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How Do You Know If Your Having A Pots Episode Or If It's An Anxiety Attack?


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I have been nervous to go to certain places in fear for having prefainting spells. They scare the living crap out of me. I have never had an anxiety attack so how do I know if I'm experiencing a pots spell or an anxiety attck?

The room starts to spin and I feel my heart race and I get super nervous. I feel real scared and then my hearing gets muffled. After this I'm real shook up and feel sick for a few days.extrememly potsie.

I'm just scared that it's anxiety and I'm going to be scared to do anything. I already won't do field trips with my kids in fear of one of these episodes and I get nervous if I have anything planned.

What is your opinions on this? Anxiety of Pre fainting spells.


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Pots makes our hearts race, our blood pressure drop, we get dizzy, sweaty, feel like fainting.

An anxiety attack makes our hearts race, our blood pressure drop, we get dizzy sweaty, feel like fainting.

Physically the same things happen. It is no wonder you can't tell them apart.

A pots attack can get worse if we get scared, because then we are having anxiety on top of it.

Worrying about anxiety can bring it on.

So what's a person to do?

I adopted a mantra, "I am not going to faint", "I'm not going to die". I wish it was as easy as saying "don't worry".

Then I got a prescription for Ativan to take as needed. When I had an "attack" I would take it and even though the symptoms were there, I could deal with them. I actually believed my mantra.

If you get an anti anxiety med and it helps, you will know there is anxiety/panic involved. If it doesn't help, it is just POTS.

I found having a med alert bracelet with all my info inside helped me be brave enough to go places.

Good luck, the fear of anxiety can make you so anxious you can become homebound.

I once read a saying, "It is only from taking risks that we become brave." Little did I know leavng the house would consitute a "risk"

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I agree with Jan on all this. My guess is that it is POTS and anxiety. Mostly the POTS, but as she said, anxiety can easily bring on the POTS symptoms and make them worse.

I've been having the same problems...I don't drive currently, except to move my car from the driveway to the street and vice versa. All the idiots out on the road when I'm driving brings on an attack like you wouldn't believe! Even being the passanger in the car with a driver I trust brings on attacks everytime I go somewhere. I have talked to my therapist about this and she has tried a certain type of hypnosis on me that I was supposed to also practice on my own and eventually I was supposed to be A LOT more calm. But that didn't work for me and the therapist strongly thinks its just because it is more than just anxiety, it's also the POTS! If we didn't have the POTS symptoms/problems, the anxiety was supposed to be very short and sweet, then eventually go away because I have never had any type of anxiety problem before I became POTSy. But even with trying all that she told me, I was getting the dizziness, heart racing and feeling all around potsy after the attacks just the same.

So, its mainly the POTS, but as Jan said, the anti-anxiety medication wouldn't be a bad idea to try. I know it helps me and I have to be really careful not to get addicted because I have very addictive behavior (that is actually the main reason I am seeing the therapist ~ I have to ~ although, I don't mind...it helps with dealing with POTS as well).

So, hang in there. (I know that's not much of a pick me up, but its the best I can do right now.


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I have the same problem telling the difference between anxiety and POTS. Before I got the POTS diagnosis, I thought I must be really out of touch with my feelings, because I would sometimes get light-headed and nauseated over the tiniest little stress. For me there's frequently a seed of anxiety, but my physical reaction gets way out of proportion.

The most useful thing for me has been learning not to feel guilty or inadequate for feeling the way I do. Whether it's physical or emotional or both, I am where I am, and trying to make myself feel different will only make things worse. I pick and choose which challenges I take on when; I'm fortunate enough to have that luxury. When I'm coming out of a bad stretch, I've learned I need to ease my way back into life, so I'll start with little challenges, like going to the post office, before I take on something bigger, like grocery shopping.

I also use medication sometimes. If I feel anxious or fragile for a few days in a row, I'll increase my Zoloft for a week or so. It helps interrupt the cycle of anxiety.


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I really thought I had anxiety but I was taking something for anxiety to try and help with migraines.....nothing changed. I still felt "anxious" and still had the migraines.

Thanks for this post......I was puzzled myself.


