Severe Anxiety/ Depression/ppd/crying Spells

[Altruism]

I know you're probably getting bored with my sobbing and whining posts, but things have completely gone out of control. I am so down, depressed, hopeless and sick that I don't even want to talk about it. I just want to ask you some questions, so I know what to talk to my therapist tonight:

1. Is PPD possible on top of POTS? In other words, did I develop a psychiatric disorder from all the stress, fear and uncertainty since I got the POTS diagnosis?

2. How can I tell the difference between a panic attack and adrenaline surge? Are they constant! Describe yours, please!

3. Can depression or PPD make my POTS worse or is it the other way round? I feel dizzier, unable to focus on things, numb, dumb, tired. Yet, I am jittery, anxious and feel IT coming as an adrenaline surge or attack every couple of hours. I have tons of desperate crying spells. I sob and think how hopeless things are. What's POTS and what's depression? Can you help me tell the difference?

4. Is Klonopin supposed to help? It's not helping me and I'm shocked! I loved my benzo, it was my miracle pill. How come it does not help? It should block NE and calm me down regardless if the reason for my anxiety is PPD or POTS or NE excess, right?!

5. How much do SSRIs increase anxiety? I'm terrified to take mine as I can't take any more anxiety! But mine feels like it's 9.5-10 out of 0-10 scale, so could it make it much worse?

6. I sometimes hate this forum (sorry). I was about to start my Zoloft when I read a couple of threads how it can cause autonomic dysfunction. Now I'm scared to take it.

7. Please, help me. It's the worst feeling ever. I'm drugged up and anxious at the same time; I'm sluggish, slow, fatigued and brain fogged but also nervous, sweating and feeling VERY bad in my own skin. How is that even possible?!

P.S I get all this while resting, lying down, not STANDING UP. Constantly, out of no where.

P.S. 2. My cardio was such a mean guy who said "You'll have it for life, admit it. No cure. So when I say jump (with a new med) you just say "How high"?
He wanted me back on metoprolol, my neuro wants me on propranolol, my PCP wants me to stop both as he thinks they contribute to my severe fatigue. Whom should I trust?!

[bebe127]

I'm so sorry you're feeling this way:( So wish I was there to hug you and tell you everything will be alright! But truth be told, everyone is so different and throw a new baby into the mix and I'm sure everything is just overwhelming for you. I can't answer most of your questions accept the anxiety/panic one. When I get this, I feel jittery, shakey, and tingly all over. I can feel the tingly feeling as it crawls up my extremities and into my head. My heart starts racing, I feel like I'm gonna hurl and I have to lay down, like, right then. Afterwards, I feel so tired, like I could sleep for days. It is an overwhelming feeling and scary too. I don't really have any advice other than to lie down and take deep breaths (inhale and then exhale slowly) and try to relax. I know it is so much more easily said than done. I usually sing a song in my head over and over until I can feel some relief (and I pray alot too). Mine comes out of nowhere as well, but I do believe that our minds can do amazing things to us--sometimes negative and sometimes positive. I find that if I try to dwell on the positive (I do know how hard this can be) and not on all the worrisome questions we have, things do get better and I feel more calm.

I get very scared and worried too when taking anything new. I try to "try" new things on the weekend when someone is home with me and can help me if I need it.

A few years ago I saw a therapist and she recommended a book called "The Anxiety & Phobia Workbook" by Bourne. It has lots of helpful tips as well as detailed explanations of both. Although it is not geared toward POTS, it was helpful and I go back to it often.

I so hope you feel some relief soon. My heart goes out to you!

[puppylove]

I'm sorry I don't have any answers, but I wanted to let you know you are not alone. I wish I could help. Don't let that doctor bother you or make you feel worse. I have been switching doctors a lot and you just have to tell yourself he is wrong and let it slide off. I really hope you feel better soon.

