Oh Gosh! We Are Labelled Again.

[sue1234]

In looking around, I found this new publication in PubMed. Unfortunately, it doesn't have an abstract yet, but I think the title explains it all:

http://www.ncbi.nlm.nih.gov/pubmed/21720193

First we're lazy, now our POTS is being tied to psychiatric disorders. There is a small chance the article has something useful in it, but...I doubt it.

[yuliya]

That just made me laugh out loud. For years most of us are told we have anxiety and its all in our head, then it seems like progress is made in studying this syndrome now all the sudden we are all mentally ill again.

[firewatcher]

I am actually going to defend this one. There is quite a bit of anecdotal evidence linking autonomic dysfunction and some psychiatric disorders. Remember POTS is a syndrome of symptoms (like a fever would indicate an infection,) not an underlying disease. I personally know of a person with schizophrenia whose earliest symptom was POTS. I don't really think that this is a setback, but more of a recognition that there is a physical dysfunction that can be measured (POTS) rather than a more difficult, possibly subjective psychiatric diagnosis.

Just because advanced diabetes will have autonomic dysfunction doesn't mean that we are all diabetic; recognizing autonomic dysfunction in a psychiatric condition doesn't mean that we all have mental disorders.

As with all research studies, context is important. I haven't read the full-text of this study, but I don't think that it is saying it is "in our heads."

[sue1234]

First, I KNOW that POTS is a syndrome, and just a collection of symptoms. Definitely don't need to convince me, as most of my posts have something to do with the possibility of various root causes of POTS.

Second, the way this title is worded just reeks of equating POTS with a psychiatric illness. If it would have said that "POTS is prevalent in schizophrenia", then I would NOT have taken issue with it. I would have thought, hmmm, I wonder what is common with schizophrenics and us POTS people? Do we have a nutrient imbalance or lack a crucial enzyme for a metabolic pathway?? But, they generalized psychiatric illness as being connected to POTS.

I don't mind that I get labelled as anxious, because with all that norepinephrine coursing through me, it is a given. But, I take issue with the rest.

[skiberthoud]

I didn't get that impression from the title at all! I guess it's all in how we read it. I'm looking forward to reading the article...

[toddm1960]

I just don't like where the study was done.....Department of Psychosomatic Medicine.

[sugartwin]

I've read the full text. The gist of it was that the doctors involved observed that POTS patients were more anxious and depressed than healthy subjects. And so they decided to test and see whether patients who were diagnosed with anxiety, depression and somatoform disorders had POTS, OH or NCS. And in their own words:

We had hypothesized that the prevalence of POTS and orthostatic [change in]HR response were higher in patients with psychiatric disorders versus healthy sub- jects because previous studies had indicated that POTS patients often experience anxiety and depression [3, 15]. However, this study suggests that this is not the case. It showed that orthostatic changes in HR are not correlated with severity of depression and anxiety, in agreement with a previous study on orthostatic stress in POTS patients and anxiety [5].

[firewatcher]

Sugartwin,

Thanks for clarifying! I wish they'd put that in the abstract.

[HopeSprings]

I didn't see a link to the whole article, just Sugarwin's post. But GOOD - they concluded that there is no correlation. I think it was a silly hypothesis to begin with. Because people with POTS appear more anxious and depressed, let's test a bunch of psychiatric patients for POTS? I'm sure people with other forms of chronic illness are more anxious and or depressed than "healthy controls." It is in RESPONSE to the illness, not a cause of illness. Are they checking the psychiatric patient population for more cancer, more diabetes, more arthritis, whatever? The way I read this is their suspicion was that POTS and mental illness somehow correlate. And I really think it's because we're mostly women. This is a very senstitive area for me because I spent YEARS searching for a diagnosis and defending myself against Dr's trying to pin a mental illness diagnosis on me - instead of finding the real cause. Had this study found more POTS in the psych patients, it would have been BAD for us. And yeah... Department of Psychosomatic Illness - says it all.