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As a POTS patient without anxiety I can say I don't ever fear leaving home or get super nervous during an episode. I don't take any meds for POTS and myself and my daughter are fainters but staying home doesn't get us anywhere in life healthwise. I can pass out at home (and do) just as simply as I can pass out at the grocery store or the gym (done those too).

I think--What's the WORST that can happen if I do this or that? I pass out and may wake up with a group of strangers around me who usually want to help. And usually I'm out with friends or family who know about my health and understand if I suddenly sit on the ground, or must always have water, or need to eat immediately, or if I do pass out.

In my personal opinion passing out, (or having tachycardia, facial flushing, sweating) isn't the worst thing to happen in one's life.

There is a huge difference in NEEDING to stay home, and being afraid to leave. I have plenty of times where my bp is too low, or I'm too dizzy, or have a migraine that it's just stupid to go out. But when you're a mom, you're generally the person who needs to get stuff done, visit the library, do the grocery shopping, get the dry cleaning, etc. etc. Not that I don't have help if I ask, but I truly don't mind doing these things.

If I'm invited somewhere I haven't been I try it out. Again, the worst that can happen is I pass out. Some bad things like being somewhere too loud, or too hot, or too crowded, or too long of wait can also happen, but I try to enjoy my time, and don't go back if it's too much. Or sit outside and wait if I can't tolerate it.

I don't want to minimize my symptoms, passing out and feeling POTSy doesn't feel good, it really, really stinks. But I'm going to do it at home, as quickly as I do it in public, so I don't feel the need to miss out on life. I get myself prepared to leave by eating right, and drinking plenty. I always leave with water and salty snacks. And I'm realistic about what I can do. I don't go out one day a week and attempt all our family errands. I go out when I can for smaller trips, and if I'm going to be gone for the day or week. I eat accordingly when I'm out and don't try and mess with things I know I can't tolerate so I don't jeopardize my time away.

One of the reasons our family loves taking vacations so much is the "Stranger Effect" we can pretty much make fools of ourselves by passing out in different locations, my daughter has the ability to throw up almost anywhere, and chances are we're NEVER going to see those people again. Maybe we can even educate some strangers on dysautonomia.

I certainly prefer risking embarrassment over turning my family into hermits anyday.

I have a close friend with social anxiety disorder that came out of nowhere, and she says Paxil gives her the ability to not worry about other people around her. Or small problems in her own life that used to be blown up in her mind, and has stopped all her panic attacks. I know her husband appreciates having his care-free wife back too because he says she wasn't good at "hiding" it at all.

I hope you're able to find the right counseling, therapy, medication, for any of you dealing with this.

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Thanks for all your imput. I'm by no means am a hermit and try to tackle my life on a day to day basis. I never had anxiety before this illness so that's why I'm unsure of what my body is going through.

I'll take some anti anxiety meds with me and if it helps than I'll tackle the anxiety part of this. If it doesn't than I'll have to get used to that scary feeling. and move on from there.

For one, I DEFINITELY overdo it. I still try to be super mom and super wife and keep up with my friends whenever I'm having a good streak. I just want to enjoy life and everyone tells me not to over do it when I feel good but I have to, it's just my nature.

I just know I'm not alone in all these strange symptoms which helps me feel alittle normal in our POTS world.

Thanks all


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It's interesting to me how everyone has their own way of dealing with their fainting and spells, their own way of thinking about it and acting around it.

I picked up on a few things from what ppl are saying.

One important point is that anxiety has physical effects AND physical roots. Anxiety is not something in your mind that produces hyperventilation, increased heartrate, etc. Anxiety is also something in your nerves that produces this reaciton in your organs and consequently your mind attempts to justify the feeling with some kind of cause. This is a well supported theory in physiological psychology. In addition to this physical role of anxiety in our psychology, we POTS sufferers have exaggerated physical responses to stress. So, although not all POTS sufferers experience the symptom of exaggerated anxiety, it is part of the disease and can be treated, like other symptoms, with appropriate medications.

Quiet Spike, the "stope the anxiety cycle" is very well put. It is a downward spiral, or cycle, and it can be stopped through interruption, not only stopped through a "cure" or such.

