Anxiety feels like much worse, how to calm it down?

[98rabbit]

Recently got diagnosed with pots post-covid. I also have a history of really bad anxiety. My symptoms like to feed into each other and just loop until I have to get my wife to take me to the ER. I get symptoms that feel like imminent heart attacks or strokes, like chest pains, numbness in face and extremities, etc. However they always send me home saying nothing was wrong. Has anyone else experienced this? What works to prevent anxiety? I'm on 25 mg of metoprolol per day. I have a prescription for hydroxyzine which seems to help a marginal amount, but only at doses of about 100 mg, which I'm worried about taking as I do have heart palpitations/compensatory pauses. I'm basically getting constant panic attacks which aggravate my symptoms which then loops and feeds into each other and I can't keep doing this. Thank you in advance for any help.

[Pistol]

@98rabbit Welcome to this forum! I am sorry you are having such a hard time. I am very familiar with what you describe. I have Hyperadrenergic POTS, meaning the mechanism behind my symptoms is uncontrolled adrenaline dumping. This causes symptoms like you describe, tachycardia, chest pain, BP changes, tremors, palpitations, cold hands and feet ... and of course anxiety. It is quite common to be labeled as having anxiety when we experience these symptoms, but I was assessed by a neuro-psychologist twice and she said I am low on the anxiety scale. I was told that the symptoms and the high adrenaline naturally CAUSE anxiety - not the other way around, that the anxiety causes the symptoms. 

What I do to minimize the symptoms - in addition to the usual treatments and taking my meds - is to avoid overstimulation. I am active around the house but take a lot of rest periods to keep the ANS calm. I have had POTS for a very long time, so by now I can tell what my body needs and when. This has helped the anxiety as well. When in a stressful time, when I cannot rest whenever I want, I have a prescription for low dose ativan. That helps me stay calm, but I take it rarely. For example - I am moving right now, so at times I get overwhelmed both physically and mentally. So my doctor told me to take the Ativan twice a day until I am settled in. It really helps me a lot. 

I also was prescribed a SSRI for the POTS symptoms, and have been taking that for many years with good effects. It also seems to help balance the neurotransmitters and to some degree the flares. 

There are many ways to calm ourselves down, deep breathing techniques are an example. This article may be helpful: 

 

[98rabbit]

10 hours ago, Pistol said:

@98rabbit Welcome to this forum! I am sorry you are having such a hard time. I am very familiar with what you describe. I have Hyperadrenergic POTS, meaning the mechanism behind my symptoms is uncontrolled adrenaline dumping. This causes symptoms like you describe, tachycardia, chest pain, BP changes, tremors, palpitations, cold hands and feet ... and of course anxiety. It is quite common to be labeled as having anxiety when we experience these symptoms, but I was assessed by a neuro-psychologist twice and she said I am low on the anxiety scale. I was told that the symptoms and the high adrenaline naturally CAUSE anxiety - not the other way around, that the anxiety causes the symptoms. 

What I do to minimize the symptoms - in addition to the usual treatments and taking my meds - is to avoid overstimulation. I am active around the house but take a lot of rest periods to keep the ANS calm. I have had POTS for a very long time, so by now I can tell what my body needs and when. This has helped the anxiety as well. When in a stressful time, when I cannot rest whenever I want, I have a prescription for low dose ativan. That helps me stay calm, but I take it rarely. For example - I am moving right now, so at times I get overwhelmed both physically and mentally. So my doctor told me to take the Ativan twice a day until I am settled in. It really helps me a lot. 

I also was prescribed a SSRI for the POTS symptoms, and have been taking that for many years with good effects. It also seems to help balance the neurotransmitters and to some degree the flares. 

There are many ways to calm ourselves down, deep breathing techniques are an example. This article may be helpful: 

 

Thank you so much!! I will ask my doctor about SSRI options, and I will also try some of the techniques listed.

[AngieP]

Hi @98rabbit, I'm so sorry to hear you've been diagnosed with POTS and also suffering from panic attacks. 

I can totally relate. I was diagnosed with POTS 10 years ago and take 25mg of Metoprolol morning and night to manage my symptoms, which sound very similar to yours.

Generally, I feel quite well but I do go through flare ups. After a bad POTS attack, I find my anxiety goes through the roof. I start avoiding certain situations; minding my young son on my own, going out to dinner with friends etc. 

Mid last year I started having dreadful panic attacks and this is what helped me break the loop...

