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~Naomi~

Article Re: Cognitive Dysfunction Related To Anxiety/depression

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Here we go again... somatic hypervigilance as partial explanation. I can't think clearly (even when NOT standing) because something is physiologically wrong, not because I am depressed, anxious or overly focused on my symptoms. Amusing too that the POTS study participants HERE were 'less educated,' whereas there was a recent article out of the UK highlighting POTS patients' higher levels of education. There was some interesting info on hormones though.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070177/

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Well - what to say? Some time ago I always grew very angry when I read such a kind of nonsense (or was told it by a doc personally).

But as a dysautonomia patient you slowly get used to the fact that a portion of medics simply doesn't know their business. Annoying, yes - but in fact not surprising.

You have this phenomenon in every scientific field, so why not in medicine?

So, just read it, shake your head, laugh it off - and forget it as soon as possible!

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I hear you Goschi. There was a time when my comments about this would have been a rant with lots of exclamation points. I can fluff it off a little better now, but I do still worry that stuff like this hurts us with Doctors. We struggle enough getting them to take us seriously. I can picture a Doctor based on this article recommending psychological therapy to improve cognition. Also, I wish they would stop wasting money on this type of research and put it towards figuring out what is physiologically wrong with us instead.

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I agree, also! I do still get somewhat !!! over articles like this. The research needs to be on the origins of this issue, such as the study looking at autoantibodies. Doing studies like this is a waste of time adding in the psyche angle to it. That's like trying to say someone with cancer can be fixed by giving them counseling. Our illness is NOT psychologically caused. There is no doubt that we do have ranges of anxiety and/or depression, but it is due to having whatever causes the POTS.

I am passionate about this, as 30 years ago I began having anxiety attacks out of the blue(sorry for repeating my story, just like to get the awareness out). My heart would begin racing for no reason and I would get mental anxiety. I was diagnosed by my GP as having "anxiety issues"(labeled), and given meds to control it. I had to grapple with how I could not control my anxiety, and I judged myself(felt weak) and was judged for it because I could not work due to it. Fast forward 25 years, and I bought a glucose monitor under the suspicion of having glucose issues. The first time I had my usual out-of-the-blue anxiety attack, I checked my glucose and it was low! A huge adrenaline release happens during hypoglycemia as the body tries to correct the low. Twenty-five years of having low blood sugar and having been chalked up to having a "psychological" issue. So I get really upset when that label is given because they don't understand the root problem.

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See i still get livid when I see articles and studies like this. It's !!!!!!!!!!?!?!? big time for this guy still.

I wish I was able to just shrug it off like ya'll and by now none of the ignorance surprises me but still it's unfortunate to see how misguided a lot of these people are, especially these so called "medical professionals". I couldn't agree more with what Naomi said... Why are they doubt studies and putting resources into this nonsense when it can be spent on finding the physiological causes of illness? Aka the real source of illness. I just posted this same point on another thread so sorry for those that gotta read the same twice from me but it warrants another mention here.

Sue I am right there with you having been misdiagnosed with my symptoms many years ago and having been thrown physch meds at me like it was a legitimate diagnose. I look at most of that stuff like quackery now. It's just wastebasket diagnosis stuff (anxiety, depression) when they can't figure out what's really wrong with you or what is really causing your illness. It's like chronic fatigue? Haha Chronic fatigue! That's a solid diagnosis. Thanks doc. You are right I am chronically fatigued and feel like **** from nothing. No pathology to my illness.... It's just CHRONIC FATIGUE" . A lot of this stuff cracks me up now.

When I was younger I didn't really know better and there wasn't even really much in the way of the internet to get info from so I was forced to accept whatever I was told, knowing very well it was all wrong, but still you end up believing it cause you think you are dealing in a competent medical system. Little did I know. What frightens me most is how there are so many young kids and children going through legitimate medical problems, Dysautonomia or even worse, and they are getting fed lithium and luvox because they haven't been referred for the correct testing and/or the goon docs they are dealing with have not informed them that anxiety and depression and those things are almost definitely being caused by some underlying medical issue. That it is a symptom and not a diagnosis. I can only hope the internet will continue to alleviate this problem and at least allow people to not be so blindly led by the ignorance. Cause it can really be damaging to be misdiagnosed and treated with the wrong meds; especially all the pysch crap.

