SarahA33

Hi, you might find the search option helpful. There's been past discussions related to this. Here's the most recent topic that I'm aware of. http://forums.dinet.org/index.php?/topic/26966-effects-of-pots-on-sexuality/

Welcome to dinet!

Rich - I am seeing my doctor also this afternoon and he is able to give me IV fluids in his office so hopefully I will feel better after two liters. I'll also be having some labs done. I will let you know if anything useful comes from this. Be safe today. Did the ivabradine help with the HR increase immediately upon standing do you think? Curious to see if you've noticed a difference now that you've been off of it.

Hi Rich, I'm sorry I've been delayed in responding-- reason being I'm actually going through something similar. For the last 8 weeks now I've been running episodic fevers (which is unlike me as my body temp is usually on lower end). I'm flushed and just exhausted (which is also very unlike me as I rarely am tired). The lethargic feeling is increasing, my muscles are achy and weak feeling. One of the scariest things that has happened is whatever this is, my joints (right knee) has been affected, too. I'm seeing a specialist the Monday after Thanksgiving. The last round of blood work was all normal last week, but I am going to call my doctor monday am because I feel absolutely terrible. I know exactly what you are describing, I'm sorry you can't seem to catch a break.. when do you see the mito doctor? I truly wish you success. Would you mind sharing why you are going to be seeing this doctor specifically. The foggy feeling you mention is something I've been dealing with also..the "detached" feeling in a way. Sending you my best. Hang in there. I wish I had more to offer, however at this point, I can only commiserate. I think when i call my doctor I'm going to let him know I'd like to go in for IV fluids and repeat blood work, especially as things with us can change so quickly. Something just feels not quite right.

Hi! Sorry I'm chiming in late! I'm really happy for you and the girls that you had a good appointment. I'm sure the confirmation and acknowledgement was a relief to you. Reading the post, I also felt relieved in a way for you all that he took notice of the symptoms and severity of them. Did he have any opinion on the recent findings in the MRI's that you've had done and the related vertigo issues? Tilts are just awful, as usual though, sounds like the girls pushed through. I just cant imagine how much the vertigo added to the pre-syncopal symptoms for them. I'm so happy that's over for them. It took me weeks to feel better after my tilt, there have been topics on here related to that, too. How are they feeling now? Please let them know that we all say hello! I hope you and your family have a wonderful Thanksgiving holiday! Sarah

Allie, I am sorry to hear that. Hopefully it's cooled off a bit in your corner of the world so you have a break with the temperature regulation? It's fall here, but I've been struggling a bit with that still. Layering on, off, flushing, goosegumps, etc. etc., you know the drill. Have also been dealing with Raynaud's symptoms quite a bit in my feet this summer, so I'm a bit nervous as to what the winter weather will bring. Take good care of yourself, Sarah

Hi there, So it looks like just for this study they had all participants start the trial 2 hours after eating breakfast. As for a general protocol, I haven't been a patient there so I don't know, but I think it would vary on the patient. For example, I take mine 2 times a day now, however, I used to have to take it 4 to receive the most benefit.. I never had any side effects from this medicine at all so it didn't bother me to take it like that, but some people can only take a PM dose because the side effects are so bothersome. In my opinion going slow and starting on a low dose is the best way to ensure that you will have the least amount of side effects. Maybe you could do a past search also on propranolol/bb dosing?

Flourescent lighting intensifies it for me also. Hmichel, do you also have blood pooling issues, that could be a reason why your symptoms increase while upright also? Hi, Allie! Have wondered how you were.. hope you are doing well

Hi nunntrio, Here's an article from Vanderbilt you might find helpful: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758650/ Your doctor knows you best, so you'll probably find they'll be more helpful regarding dosing. Titrating always has been a good option for me. You mentioned failed attempts w/ BB's, is this your first time trying propranolol?