[RubyLane]

From my experience (and from what I have read, others) an SSRI should help your anxiety, not make it worse. I know the first week was a little hard for me, but they gave me some ativan to help ease me on to the medication (prozac). I recommend trying it. It sounds like you do indeed have PPD on top of the POTS. PPD is very dangerous if not treated so I would start your SSRI as soon as possible. Don't be scared, any medication can give a certain percentage of people a bad reaction, but it is not common. I've left many doctors offices crying so I understand. I'm sorry.

Edited February 1, 2013 by corina

[joyagh]

I know you're probably getting bored with my sobbing and whining posts, but things have completely gone out of control. I am so down, depressed, hopeless and sick that I don't even want to talk about it. I just want to ask you some questions, so I know what to talk to my therapist tonight:

1. Is PPD possible on top of POTS? In other words, did I develop a psychiatric disorder from all the stress, fear and uncertainty since I got the POTS diagnosis?

2. How can I tell the difference between a panic attack and adrenaline surge? Are they constant! Describe yours, please!

3. Can depression or PPD make my POTS worse or is it the other way round? I feel dizzier, unable to focus on things, numb, dumb, tired. Yet, I am jittery, anxious and feel IT coming as an adrenaline surge or attack every couple of hours. I have tons of desperate crying spells. I sob and think how hopeless things are. What's POTS and what's depression? Can you help me tell the difference?

4. Is Klonopin supposed to help? It's not helping me and I'm shocked! I loved my benzo, it was my miracle pill. How come it does not help? It should block NE and calm me down regardless if the reason for my anxiety is PPD or POTS or NE excess, right?!

5. How much do SSRIs increase anxiety? I'm terrified to take mine as I can't take any more anxiety! But mine feels like it's 9.5-10 out of 0-10 scale, so could it make it much worse?

6. I sometimes hate this forum (sorry). I was about to start my Zoloft when I read a couple of threads how it can cause autonomic dysfunction. Now I'm scared to take it.

7. Please, help me. It's the worst feeling ever. I'm drugged up and anxious at the same time; I'm sluggish, slow, fatigued and brain fogged but also nervous, sweating and feeling VERY bad in my own skin. How is that even possible?!

P.S I get all this while resting, lying down, not STANDING UP. Constantly, out of no where.

P.S. 2. My cardio was such a mean guy who said "You'll have it for life, admit it. No cure. So when I say jump (with a new med) you just say "How high"?

What an insensitive idiot. I was about to jump out of the window after I met him. He wanted me back on metoprolol, my neuro wants me on propranolol, my PCP wants me to stop both as he thinks they contribute to my severe fatigue. Whom should I trust?!

#1. sure - POTS can screw up your neurotransmitters and hormones which are already going through major changes. How far post partum are you? It may be an issue of waiting for the hormones to go back to normal. In the meantime, I think treatment is essential! Have you talked to your OB/midwife?

#2. with a panic attack, you'll have emotional fear with the physiological symptoms. with an adrenaline rush you'll ONLY have the physiological symptoms but no mental or emotional fear.

#3 - of course. anything that changes your brain chemistry and/or hormone levels will affect POTS, and vice versa, as POTS affects the brain chemicals and hormones. the crying spells might be PPD and might pass, but I think they might need treatment until your hormones even out. That's not a POTS symptom. Cortisol remains high in post partum women for months after delivery and may increase PPD. alot of this may pass in time, but PPD is very serious.

#4 - are you nursing? As far as I know Klonopin is not recommended if you're breastfeeding.

#5 - Zoloft didn't increase my anxiety at all. In fact, I was so anxious after delivery and it took me 6 months to start zoloft and it helped. SSRI's are a treatment for POTS. I think tricyclic antidepressants are the ones to worry about. I found 50 mg was enough to help, still a small dose. I was SOOOOOOOOOOO paralyzed with fear about taking Zoloft and it really saved me when I got the guts to take it. I personally like my Metoprolol. It helps and doesn't make me tired. You will be sleep deprived with a new baby no matter what, and that will make your POTS and anxiety worse. getting sleep is key, too.

