unstable until I took that drug and I only took 2 doses. Bad news! Quote Link to comment Share on other sites More sharing options...
basktbal22 Posted October 1, 2010 Author Report Share Posted October 1, 2010 Pat57- norepinephrine is a catecholamine, as you stated. It actually increases heart rate and constricts blood vessels, thus leading to a higher blood pressure. At this point in time, I am not trying the drug because my norepinephrine levels are already 4x the upper limit, and this drug would just make them higher. Also the serotonin issue, which I explained in my post. Normally I wouldn't stress so much about taking a drug, but I recently returned to school after being out due to symptoms for a year and a half, and don't want to crash again. My understanding regarding SNRI's/SSRI's is that they are good for raising blood pressure, but my blood pressure is already slightly elevated. It has also been suggested that SSRI's/SNRI's might help to 're-regulate' the autonomic nervous system, which is something I don't understand at all. I would think this 're-regulation' and blood pressure boost would be the reason most doctors prescribe the drug for POTS. Quote Link to comment Share on other sites More sharing options...
kayjay Posted October 2, 2010 Report Share Posted October 2, 2010 Jay.. I am very hyper pots... will test positive for Pheo with a 24 hour urine ( but don't have one... a tumor I mean). Though blood work Mayo clinic found that I am highly hyperadernergic. I also have ( had ) high blood pressure. sometimes like 160/120... anyway it seems counter intuitive ... but we are not doctors. I am on Cymbalta (snri) and doing much better then i did on Lexapro. It has not raised my BP. I also take a small dose of a beta blocker. to give you an idea unmedicated my hr would go from the 50's sitting to 170's standing.I also take birth control pills which have not raised my blood pressure. I would consider trying the meds. It seems to not make sense but Mayo clinic uses them in hyper people and I am sooo much better! whatever you decide... good luck. Quote Link to comment Share on other sites More sharing options...
StacyRN Posted October 2, 2010 Report Share Posted October 2, 2010 I wouldn't recommend it, I have hyperadrenergic POTS too, and Vanderbilt said it would make me worse, in fact they did a med trial and it DID make me worse! I was on Zoloft for 15 years before being diagnosed with POTS, went off it for the Vanderbilt study last April, and didn't start it again. I think I've felt better since stopping it. Also, like someone else said, you already have high serotonin and norepi levels, SERATONIN SYNDROME is a real danger... Let us know!Stacy Quote Link to comment Share on other sites More sharing options...
cationiks Posted December 22, 2022 Report Share Posted December 22, 2022 i took effexor for years with no issues except really bad insomnia that made me burnt out at the tend.... When I stopped effexor, I developped dysautonomia (gastroparesia AND POTS). My bllod pressure does not drop when I stand up but my heart rate goes from 60 to 150 as soon as I stand up. Doctors just say I'm disabled for life now... Did not dare to "try" anything on my own..; but now I know this drug is sometimes prescribed for dysautonomia, I'm wondering if doctors aren't just lying to me because actually effexor withdrawal has caused a iatrogenic condition.... Quote Link to comment Share on other sites More sharing options...
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