Hi Pumpkin, You don't have high blood pressure do you? I cant remember that far back. I read that this med can increase BP, so if your on midodrine of florinef, that may be something you'd have to talk to your pots doc about. I'm sorry that sounds like much more than a nuisance at this point. I haven't tried it myself, sorry I cant give you more feedback. I did see that some of the interactions were warfarin, digoxin, and metoprolol. I really hope that you find relief if you decide to try this! We've all been through this really hard decision of "should we", "shouldn't we", but in the end it just comes down to what you feel comfortable with. I'll be wishing you the best! Sarah

Matt, this is from DINET's main page explaining An Overview of POTS that you might want to share with your GP: http://www.dinet.org/index.php/information-resources/pots-place/pots-overview I'm from the US, so I'll try some googling to see if I can be of any help. Hopefully, some of our UK friends will come to the rescue! "POTS can be categorized as primary, meaning it is idiopathic and not associated with other diseases, or secondary, meaning it is associated with a known disease or disorder (Grubb, Kanjwal & Kosinski, 2006). Physicians believe there are distinct subtypes within both the primary and secondary forms, however the subtypes are still in the process of being identified, labeled and universally accepted. Regardless of type, POTS is not contagious. People generally develop POTS after becoming sick with a virus, giving birth, or being exposed to great bodily stressors (i.e. surgery, trauma or chemotherapy). Some people have had POTS their entire lives. Teenagers sometimes develop the disorder during the years of rapid growth, and 75-80% of them can look forward to being asymptomatic when they reach adulthood (Grubb, Kanjwal & Kosinski, 2006). The symptoms of POTS are life altering and debilitating at times. POTS patients use about three times more energy to stand than a healthy person (Grubb, 2002). It is as if these patients are running in place all the time. Activities such as housework, bathing, and even meals can exacerbate symptoms (Grubb, Kanjwal & Kosinski, 2006). Research shows that POTS patients' quality of life is similar to those with congestive heart failure and chronic obstructive pulmonary disease (Benrud-Larson, Dewar, Sandroni, Rummans, Haythornthwaite & Low, 2002) Twenty-five percent of people with POTS are disabledand unable to work (Goldstein, Robertson, Esler, Straus, & Eisenhofer, 2002). Most patients will have to make some lifestyle adjustments to cope with this disorder. It was once estimated that nearly 500,000 Americans had POTS, which made standing up a challenge (Robertson, 1999). However, with research advances and growing physician education the number of people found to have POTS symptoms is steadily rising. It is now estimated that one out of every hundred teens has POTS (Fischer, 2007). POTS patients tend to be between the ages of 15 and 50 (Grubb & McMann, 2001, p. 65). Women are 5 times more likely to develop POTS than men (Grubb & McMann, 2001, p. 65). POTS does run in some families. The onset can be sudden or gradual. The quantity and severity of symptoms varies from day to day. There are treatments for POTS symptoms which can be tailored to each individual patient, especially if an underlying cause is discovered. Researchers are attempting to identify and treat the mechanisms and causes of POTS. Studies show that most patients will eventually be able to stand up with fewer symptoms (Low, 2000). Most people with POTS can look forward to experiencing improvement with proper treatment."

Hi Callie, My apologies for not responding sooner. I came across your post in a search I was doing and felt so badly I hadn't gotten back to you. I'm not how far you are from Calgary? Dr. Raj moved from Vanderbilt to Calgary, here is his information for you: http://www.dinet.org/index.php/index.php?option=com_physicianlist&view=physiciandetail&Itemid=0000&phyid=387 Also, here is a list of practicing ans doctor's in CA: http://www.dinet.org/index.php/index.php?option=com_physicianlist&view=physicians&Itemid=276 Have you tried calling a place like Mayo or Cleveland to see what they offer for international patients? This is what I found from CC, http://my.clevelandclinic.org/patients-visitors/international

Hi evergreen, just an fyi for you, typically male's have a faster heart rate than females. Here's a link to site that may offer an explanation. I'll write some more later.. http://www.livestrong.com/article/208145-what-is-the-difference-between-male-female-heart-rates/ Best, Sarah

http://www.dinet.org/index.php/index.php?option=com_physicianlist&view=physiciandetail&Itemid=0000&phyid=387 Hi Sue.zee.q, here is a link from our physician list website to dr. raj who moved from Vanderbilt to Calgary. It says he only sees adults, maybe you could contact the office and see if they have any recommendations for pediatric patients. best of luck to you. Sarah

Hi, Evergreen, Are any of the supplements new? I think I remember reading in your last post that you had weight loss, is that where the dandelion comes in? I don't know a great deal about it, but I researched it and discussed it w/ my NP when I wanted to take it for UTI's/Kidney Infection. She said people with any allergies to ragweed or similar plants can have a pretty terrible reaction. Also, I'd need to stop it when I started my antibiodic because it decreases the effectiveness and it can also interfere with medications metabolized through the liver. Did you have a tilt table test? I was also wondering if you were able to follow up with a cardiologist and if you've worn a 24 or 48 hour holter monitor as of yet? I'm sorry to hear that you are feeling so poorly. Did your neuro run any bloodwork that came back abnormal at all?

