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Anxiety And Pots

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So I had my first appointment with a psychologist yesterday. She had me take the Beck Anxiety Inventory right off the bat. Nearly all of the symptoms are the same as POTS

But I know that POTS side of me isn't caused by anxiety (i am not anxious upon standing, but heart rate goes up)

And I know that I have anxious tendencies and have had anxiety attacks before POTS even began

How can we differentiate?

How can we make one better if the other is always there?

My psychologist does not prescribe medication, but what are typical options for anxiety?

I was on Xanax but basically just used it to sleep.

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There are some great articles on pubmed that discuss POTS and anxiety.

I like you, had an underlying anxiety issue before my POTS diagnosis I think, but it was definitely worse with the onset of tachycardia. I read an article that was saying something to the extent that anxiety and POTS have similar somatic symptoms but psychologically POTS and anxiety disorder differ. Something like people with pots dont stress about dropping dead (However I do, lol) I fit the bill for anxiety disorder more than I do for POTS. So who knows. I wish I could find that article, but I dont have the time right now. There are also some older studies on "soldiers heart" a sort of psychologically induced orthostatic intolerance; however, there have been many studies stating that GAD, PTSD etc is not a cause of OI.

For me, an SSRI (celexa) really helped to stop the anxiety. I would say that 99% of the time my anxiety is non existent. I havent had a "panic attack" or "pots attack" in a long time. I dont know if that means mine is more anxiety since an SSRI helped?

There has been much discussion on here regarding anxiety, panic attacks and pots attacks. You might want to try and search those terms to find some great info too :)

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Your brain is heavily influenced by hormones, think how estrogen/testosterone affect behavior and thought patterns. Likewise, in POTS you tend to have 2-10 times the level of norepinephrine coursing through your body. This hormone will make you anxious.

I'm almost positive my anxiety is secondary to my POTS, POTS is just a word, what it really is - is parasympathetic dysfunction (for me anyway). And of course parasympathetic dysfunction (which I believe causes the adrenal dysfunction which causes the elevated norepinephrine) is what causes anxiety.

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Hot off the presses:

Fortschr Neurol Psychiatr. 2012 Jun 12. [Epub ahead of print]

[Anxiety in Patients with Postural Tachycardia Syndrome (POTS).]

[Article in German]

Wagner C, Isenmann S, Ringendahl H, Haensch CA.


Klinik für Gefäßchirurgie, Helios Klinikum Berlin-Buch.


Background: The postural tachycardia syndrome (POTS) is a condition of the autonomic nervous system with symptoms of orthostatic intolerance. In POTS patients, orthostatic stress leads to an overshoot of heart rate increase without a fall in blood pressure. The purpose of this study is to distinguish between anxiety disorders and anxiety as a concomitant phenomenon of orthostatic stress.Methods: 50 patients fulfilling the diagnostic criteria (orthostatic symptoms, heart rate increase of > 30 bpm or up to > 120 bpm by testing with tilt-table) were included. The study design included a thorough medical history as well as standardised questionnaires about anxiety.Results: The average heart rate increase was 36 bpm after ten minutes of standing and 42 bpm after maximal standing time (max. 45 minutes). POTS patients scored significantly higher than a comparison group in a range of anxiety disorders by using anxiety questionnaires like "Beck Angst-Inventar" (BAI) and trait test of "State-Traits-Angstinventar" which include autonomic items. When questionnaires were used that exclude autonomic items (anxiety sensitivity index: ASI; Interaktions-Angst-Fragebogen: IAF) there was no difference.Conclusion: POTS patients do not exhibit signals of anxiety disorders more often than control groups, provided that questionnaires without autonomic items are used.

© Georg Thieme Verlag KG Stuttgart · New York. PMID: 22692879 [PubMed - as supplied by publisher]

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I can absolutely say, for me, I have alot of anxiety. But, it is caused by the absolute need by the body to get adrenaline to FIX a metabolic problem. I have POTS that sends the adrenaline pumping when I am upright for too long. Plus, I have years of hypoglycemia that actually give me a worse adrenaline rush than the POTS during my episodes. I have those two going on everyday, together, as some others here also have.

There is no way any doctor is going to pin psychological anxiety on me. I can produce adrenaline on demand by standing up or not eating. Anxiety is CAUSED by the need for the body to correct something. I'm not saying people in general can't have psychological anxiety, but I know from my two co-morbid, adrenaline-producing issues, anxiety is a daily fact that can only be cured when they fix the POTS and hypoglycemia.

Firewatcher, I bet they spent thousands of dollars to do that clinical trial, and any one of us could have easily explained it to them.

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Yeah, I have anxiety ~ do these doc's understand what it feels like in the 10 minutes before you know your body is going to faint and smack your head someplace. Or how it feels when I'm standing in the middle of the mall trying to buy my daughters a pair of flip/flops and my HR decides 150 seems like a good number?? This symptoms play with your emotions and I can very clearly distinguish what POTS feels like compared to anxiety. I told my Doc that I would happily fix my problems with a huge hunk of xanax if he thought I was just crazy but if he could kindly treat me first and do his job that would be great. He smirked at me and said he predicted the xanax and guess what - blood work positive for low blood volume, anemia, low ferritin etc...I still read every post on here about anxiety drug usage as I haven't ruled out that I could benefit from a trial of the right drug. But when POTS symptoms are low for me then I feel pretty good. I think the best plan is to look for each person's individual answer because we are all so different. Good luck

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