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POTS and stimulants...


Momof3boys

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My POTS dx's by TTT, 3 years ago, and just recently confirmed with another TTT.  I am on fludrocortisone, wear compression hose & abdominal binder, drink tons of water & salt, all which have helped.    I see a cardiologist once per year for the fludrocortisone rx and that's it.  He's not well versed on POTS.  My fatigue and brain fog are my biggest problems.  My son is ADHD and recently had a dose increase in his medication.  You know where this is leading.... I know that stimulants are used for POTS so I tried one of his Adderall that was not longer the appropriate dose for him.  Brain fog and fatigue were lifted.  I felt like I used to.  10 mg Adderall.  I have taken it 5 different days, and it is so nice to feel like my old self and actually get stuff done.  I talked to my PCP about this today, and was scolded "You took speed and you felt good.  Not surprising."   The scolding was somewhat deservedly so, because I know you should never take someone else's meds.  BUT he knows how long I have been struggling with the fatigue and not being able to think straight.  He would absolutely not prescribe a stimulant unless I get a DX of ADHD from a psych and get a letter from the cardiologist that it is ok for me to take a stimulant.  All very valid, but got me thinking..  Why would stimulant use in POTS not cause HR increase as it would in the typical person?  I'm pretty sure the cardiologist will think its a bad idea too.  Common sense says it would be a bad idea to give stimulants to someone with a diagnosis that includes the word tachycardia.  Can someone explain?    

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I'm sorry your doctors don't understand. Could you present info re this to your doctor like yogini mentions? If not it might be helpful to find doctors that are willing to work with you!

This is from the POTS what helps page:  Ritalin increases peripheral vascular resistance via alpha receptor stimulation (Grubb, Kosinski, Mouhaffel & Pothoulakis, 1996).  Ritalin is prescribed by some physicians, but can be addictive.

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Thanks.  I do drink soda for the caffeine ( I SO wish I liked coffee), but I have IBS also which can get bad if I have more than 1.  Caffeine pills made me irritable.  I've read that Rx stimulants such as Adderall are used w POTS, which is the only why I tried it.  While I did not check my pulse on those days, I did not notice any problems with it either.  I mostly posted because it got me thinking & I'm curious is there a scientific reason it's not raising the HR in POTS patients, or is it probably just the fact that it is such a low dose?

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If I remember correctly the stimulants help with vasoconstriction.  But there's also the different effects on ADHD vs neurotypical people.  If your brain is deficient in dopamine to start with, the stimulants get you up to where you should have been, and you calm down and are better able to focus.  If you already have enough, then you get high.  Maybe there is a similar differential effect with respect to heart rate? 

I have ADHD as well as POTS, and my neurologist will not prescribe any stimulants for me either, because of the tachycardia thing.  Fortunately, Wellbutrin is able to provide extra dopamine for my poor, deficient frontal lobes.  I would probably have to get a letter from the cardiologist.  I think that maybe the Wellbutrin makes me feel less fatigue, but I'm not sure.  It certainly helps with getting started on tasks!

BTW: If your son has ADHD, you might, too.  That could be the reason you have brain fog in the first place.  ADHD and POTS cause similar cognitive/attention symptoms.

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   I do tend to agree with Lily - something like caffeine helps some (but not all) people because it raises BP. But all "stimulants" aren't the same.  Drugs like ritalin and adderall  are more complicated than caffeine. They have effects and don't occur in nature the way caffeine is in coffee. That's why those drugs are prescription and caffeine is OTC.   A doctor can best explain.  If your doctor isn't aware that Adderall is used in some cases for POTS.  it might be helpful to give him some medical articles.  

Edited by yogini
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