[enko]

I'll just put a signature under your words, Naomi.

[lieze]

I really wanted to read this article and I was unable to find a link to open it.

Any idea of what I am doing wrong?

[enko]

lieze,

I think that you need to have an account for that.. I can't see the text either, when I've clicked on the full text I was asked for account or payment

[sugartwin]

For anyone who wants to read the full article, if you message me your e-mail, I can send it to you. I was only able to access it because my sister let me "borrow" her upenn id and password.

[Birdlady]

I don't know about you guys, but I am a little crazy. hehe

With all of the catecholamines flowing threw my veins, I still find it amazing I'm as normal as I am.

[Libby]

Just read the article (thanks sugartwin! ) .

In conclusion, this study suggests that patients with depressive, anxiety and somatoform disorders do not have an increased risk of POTS, but patients with depressive disorders may more frequently complain of POTS-related somatic symptoms compared to healthy subjects. Therefore, when patients complain of somatic symptoms like light-headedness or fatigue during standing (without showing POTS), physicians should consider that such individuals may suffer from psychiatric illnesses, especially depression.

They're recommending ruling out POTS first before looking into a psychiatric cause. That's something.

Baby steps.

[delphicdragon]

I thought this was actually a good step in the right direction. I'm attempting to put the full article here (as it's short)

Prevalence of Postural Orthostatic Tachycardia Syndrome in Patients with Psychiatric Disorders

Battuvshin Lkhagvasuren a , Takakazu Oka a , Keisuke Kawai a , Masato Takii a , Yoshio Kanemitsu a , Shoji Tokunaga b , Chiharu Kubo a

Departments of a Psychosomatic Medicine and b Medical Informatics, Kyushu University Hospital, Fukuoka ,Japan

Postural tachycardia syndrome (POTS) is a form of orthostatic intolerance. POTS is characterized by a heart rate (HR)increase of 1 30 beats/min or a maximum HR 1 120 beats/min on standing without orthostatic hypotension (OH) and is associated with orthostatic symptoms that are relieved by recumbence[1] . Patients with POTS often complain of light-headedness or dizziness, palpitations, blurred vision, tremulousness, sense of weakness, shortness of breath, fatigue and sleep disturbance [2] .

In addition to reporting numerous physical symptoms, POTS patients are more anxious and depressed compared to healthy subjects [3–5] . Conversely, patients with anxiety, depressive and somatoform disorders frequently complain of somatic symptoms resembling POTS [6–10] . However, there are no reports assessing the prevalence of POTS in patients with these disorders. Therefore, in the present study, we assessed the prevalence of POTS and other subtypes of orthostatic intolerance, time course of HR response to orthostatic stress, correlation between severity of depression or anxiety and maximal HR changes after standing (HRmax), and prevalence of POTS-related somatic symptoms in psychiatric disorder patients and healthy subjects.

We studied consecutive 198 patients who were first-time referrals to our department between October 2008 and May 2009 prospectively. The following patients were excluded from the analysis: patients who were diagnosed as having disorders other than depressive, anxiety and somatoform disorders; patients who had taken or were taking medications that affected autonomic functions such as antidepressants; patients with physical diseases,

including hypertension, hyperthyroidism, diabetes mellitus and obesity. The final assessment included 101 patients and 30 healthy subjects. All patients had a complete general medical evaluation and diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) using semistructured clinical interviews for axis I disorders. The participants completed the Center for Epidemiological

Studies Depression Scale (CES-D) [11] , Spielberger’s State-Trait Anxiety Inventory (STAI) [12] , self-report questionnaires to assess

depression and anxiety, and underwent orthostatic testing (astanding test) in a quiet room at 24 ° C.

