How does POTS and anxiety work together? Any clear explanation?

[Elizaangelica]

I’m having trouble getting a clear understanding of how anxiety works in relation to POTS. Both anxiety and POTS have been chronic conditions for me since I was a teenager (now 39). No treatment (meds or therapy) have ever been able to make a difference to my almost constant free-floating anxiety. The anxiety has always been approached as a separate ‘mental health problem’ rather than potentially a physical one being triggered by the POTS. I guess I’d like to be able to grow some greater acceptance of the anxiety, just like the other POTS symptoms, rather than feeling like I’m just ‘failing’ to make the kind of improvements through therapy/medication, like the doctors expect. 

 

Can someone please give me a clear explanation of how/why POTS can cause heightened anxiety? I’ve read about different elements, like the sympathetic nervous system and fight/flight. And about the hormones or Adrenalin (?) release in POTS. But I don’t understand how any of it fits together. Like, why does it release the chemicals? Is it linked to my blood flow? Or lack of blood to the brain? Am I literally getting stress hormone inappropriately released over and over while my body is trying to compensate? Is my sympathetic nervous system ‘broken’ by dysautonomia?

 

POTS sure has a lot of facets that somehow fit together. But I’m very confused. I’d like to be able to clearly explain it to myself and my treatment team (who are not very knowledgeable about POTS at all).
 

 

[Pistol]

Hello @Elizaangelica! -- In simple terms: anxiety and POTS share a lot of symptoms: fast heart rate, tremors, fast breathing, sweating ... but the CAUSE is different. Anxiety often starts first and triggers the symptoms. In POTS the symptoms start first and then trigger the anxiety. Since the symptoms are so similar POTS attacks for the longest time misdiagnosed as anxiety and even panic attacks. In reality studies show that most POTS patients score low on the anxiety scale. 

[Elizaangelica]

Thanks Pistol. I think I know what you mean. But isn’t dysautonomia a problem with the Sympathetic Nervous System? Do you mean that in our case our SNS creates similar physical symptoms to anxiety (like increased heart rate, sweating etc). Where as in anxiety the thought/event comes first, which then causes those same symptoms?
 

But why does our SNS do this in POTS? Or is that just what POTS is (our SNS acts dysfunctionally). Someone had written that because our vessels don’t constrict correctly our body keeps releasing Adrenalin (?) to get the vessels to do the right thing, because the brain/heart knows it’s not getting the blood flow it should be. 
 

I hope I’m not asking too many questions. I think I want it clear in my head so that I can explain POTS easily to healthcare providers who don’t know of it. 

[Pistol]

@Elizaangelica - you have the right idea. In POTS our blood vessels do not constrict properly - either by dilating too much or constricting too much. To ensure proper circulation of the heart and brain the ANS dumps out adrenaline, which is supposed to constrict vessels and also causes tachycardia, to pump more blood. Unfortunately too much adrenaline causes the Fight-and-Flight reflex - designed to keep us ready to react to a threat and act quickly. The symptoms are essentially what happens in an anxiety attack. Here is an article explaining this:   How the Fight-or-Flight Response Works (verywellmind.com)

So your explanation stated above is right. To an outsider a fight-and-flight response can easily seem like an anxiety attack, especially since they cannot see the trigger. If you turn pale, start to tremble, have a fast HR etc when you encounter a bear in front of you everyone would understand your physical reaction. But if it happens simply in response to standing up, getting startled by a ringing phone or by doing the dishes people cannot see the trigger and therefore cannot understand why it happens. 

Also - keep in mind that our symptoms are very scary, so it is no wonder we develop anxiety over them. I used to be very afraid of passing out in public and became anxious just entering a store or doctors office, even if in a wheel chair. Becoming anxious then set off the ANS, it dumped adrenaline and .... so you can see how the two are related. However - in true anxiety the trigger is psychological, and the physical symptoms follow. Whereas in POTS the physical symptoms come first and trigger the anxiety.