Edited February 1, 2013 by corina
medical advice

[issie]

As for meds - sometimes, with certain people the anti-anxiety med can cause some depression because it slows down the sympathetic system.The SSRI might be the perfect thing for you. It might be just what will help. Hang In There! When it's all new ---it's overwhelming. We've all had that feeling and we still do sometimes. Keep telling yourself you will get it figured out and tomorrow will be a better day. It will - you know ---things will get better. It just takes a lot of patience the determination to find an answer. Medicine is advancing and some of us are finding many things that are helping. You will too. Big ((((((((HUG)))))))))).

Issie

[Chaos]

Sounds like Joyagh is giving you good info. Some of the SSRIs will address anxiety as well as depression and I believe zoloft is one of them. Also keep in mind the same neurotransmitters that are involved with depression ( serotonin, norepinephrine, dopamine) are also involved in POTS, so treating one thing may very well affect the other.

Crying is not a POTS symptom. That IS a PPD symptom. Please take care of that and talk to your OB/midwife and get that addressed. That is not something to mess around with! Treating that may also help your ANS symptoms...not because the depression is causing your POTS symptoms but because it's all part of the same neuro transmitters being totally messed up. I used to teach childbirth classes and we saw this fairly frequently...maybe 5 -10% of patients had serious PPD. It needs to be treated!!! Can't stress that enough.

While this forum is a great source of information, you really need to listen to what your doctors who are working with you and seeing you personally are suggesting. Every one of us is so different and has unique symptoms and issues, so what works for one may not work for another. Conversely what doesn't work for one, may be the thing that makes all the difference for you. Largely the treatment for all of this is simply trial and error in your own body because no one can predict (at this point anyway) how you will react to any medicine they give you.

Please take care of yourself and keep us posted.

Sending you lots of gentle hugs!!!

[MomtoGiuliana]

Altruism--It is certainly frustrating that your doctors are not working together to develop a strategy for getting you better.

From what I understand, SSRIs do cause autonomic dysfunction initially as a side effect for some people. It may make some POTS symptoms worse, initially, but after your body adjusts (which could take some time, days to weeks) it could make your symptoms much better. This was my experience. I was also scared to start it, and the first week was very hard and I was really scared by the worsened symptoms, I will be honest, but my specialist kept reassuring me I'd be OK and that I really should try to ride it out. I am glad that I did b/c I believe that ultimately the SSRI did help my symptoms to abate.

As far as PPD, you may have this, independent of POTS. In which case, it really must be treated as others have said. I agree with Chaos that lots of crying is not a POTS symptom (although I think it is natural and normal to feel sad and frustrated when you are feeling so poorly). I also agree that treating PPD may also have the benefit of improving your POTS symptoms, as SSRIs can be effective for many POTS patients. Please talk to your doctor about your concerns about the SSRI and I'd suggest you ask if you can start on a very low dose like others have suggested.

I hope you have adequate help at home right now. I was reminded, when I was feeling badly about being sick and unable to care for my baby as I wanted to--you have to take care of yourself adequately before you can take care of someone else.

Let us know how you are doing.

[badhbt]

I can honestly say I was where you are at about 4 months ago and I didn't have a baby. I was having bad crying spells. I think I was grieving about the loss of myself. I didn't know if I would ever be able to work, drive, travel....etc It was so overwhelming because I was so healthy before. I was having constant surges....like I wanted out of my skin.

I finally gave in to the SSRI, I didn't want to take it because I have never been depressed in my life...I had a happy life. I was desperate though so I did. Now I am glad I did. It took away the anxiety feeling and made me feel hopeful. My symptoms have slowly become more manageable.

It sounds like you don't have anything to loose. I did take Ativan to help with the first couple of weeks.

Big Hug

[joyagh]

also, the zoloft didn't make my POTS symptoms worse at all. I guess they can for some ppl but I was fine with it.