Fear of going to public places, or fear of crowds, social fears, go hand in hand with fainting, panic attacks, and siezures. The common thread: feeling extremely embarassed during bad experiences (ie fainting in public or hyperventilating in public) in the past, and fearing that embarassment will recur.

Patricia, it seems as though you have been able to avoid developing this phobia due to the fact that you have conquered the embarassment; you don't care what ppl think of the episode. This is great for you.

Personally, I have fainted many times in public, and I have gone through different stages with my psychological reaction. I don't like big crowds of strangers and I avoid parties or crowded stores. At one point, I would not go out w/out my husband, and it became like a dependency (when I faint, he picks me up and carries me to the car, tells passing strangers that I'm "just tired" and so forth). It's not just bc of the fainting in public though; it's because the heat of crowds and parties makes me faint. Heat is a big trigger for me.

I have a friend with an anxiety disorder (not POTS related). She has GAD, PTSS, and Panic Disorder. She has had panic attacks many times and she knows them very well. All her sisters suffer from the same problem and it seems genetic in origin. She saw one of my POTS episodes, and afterwards (when I was fully conscious), she told me, "Masumeh, this is definately NOT a panic attack. This is neurological." At the time, my neurologist had done a "just in case" EEG, told me that I do not have epilepsy and therefore have conversion or anxiety disorders behind the scenes of my episodes.

My episodes are wierd. THey are preceded by a hyper state wherein I cannot stop talking and I ramble on very very fast. I can't concentrate or stop talking (if w/ppl) and my mind skips from one topic to another relentlessly. Then the wall. My episodes start with a sleepy feeling. Then, I become aware of weakness in my muscles and start leaning against things to keep me stable. Then I cannot use my hands (like, can't turn a key or pick up a glass of water). Then I can't speak very fast, or understand anyone easily. I usually respond to everythign with a "What? I don' know." Then I can't pick my legs up, have to drag them along. Sometimes I'll see stars or have sharp pain wrapping around the left side of my head from just above my eye towards the middle over my ear before the wall. In the end, I just black out and fall over. Sometimes everything turns green before or after the fall. This green tint on the world is due to low blood pressure. It's green in one eye, red in the other. I never feel scared...but sometimes I get hyper, or sometimes angry or annoyed with whoever is with me for no particular reason.

Even though I don't panic or get nervous or scared during my episodes, I still like to avoid crowds, etc. See, it's not just anxiety or panic disorders that result in this coping mechanism. It's just embarassment that does it.

Hope you figure out the best treatment for your symptoms. I think it sounds like anxiety meds would really help.

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{I can't resist continuing on with some more from my side of things as well as all of you whom have continued throughout this post.}

For me, its not the embarassment at all (okay, well maybe .1% embarassment), but mine is being scared! Scared out of my mind sometimes. Everytime I've fainted, I have hurt myself in some way or other, sometimes bad, sometimes not so bad.

Also, as I've said before, driving is the main thing that I will not do yet. I got into a really, really bad car accident before I got POTS symptoms, so I very much fear not having control of my car and hurting or killing myself or someone else.

And my ex-husband had a seizure disorder, with grand-mal seizures, where I had to call 911 almost everytime he had one because he had fallen and hit his head, leg, arm, something so bad that he could barely move (and he was about 150 lbs heavier than me, so there was no way I was going to carry him to the hospital).

So, to sum it all up, honestly, I really couldn't care what anyone thinks, I just don't go anywhere by myself because it brings me some comfort to have someone there with me, so they can help to calm me down if the adreniline is too high, or to be there to help me if I feel like I am going to go down (along with medication to chemically keep the adreniline factor low). I'm just afraid of getting hurt so I limit myself to what I do, which is what it seems that most people try to do.

And on an ending note, to give you an idea of who I am, how I try my hardest to not let anything get me down, I worked in a factory with heavy, moving machinery that would kill you if you fainted anywhere in close range to it, for at least 5 months after first getting symptoms because no one could figure out what was wrong with me, most people, although believing that I was dizzy, did not believe the severity of how I felt. So, I continued to work because I needed the money and nobody could support me. Then, one day, I just decided that I didn't want to risk my life anymore, I stopped driving, I went on medical leave from work (which is still where I'm at today), and it forced my family to realize how severe my condition is, even though I wasn't diagnosed with anything until a month ago.