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What I see missing from this article, and others like it is common sense.

One is that most of us experience a degree of increased sympathetic activity. It goes with the territory, and we know that these same receptors are part of the "fight or flight responses". Of course many of us will display some evidence or increased evidence of anxiety. That does not mean it is "Lymbic Responses".

Then many of us have problems with cerebral perfusion. I am just guessing, but maybe that effects cognitive function. Particularly if it is a chronic condition. I know that I have experienced a change. I am not the only one that sees it. I have been asked about it by people that know me. Especially those that I communicate with in writing.

Then I would like to see a comparison of rates of depression and anxiety to others with chronic illnesses. I am guessing that there would be a higher incidence rate across the board. Particularly with illnesses that are especially difficult to get diagnosed, and poorly understood.

Also the article seams to assume that the only affect that POTS has is an increased HR upon standing. A review of the posts on this board shows a wide spectrum of symptoms, and many of us have them in common Some are difficult to tolerate, and even down right disturbing.

I will use my coronary vasospasms as an example. Is it an example of sympathetic over activity? Maybe. There is a good chance, if not part of a broader autonomic neuropathy. Anyways, when you get a run of having them two and tree times a day, you are darned right to say it starts getting to you a bit. Especially when all of the doctors shrug their shoulders, and offer another pill.

And to comment on getting treated with the wrong meds. Recently I had a respected doctor suggest that an SSRI, or SNRI could help. This is with a vasospasm diagnoses sitting in front of him. I do not know a lot, but I know that there are a few things that you do not want to give to someone with vasospasms. These are two of them. He also commented on Mestinon. Bad idea. Acetylcholine is what they use to diagnose vasospasms in a diagnostic test. (Now I know why I had such bad reactions to it).

I could not possibly list all of the prescriptions that I have had written for me. My wife even started asking why I would not take any of the meds given to me. She started questioning me. It was difficult to explain why this or that was a bad idea. Her instincts were to trust the doctor. Mostly we can and should, but . . .

I am sorry. I had to vent. I see a lot of complacency, and an inability to see past our own foreheads. That is how I see this article. Lazy and poorly conceived.

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I appreciated the fact that this article did bring up the hormone issue. This indeed affects POTS and patients cannot control these. However giving the psych meds. to help is not the answer either. My son was given these types of medications when he was having a headche early on. These medications made him worse and caused other horrible side effects. Of course when you have a young patient, your doctors want to blame everything on Anxiety.

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This thread is dead. But I wanted to point out that I think you're all misreading the article.

The article suggests that the cognitive symptoms of POTS may be a result of neurophysiology:

"Perhaps underpinning the acute impairment in cognitive performance, reduced cerebral blood flow and a possible uncoupling of cerebral autoregulation during head up tilt has been demonstrated in patients with POTS.

It also suggests that POTS patients may MISTAKE the physiological syptoms of POTS for anxiety:

"Additionally, given that the reduction in cognitive performance during the detection task was significantly associated with the magnitude of the change in heart rate, and that patients with POTS displayed significantly elevated anxiety sensitivity in relation to cardiac symptoms, it is possible that, in the context of increased vigilance to somatic sensations, attention is diverted and impaired cognitive performance follows."

But, notice that the study found that POTS patients have more cognitive trouble when standing up than when lying supine. That broadly supports the claim that the cognitive symptoms of POTS are neurophysiological and not psychological, although the authors are doing their academic due diligence, by saying "well, it LOOKS like they do poorly when they stand up because they don't have enough blood in their brain, but, it is POSSIBLE that they're just distracted by thought that the pounding sensation in their chest is a pending heart-attack.....

I don't think this article is pushing the "POTS is just anxiety" folk theory.

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