Robstah, If you've got concerns regarding your BP spikes and the Florinef, I'd suggest talking to your doctor about wearing a 24 hour BP monitor. Because I have high bp and orthostatic hypertension, my doctors had me check my bp's 3 times a day when I started this med to make sure I wasn't too high also. I'm not exactly sure of the science behind it, but ks mentioned how the system can basically balance out with florinef. It's been so long, but I think it has something to do with Aldosterone escape. Your doctor can get into detail and science behind that. You asked about how one can tell if they are hypovolemic. I had my testing done at the Cleveland Clinic, and I believe Mayo Rochester does it also. Ks answered your question here also: http://forums.dinet.org/index.php?/topic/27109-new-member-hi-compression-query/

Hello there! Welcome to our community

I've seen the treatment on tv for arthritis I believe. Its a no for me too because I have Raynaud's, hypertension, angina, and I just never know how my bp will respond. I hope you find other alternatives to help with your pain. Take care! Sarah

Hello, here is our physician's list to search for a doctor closest to you who specializes in dysautonomia: http://www.dinet.org/index.php/physician-list

This is from Cryohealthcare: Who should not use whole body cryotherapy? The following conditions are contraindications to whole body cryotherapy: Pregnancy, severe Hypertension (BP> 160/100), acute or recent myocardial infarction, unstable angina pectoris, arrhythmia, symptomatic cardiovascular disease, cardiac pacemaker, peripheral arterial occlusive disease, venous thrombosis, acute or recent cerebrovascular accident, uncontrolled seizures, Raynaud’s Syndrome, fever, tumor disease, symptomatic lung disorders, bleeding disorders, severe anemia, infection, claustrophobia, cold allergy, age less than 18 years (parental consent to treatment needed), acute kidney and urinary tract diseases. What are the risks of whole body cryotherapy? Whole body Cryothherapy is very well tolerated and has minimal risks: Fluctuations in blood pressure during the procedure by up to 10 points systolically (this effect reverses after the end of the procedure, as peripheral circulation returns to normal), allergic reaction to extreme cold (rare), claustrophobia, redness, and skin burns (only if exposed to low temperatures longer than recommended). You may have already seen these risks.. do you have a pots doc you can ask? Sarah

Hi dm886, Welcome to the forum! I think the explanation you just provided to all of us was perfect. This can be a difficult condition for others to understand,so my advice would be to let them know that you have your good days and bad days and that the cane provides additional support and safety to you on not so good days.

Hi Jared, Welcome to the forum! There is a company called Zensah that makes athletic compression wear that I've now started ordering some pieces from. I purchased a pair of Recovery tights that look just like a pair of black leggings that I'd buy while out shopping. They were about $150.00, but I get a ton of use out of them. I've also gotten a compression tank top and some sock's from this manufacturer. One of my md's nurse's recommended that I check this brand out, so glad I did because the style and support is fantastic. I'm glad that you have a doctor who is familiar with this condition. I hope PT is helpful for you. Are you incorporating the Levine protocol at all? Again, welcome to DINET. Sarah I've copied and pasted some items that have a high sodium content, From the entry Please Pass the Salt, http://www.dysautonomiainternational.org/blog/wordpress/pleasepassthesalt/ V8 vegetable juice 8oz 420 mg Morton table salt ¼ tsp 590 mg Boar’s Head Cold Cut Turkey 2oz 330 mg Board’s Head American Cheese 2 oz 700 mg Breakstone Cottage Cheese 4oz 340 mg Athenos Feta Cheese 1 oz. 340 mg Kikkoman Soy Sauce 1 tsp. 307 mg Swanson Chicken Broth 2 cups 1720 mg Swanson Veggie Broth 2 cups 1600 mg Swanson Beef Broth 2 cups 1600 mg Knorr Chicken Boullion Cube 1 cube 1270 mg DelMonte Creamed Corn 1 cup 480 mg Vlasic Kosher Dill Pickles 1 oz 210 mg Kalmatta Olives 1 oz. 429 mg Goya Manzanilla Olives 2 tbsp. 330 mg Rold Gold Pretzel Rods 6 pretzel rods 1220 mg Heinz Ketchup 1 tbsp. 160 mg Goya Capers 1 tbsp. 380 mg Oscar Mayer Fully Cooked Bacon 3 pieces 340 mg Hebrew National Quarter Pound Franks 1 frank 1070 mg