You might wanna check with your OB/midwife re: Klonopin. If you're breastfeeding or co-sleeping they might not want you on it. (also, it makes me feel more tired, grumpy, dizzy and irritable if I get too much in my system. It has such a long half life that it builds up and causes me a lot of symptoms).

[Altruism]

Thanks for all the support!!!

I finally gave up and started Zoloft. Started at 12.5 mg, really low. Then I upped it to 18.5 mg and I'm planning on taking 25mg today. I still have HORRIBLE daily MORNING panic sensations with sweaty palms and feet, feeling a flushing hot/cold sensation in my arms, neck, head, cheeks and abdomen and I feel like I'm dying. I upped my Klonopin and it helps a lot in terms of sleeping - I sleep 13 hours now, compared to the 6 hours of sleep I was getting before.

By the way, I was reassured by a couple of doctors that Klonopin is ok while breastfeeding. I have to stay on dosage below 1 mg (I take 1mg now) and I check my baby if he's too sleepy. But researchers have proven than only ONE baby had issues with a mom taking Klonopin + 3 more drugs. So I'm trying not to panic.

Is the hot flushy sensation common with POTS? Don't start me on MCAS, cause I can't find a doctor to test me for this. I almost gave up and might just try hydroxyzine as it works on histamine and anxiety as well.

I still feel like death. Is this ever going to end?.... I'm ok to have POTS, but I NEED the terrible anxiety/adrenaline/NE to be controlled. It can be, right?

[ramakentesh]

Sometimes its the response to impaired blood flow and lack of sodium to the brain that gives off symptoms of anxiety.

[Altruism]

Thanks. Is there a way for this to be fixed?

[issie]

Thanks. Is there a way for this to be fixed?

Not easily. It is thought that there is an issue with blood flow above heart level and therefore, to the brain. If we can get more blood flow to our brain we will get more oxygen and things should get better. There is a whole lot of research going on right now and hopefully, a little more time will figure more things out. There is a lot of speculation on what is causing the issues with blood flow ---some are increasing their sodium intake and or having their bodies hold onto more salt (via florinef) that will increase the volume in the blood because where salt is there is more fluid. But, there are also ideas out there that there is something causing the blood to be thicker and causing issues with the flow. (Parasites, thick blood for who knows why, too low blood volume, MCAS causing the tissues to abnormally release fluid into the surrounding tissues and not keep it in the blood stream like it should be.) There are a lot of ideas out there. There is also a lot of research going into auto-antibodies and the autoimmune system. So, there are lots of things very close on the horizon - almost within reach of us. If you can find something to help you get through this rough spell - hopefully, it won't be too long that things will be understood more and we may have something a little more concrete. Right now ---there is still a lot of things unknown. Hang In There. I hope that your doc will find something to give you a little relief.

I have found that Motherwort, helps me with the tachy and anxiety issues. Also Blackstrap Molasses - the unsulfured one - helps me too. I'm not sure if you can do these with nursing - something that you would have to find out. But, they have helped me and a few others.

Issie

[Chaos]

Altruism- With your significant blood loss that you had with your delivery, have they discussed maybe doing some IV saline just to see if that would help as a "stop gap" measure? Maybe just to see if it helps get you out of this spot you're in? Might help get the baroreflex receptors to calm down a bit which might help stop some of the surges.

[issie]

Altruism- With your significant blood loss that you had with your delivery, have they discussed maybe doing some IV saline just to see if that would help as a "stop gap" measure? Maybe just to see if it helps get you out of this spot you're in? Might help get the baroreflex receptors to calm down a bit which might help stop some of the surges.

Good call Chaos - that might help. Along with making sure you aren't anemic.

Issie

[Altruism]

Hi, unfortunately IV salines did not help. I've had 4 IVs in 12 hours and I felt absolutely nothing. Had 2 more IVs next time I was in the ER. I'm sick of being sick without answers.

Issie, I was severely anemic when I gave birth HG 7.9 borderline for transfusion. Now it's 14.0, so I'm not anemic anymore. Took iron pills for 2 months.