I just know that we all deal with our situations differently probably based on what sort of support we have, along with our own problems and body systems. Patricia, I think it's absolutely great that you can feel the way you do about it, and I'm sure a lot of that has to do with having a close family member (your daughter) that has a lot of the same health problems as you...it sounds like it makes it a lot easier to deal with. :rolleyes:

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Lots of folks with POTs have "hyper adrengic" attacks---(not necessarily meaning you have hyper adrengic pots)---------but an over active sympathetic nervous system (flight of fight response) can make one feel tons of anxiety---thus the anxiety is secondary to the POTS. This happens often in POTS patients. The sympathetic NS is part of the ANS. Generally if I just have an anxiety attack---the heart racing isn't all that intense.

It's so very hard to tell, and if it's caused from the POTS---it's still hard to tell---because the anxiety can be a symptom of one of the POTS symptoms---heart racing alone will make a person anxious. That is why this stuff is so hard to figure out----the old ---"did the chicken or the egg come first" thing.

Doctors should look at "anxiety" as tool to look deeper-------that is if they're wise------ and smart enough.

You just don't see a lot of that-----being "smart" doesn't' necessarily mean--(MD)----as some of us have had the misfortune to find out.

Maxine :0)

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sjprince23, thanks for sharing your experience. It's really true that everyone has their own factors, situations, and ways of coping, solutions, etc. Since even symptoms differ, let alone family and social support, job environment, medical support, etc...this seems to come up often, the differences and everyone having is own concerns and coping techniques.

For the injury part, back when my doctors suspected that I had epilepsy, I read about tips to help epileptics avoid injury during a siezure. Although my fainting spells (which can last up to 45 minutes unconscious time and involve some tremors/convulsions) are not technically siezures, I've benefited a lot from the simple advice I read for epileptics. Since your husband has grand-mal siezures, you've probably read it all before...but just in case, one tip that I've benefited from very much is flooring: Always have paded carpeting--everywhere. In my house, all but the bathrooms and kitchen are carpeted. The worst head injury I got was from hitting a concrete floor after falling from a standing position when the carpet had been pulled out due to a washing machine mishap. Also, cooking, being careful to keep pan handles and knives out of knocking range. Personally, since I'm out cold for so long, I mostly cook soups and things that can sit by themselves w/out burning while I'm unable to turn off the stove. Stairs--I get very nervous/scared taking stairs when I'm dizzy and I try my best to avoid that. Would any of that help prevent injuries for you guys?

It's nice to take a friend along, and nice that your friends can calm you down.

For me, it's just embarassing, even fainting in front of my family, because it's like weakness to me, and everyone gets all upset and worried and cries every time. It's just embarassing to be the cause of it. I guess I imagine that I look stupid too, with my head falling this way and that, my clothes out of place, and my arms twitching, and God knows what else because I can't tell really. Before getting sick, I'd always been athletic and proud of it...I guess this weakness is humbling.

It helps a lot now, being able to say it's POTS, instead of saying, "Well, my doctors think I'm subconsciously reacting to past trauma (conversion disorder--yeah, why did it start when I had mono during my honeymoon, instead of 9 months before that when my father was trying to kill me for trying marry out of my "race"? let me not go there.)...but really I'm not, at least I don't think I am...what do you think?" It really helps to have a label, and others suffering with similar symptoms...instead of everybody around me having their own theories (husband=possession; sister-in-law=anorexia; father=stress reaction; mother=life-threatening "something" like a brain tumor; me=curse of God for some sin I cannot even recall). Since I just found out about POTS a month ago or so, I'm hoping it will relieve some of the embarassment. Like I'm not "doing it to myself" by being anorexic (I swear I eat a lot when the IBS is okay...but since all anorexics say the same, I can't prove it to anyone) or by failing to resolve the past in my head or heart. Yeah, that helps a lot. I hope that I can find the right medication too...and perhaps even stop fainting...