Hi, Sue.. Sorry you aren't feeling well. Mono is terrible, I've had it before I got sick. Couldn't image having it now. I really hope you don't have it! I can often have a low grade fever and not even know it because of the temperature fluctuations that I have on a daily basis. Does that make sense? I normally run around 97.3, so when I have a temperature of 99-100, I feel really yucky, like someone ran over me with a truck. I hope you feel better soon. Take good care of yourself! Sarah

Hey Praxxtor, this link is pretty helpful and at the bottom lists the various classes of vasodilators, http://www.cvpharmacology.com/vasodilator/vasodilators Not sure what symptoms you have specifically with your eyesight, but I have had normal eye exams but experience a lot of blurred vision at times, so its attributed to pots symptoms. Regarding your GI issues, I hope you and your dr. will be able to find something helpful for you. Good luck at your appointment! Sarah

Hi Praxxtor, what symptoms do you have the bother you the most? Regarding medications, I copied and pasted the Medications from DINET's "What help's" section http://dinet.org/index.php/information-resources/pots-place/pots-what-helps Anti-arrhythmic drugs, such as disopyramide (norpace), have been used to treat POTS patients. However, studies have shown that some anti-arrhythmic drugs may increase the risk of death, and they are usually used only to treat life-threatening arrhythmias. Benzodiazepines, such as Clonazepam (klonopin) or alprazolam (xanax), are not used as a first-line of treatment and can worsen tachycardia and hypotension. However, they may be helpful in select patients. Klonapin has been shown to be effective in the treatment of some patients with neurally mediated syncope (Kadri, Hee, Rovang, Mohiuddin, Ryan, Ashraf, Huebert & Hilleman, 1999). These drugs are central nervous system depressants. They are thought to enhance the effect of gaba, an inhibitory neurotransmitter. Benzodiazepines should be used with caution, as they are highly addictive. Some physicians do not advocate their use. Beta Blockers are especially useful in those with elevated norepinephrine levels, beta-receptor supersensitivity and a hyperadrenergic state. Beta blockers can exacerbate hypotension and are not well tolerated by some dysautonomics. Beta blockers need to be used with caution, as they are known to reduce plasma renin activity. Research shows that hypovolemic orthostatic intolerant patients commonly have inappropriately low levels of plasma renin activity (Jacob, Robertson, Mosqueda-Garcia, Ertl, Robertson & Biaggioni, 1997). Reduced plasma renin activity may be an important pathophysiologic component of the syndrome of orthostatic intolerance (Jacob et al., 1997). Hence, some POTS patients may have low plasma renin activity that is contributing to their disorder. Beta blockers may further lower plasma renin activity in these patients. Therefore, the use of beta blockers in some hypovolemic patients may be counterproductive. Beta blockers should be used with caution, if at all, in those with mast-cell activation disorders (Shibao, Arzubiaga, Roberts, Raj, Black, Harris & Biaggioni, 2005). Beta blockers may trigger mast-cell activation. Cerefolin is a vitamin supplement that may help patients combat fatigue and feel more alert. Clonidine (Catepres) is a centrally acting alpha-agonist agent. Clonidine inhibits sympathetic outflow (Grubb & McMann, 2001, p. 117). It can stabilize heart rate and blood pressure in patients with post-ganglionic sympathetic involvement (Gaffney, Lane, Pettinger & Blomqvist, 1983). Clonidine will actually display a vasoconstrictive effect in these patients. Clonidine is started at 0.1 mg a day and titrated upward (Grubb, Kanjwal & Kosinski, 2006). It is available in a long-acting patch form. DDAVP (Desmopressin) is used to help patients retain water. DDAVP can raise blood pressure and seems to be especially useful in lessening morning hypotension. It is a man made copy of the anti-diuretic hormone vassopressin. Vassopressin and DDAVP stimulate the kidneys to concentrate urine. Erythropoietin raises blood pressure and red cell mass. Red blood cell volume has been found to be low in POTS patients (Raj, Biaggioni, Yamhure, Black, Paranjape, Byrne & Robertson, 2005). Erythropoietin is also a potent vasoconstrictor and is quite useful in the treatment of orthostatic disorders (Grubb, Kanjwal & Kosinski, 2006). There may be an impairment in erythropoietin production and/or function in some individuals with POTS. Erythropoietin reportedly works in 80% of patients (Grubb, 2002). One study showed that erythropoietin administration led to dramatic improvements in