BTW, is it possible to feel a slight relief (OMG RELIEF) from SSRI on day 7-9? I'm only taking 25mg Zoloft, but I feel less foggy and lightheaded. I upped my benzo and it lowers my HR as well. Apart from the SEVERE morning adrenaline surges/anxiety attacks, my days feel a little better. Is it possible that I respond to SSRI>!!>!> Is it just in my head? And I also don't have side effects, that feels so abnormal... Hmm... Maybe it's just not working huh?

[MomtoGiuliana]

Not everyone has side effects or at least very noticable effects. That is good! I am not sure about getting relief that quickly. I really think it takes awhile. For me it was 2 weeks of bad side effects (which for me was worsened adrenaline surges and worsened dizziness) and then after about a month I started to slowly feel stronger and less dizzy and fogged out.

[ramakentesh]

A lot of patients with a fairly large amount of anx that ive spoken to from their POTS felt a decent amount better on mestinon. Im not saying that you should try it or trying to give you medical advice but it might be something that is worth talking to your doctor about.

Some take clonidine and beta blockers to suppress beta receptor stimulation. But the problem with this is that if you expereince dizziness or abnormal cerebral autoregulation this will make this symptom worse.

For me I used to take beta blockers to calm this down but they reduced my standing tolerance even more. Then I started on volume expanders and other meds that try to improve postural tolerance and volume and this symptom vanished.

[Chaos]

I think everyone responds differently to meds. If you are feeling better...that's GREAT! I think what the "normal" is for other people has no bearing on what "normal" will be for us, so you just have to go with what works for YOU.

Glad you are getting a bit of relief!

[shan1212]

I missed this when you first posted. I just watned to say that I'm so sorry you're going through this.

I've been there. Last July (four months postpartum) I felt very much like you describe. I just felt like a caged wild animal, like it was taking all of my powers of concentration not to go completely bonkers. I had tried and stopped metoprolol. I didn't want to take Florinef because everyone was all, ooooh, steroids and breastfeeding, scary! (I'm now taking it and still breastfeeding). We went to the ER and they didn't do anything.

Then I started Zoloft. My PCP had me take 50mg the first night! Horrible horrible night. Should have started much slower. So then we cut it back to 25 and increased slowly. Ever since then I've felt that it's helped me. I felt amazing for four days after I'd taken it for 11 days, but then that went away (boo). But I can tell that my lows are much more stable. I was regularly calling friends and family to help me with the girls when the POTS got bad (when it does I get the surges you're describing, dizziness, chills, hot flashes, nausea, vomiting, diarrhea). I haven't had to call anyone for help or go to the ER except for when I got the stomach flu. I've had some ick moments but I can manage them with some meds and getting in bed. So it's been helpful for me. I do feel like it kind of muted my emotions, though. Not that it made me numb, just like it turned down the volume. But oddly enough, now that I've been taking Florinef regularly for the last few weeks, I feel exuberant again, even when I had a so-so POTS day. Hmmm.

If you're a vain mom like me, I'll tell you that I had been steadily losing weight until I started Zoloft. I haven't gained any, but I haven't lost any since I started it either, and I'm stuck about 15 pounds over my pre-pregnancy weight. Sigh. And I don't think the Florinef is going to help in that regard . . . But if I can feel OK and live my life fairly normally, I'll make that trade.

My number one piece of advice is not to lose hope. For some reason I felt like there was no way out . . . I didn't believe any medications could help. Obviously that's not a rational thought, but I remember feeling that way. And don't forget that this is a dynamic time period. Your body will change for a year or more after having the baby. So don't worry that you'll always feel the way that you do now. I feel a lot better than I did in July. I'm functioning at about 85%, and hey, I was always an overachiever anyway.

ETA: I have ativan for the bad surges, but I usually take phenergan instead. I feel like it's "ativan lite." It relaxes me without totally knocking me out, and treats the nausea I usually have at the same time too.