- Talking to a therapist once a week  (I did this for a few months when I was really struggling)
- Reading 'Complete Self Help Book For Your Nerves' by Dr Claire Weekes
- Viewing Neal Sideman's tips on paniccure.com
- Meditation, ASMR

When I'm having a panic attack, I focus on the language I use to describe it and my internal thoughts. I tell myself this feels very uncomfortable but it will pass instead of I'm going to die! It's really hard sometimes and I don't have a complete handle on my anxiety, but it has definitely been reduced. 

I hope you start to feel better soon. Living with POTS and anxiety is exhausting. Glad you've joined DINET - it's a great community for support.

 

 

 

[Sarah Tee]

Perhaps you already know this, but I wanted to mention that chest pain is a fairly common symptom of POTS. (Cause unknown.)

So if you have been thoroughly checked out for any dangerous causes of chest pains and given the all clear, it might be helpful to work on re-labeling the chest pain as "POTS symptom" or "adrenaline surge symptom" rather than "sign of impending heart attack or stroke".

Of course, if the chest pain changes in any way or come in a different presentation, then you can always get it checked again.

You have been examined several times at the ER, but perhaps you could ask your regular doctor to give you a heart health/stroke risk check up and assessment. Sometimes this type of assessment is offered free by health support organisations, e.g. Heart Foundation, that visit towns and set up temporary clinics.

I know anxiety doesn't necessarily reduce in the face of facts, so this is just a small suggestion compared to the very good advice you have already gotten from the other people in this thread.

I am sorry that you are going through all this. I had a close relative who experienced severe anxiety when I was younger. I wish now that I had known more about this condition and done a better job of supporting her.

[98rabbit]

Thank you all everyone for responding, it's been really reassuring. I saw my physician today who prescribed venlafaxine for anxiety, and 1mg of ativan to be used as sparingly as possible while the venlafaxine establishes. Anyone have any experiences with those?

10 hours ago, Sarah Tee said:

Perhaps you already know this, but I wanted to mention that chest pain is a fairly common symptom of POTS. (Cause unknown.)

So if you have been thoroughly checked out for any dangerous causes of chest pains and given the all clear, it might be helpful to work on re-labeling the chest pain as "POTS symptom" or "adrenaline surge symptom" rather than "sign of impending heart attack or stroke".

Of course, if the chest pain changes in any way or come in a different presentation, then you can always get it checked again.

You have been examined several times at the ER, but perhaps you could ask your regular doctor to give you a heart health/stroke risk check up and assessment. Sometimes this type of assessment is offered free by health support organisations, e.g. Heart Foundation, that visit towns and set up temporary clinics.

I know anxiety doesn't necessarily reduce in the face of facts, so this is just a small suggestion compared to the very good advice you have already gotten from the other people in this thread.

I am sorry that you are going through all this. I had a close relative who experienced severe anxiety when I was younger. I wish now that I had known more about this condition and done a better job of supporting her.

 

15 hours ago, AngieP said:

Hi @98rabbit, I'm so sorry to hear you've been diagnosed with POTS and also suffering from panic attacks. 

I can totally relate. I was diagnosed with POTS 10 years ago and take 25mg of Metoprolol morning and night to manage my symptoms, which sound very similar to yours.

Generally, I feel quite well but I do go through flare ups. After a bad POTS attack, I find my anxiety goes through the roof. I start avoiding certain situations; minding my young son on my own, going out to dinner with friends etc. 

Mid last year I started having dreadful panic attacks and this is what helped me break the loop...

- Talking to a therapist once a week  (I did this for a few months when I was really struggling)
- Reading 'Complete Self Help Book For Your Nerves' by Dr Claire Weekes
- Viewing Neal Sideman's tips on paniccure.com
- Meditation, ASMR

When I'm having a panic attack, I focus on the language I use to describe it and my internal thoughts. I tell myself this feels very uncomfortable but it will pass instead of I'm going to die! It's really hard sometimes and I don't have a complete handle on my anxiety, but it has definitely been reduced. 

I hope you start to feel better soon. Living with POTS and anxiety is exhausting. Glad you've joined DINET - it's a great community for support.

 

 

 

Thank you both for the tips. My doctor said my heart is fine fortunately, all that's left is to tackle the mental blocks around my anxiety.

 

[98rabbit]

In addition, twice now I've had episodes where it felt like my heart stopped or blood pressure plummeted while just laying in bed; I got severe head pressure, ringing ears, numbness and I have fainted. Does anyone else experience this?