After enough resting time (at least 10 min), the subjects were asked to lie in the supine position for 10 min. Then, they had to initiate and maintain an active standing position for another 10 min if tolerated. Blood pressure (BP) and HR were recorded every minute by an electric sphygmomanometer (Nico PS501, Parama-tech, Japan). Thereafter, the participants filled out a checklist assessing somatic symptoms that occurred during orthostatic testing ( table 1 ). Baseline BP and HR were taken as average values of the last 5 min in the supine position. Change in HR (HR) was expressed as the difference in HR after standing from baseline HR. Based on the results of orthostatic testing, they were diagnosed into 3 orthostatic intolerance subtypes: POTS, OH and neutrally-mediated syncope(NMS). OH was defined by a fall in BP of at least 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP within 3 min in the upright position [13] . NMS was diagnosed as a sudden onset of fainting/ near-fainting during standing [14] . Differences among the groups were assessed using a Pearson 2 test for categorical variables or by Fisher’s exact probability test if appropriate, and 1-way analysis of variance for continuous variables. A random effects model was used to test the differences in HR among the groups after standing across every minute. This study was approved by the Kyushu University Institutional Review Board and all participants

provided oral informed consent.

POTS was found in 17% of the depressive disorder patients, 3% of the anxiety disorder patients, 6% of the somatoform disorder patients and 10% of the healthy subjects. The prevalence of POTS in patients with psychiatric disorders was not different from that observed in control subjects. HR was increased after standing in all groups. For example, in the control group, HR varied between 11.9 and 15.7 beats per minute during the observation period. Baseline HR and HR were not different among the groups across time (data not shown). No correlation was found between

HRmax and CES-D, STAI-1 and STAI-2 scores in patients with depressive disorders and anxiety disorders (data not shown).

However, complaints of POTS-related somatic symptoms such as fatigue and light-headedness were more frequent in psychiatric disorder patients versus healthy subjects. This study describes for the first time the prevalence of POTS, OH and NMS in patients with psychiatric disorders. Among 3

subtypes of orthostatic intolerance, the most common subtype observed in psychiatric disorder patients was POTS, followed by OH. NMS was not detected in any group. We had hypothesized that the prevalence of POTS and orthostatic HR response were higher in patients with psychiatric disorders versus healthy subjects because previous studies had indicated that POTS patients often experience anxiety and depression [3, 15] . However, this study suggests that this is not the case. It showed that orthostatic changes in HR are not correlated with severity of depression and

anxiety, in agreement with a previous study on orthostatic stress in POTS patients and anxiety [5] .

The most interesting finding here was that psychiatric disorder patients complained more of fatigue (36%) and light-headedness (25%) than control subjects (3% each symptom). Therefore, although severity of orthostatic dizziness and fatigue were reported to be good indices for the diagnosis of POTS [16] , such somatic symptoms may not necessarily predict the existence of POTS in psychiatric disorder patients.

In conclusion, this study suggests that patients with depressive, anxiety and somatoform disorders do not have an increased risk of POTS, but patients with depressive disorders may more frequently complain of POTS-related somatic symptoms compared to healthy subjects. Therefore, when patients complain of somatic symptoms like light-headedness or fatigue during standing (without showing POTS), physicians should consider that such individuals may suffer from psychiatric illnesses, especially depression.

[HopeSprings]

POTS was found in 17% of the depressive disorder patients, 3% of the anxiety disorder patients, 6% of the somatoform disorder patients and 10% of the healthy subjects.

Imagine how surprised those healthy subjects must have been to discover they have POTS!

[lieze]

10% does seem like a relatively high number for supposedly health people.

[Libby]

^The sample size of the healthy people was pretty small, relatively. That and blind chance could definitely account for it.

[enko]

Therefore, when patients complain of somatic symptoms like light-headedness or fatigue during standing (without showing POTS), physicians should consider that such individuals may suffer from psychiatric illnesses, especially depression.

I don't have any official diagnosis yet and I have to admit that I'm not too happy with this line of text. I wasn't even given TTT and was declared anxious and sent to psychiatrist to determine am I depressed How the heck is a person supposed to feel when every doctor is ignoring her for years?!