So thanks everyone...for making me feel normal. Although I wish no one else, no one at all, had to go through these things.

Sorry for getting a bit off track.

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It helps a lot now, being able to say it's POTS, instead of saying, "Well, my doctors think I'm subconsciously reacting to past trauma (conversion disorder--yeah, why did it start when I had mono during my honeymoon, instead of 9 months before that when my father was trying to kill me for trying marry out of my "race"? let me not go there.)...but really I'm not, at least I don't think I am...what do you think?" It really helps to have a label, and others suffering with similar symptoms...

Yes! It does help to have a label, instead of having to answer with a list of symptoms and theories when someone asks what's wrong. It's so easy to dismiss it as emotional when doctor after doctor can't figure out what's going on, because, frankly, everybody's got some emotional problem if you look hard enough. Not to mention, there's nothing like living with undiagnosed illness to make everything else in life overwhelming. The diagnosis gives you validation.

I'm glad you finally got one. It sounds like you've had enough other stuff to deal with, too.


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Re being scared to leave the house- I can understand it, BUT I should tell you that the times I've hurt myself the worst have been when I'm in my own surroundings.

I snapped my foot in half two years ago fainting just standing up to get out of bed in the morning. I will never forget that pain- I screamed until I passed out again once I came to on the floor. There was a big blue golf ball sized lump sticking out of my foot.

And just two weeks ago, I was standing up after writing a chapter of my thesis and I just went down with no warning and heard a terrible crunch and snap in my arm as I hit the floor.

I'm not saying this to scare you- but to hopefully show you that it's no MORE frightening to get out of bed and go outside than it is to stay at home.

If you're going to faint, you're going to faint. I normally get enough of a warning to tell people what's happening.

TRy not to panic! That will undoubtedly exacerbate the organic and physiological things going wrong in your body, and extend into anxiety.

Good luck.

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The difference for me w/ panic attacks vs. POTS hyperadrenergic attack is I feel scared with the first, but not with the second. I tend to get more flushed, I start to feel like I'm choking, and my heart rate gets higher w/ the POTS attack, and I tend to get very weak in my muscles. With a panic attack, it's more of a feeling of disorientation, tingling and numbness, and fear.

However, I treat them both the same. I usually take Klonopin if it lasts more than five minutes, plus I lie flat (which is hard to do with your heart pounding out of your chest, but it works for me).


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Just remembered something (actually, I remembered it a few times and always forgot it again by the time I got in front of my computer...anywho...)

The neurologist that thought I was having hyperventilation way back when told me that the dizziness, etc. with that kind of attack comes from CO2 working on the blood vessels, and therefore it's alleviated by breathing into a paper bag (bc it's from lack of CO2 and breathing exhaled air returns higher levels of CO2 to your body). We tried this (I would be semi-conscious, unable to move or speak, so my husband would hold the bag around my mouth and nose) during what later turned out to be POTS episodes....it does not have any positive effect then.

Anybody with panic attacks ever tried the paper bag thing? Does it help for that?

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I just posted something earlier tonight on another post, I can't remember which one, about a doc thinking I had hyperventilation syndrome as well (before they found the pots) and to carry a paper bag around with me to use. The way he diagnosed me with that is he had me lie down on the exam table and breathe really heavy, really fast, and I got dizzy, but wouldn't anyone get dizzy doing that? I had my boyfriend try it, he got dizzy, I told my mom about it, she did it, she got dizzy, but neither of them have anything even remotely close to what I experience ~ both of them are fairly healthy when it comes to the cardiovascular system, etc. Weird doctor.

The only thing the paper bag has ever helped me with are hiccups! That's about it. As I told my doctors, many times that don't know pots, I know how to breath, its that my body, the ANS, sometimes won't let me!

Some people, I'm sure it does help, but for me, its the pots episodes that are bringing on anxiety, so its not true anxiety, but with medication, my primary doc now, is suggesting I take anxiety meds to more or less help with the more manic depression I have been getting since getting sick (regular anit-depressents used to work for me, but my depression seems to be morphing more towards the manic side~great :huh: )

Which is taking a toll on my pots symptoms of course!! Urgh! :o

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