some patients with orthostatic hypotension (Hoeldtke & Streeten, 1993). However, a later study of (only) 8 patients with orthostatic tachycardia reported that erythropoietin did not help the tachycardia (Hoeldtke, Horvath & Bryner, 1995). Erythropoietin is not commonly used because it has to be injected and is expensive. Procrit is a common medication that increases erythropoietin, which in turn increases red blood cell mass. Patients treated with erythropoietin may need iron supplementation as their hematocrit rises. Prior to starting erythropoietin, a complete serum blood count (CBC) as well as a serum iron, total iron binding capacity, and ferritin level should be obtained by one's physician (Grubb, Kanjwal & Kosinski, 2006). Erythropoietin can be employed as long as the hematocrit (HCT) is less than 50, and patients appear to achieve the best hemodynamic effect when the HCT is in the low to mid-40 range. The usual starting dose of erythropoietin is 10,000 units injected subcutaneously once weekly, and it usually takes 4-6 weeks to see the full effects of this medication (Grubb, Kanjwal & Kosinski, 2006). Patients should have their HCT checked monthly to make sure it is below 50. Florinef (Fludrocortisone) increases plasma volume. It helps the body to retain salt and water. It also sensitizes blood vessels so that they can constrict more easily (Haran, 2004). Some doctors administer salt tablets with florinef. This is because the effectiveness of Florinef depends upon salt intake. Florinef can deplete potassium and magnesium and supplements may be required. Florinef increases intracranial pressure and should not be used in patients with hind brain compression. Numerous symptoms of sympathetic overactivity are enhanced by Florinef and some people develop severe headaches as a result of treatment (Schondorf & Freeman, 1999). Florinef is a mineralocorticoid and, like beta blockers, can reduce levels of plasma renin activity (Jacob et al., 1997). Reduced levels of plasma renin activity correlate with the hypovolemia observed in some POTS patients. Florinef may be a counterproductive treatment in these patients. Usually, POTS patients are prescribed 0.1-0.2 mg of fludrocortisone daily. The dose should never exceed 0.4 mg orally each day as adrenal suppression may occur (Grubb, Kanjwal & Kosinski, 2006). Ivabradine, a sinus node blocker, has reportedly helped some POTS patients experience less symptoms. Ivabradine is sometimes used as an alternative to beta-blockers because it results in heart rate reduction without vasodilation, sexual disturbances, ornegative inotropic effects. Labetalol is sometimes used in POTS patients because it induces both alpha- and beta-blockade. Dosages of 100-400 mg orally twice a day may be employed (Grubb, Kanjwal & Kosinski, 2006). Carvedilol works in a similar fashion to labetalol and is also sometimes employed as a treatment for POTS. Methyldopa is helpful in select POTS patients (Grubb, Kanjwal & Kosinski, 2006). Mestinon (Pyridostigmine Bromide) has traditionally been used to treat myasthenia gravis, but is now sometimes being used to treat POTS patients (Grubb, 2002). Mestinon works by inhibiting the breakdown of acetylcholine. Acetylcholine is the main chemical messenger of the parasympathetic nervous system. Some POTS patients may have immune systems that are mistakenly making antibodies that are plugging up acetylcholine receptors (Grubb, 2002). Mestinon works to unplug these receptors by allowing more acetylcholine to remain at the neuromuscular junction. Mestinon is particulary useful in patients who have the postviral, paraneoplastic or autoimmune forms of POTS. Mestinon is usually started at 30 mg orally twice a day, titrating to 60 mg orally twice daily, if necessary (Grubb, Kanjwal & Kosinski, 2006). Motrin (Ibuprofen) or Indocin (Indomethacin) might be beneficial treatments for patients with postprandial hypotension (Hilz, Marthol & Neundorfer, 2002). Postprandial hypotension refers to low blood pressure occurring after meals. Motrin and indocin block the blood pressure lowering effects of prostaglandins (Hain, 2001). Studies have suggested that nonsteroidal anti-inflammatory drugs may also lower one's risk of developing Alzheimer's disease(in t' Veld, Ruitenberg, Hofman, Launer, van Duijn, Stijnen, Breteler & Stricker, 2001). However, long term use of nonsteroidal anti-inflammatory drugs can have serious side effects. Phenobarbital is a central nervous system depressant. It can be useful in the hyperadrenergic form of dysautonomia. However, phenobarbital is a barbiturate and people can become addicted to this drug. Barbiturates can also cause fainting (Grubb & McMann, 2001, p. 109). Prednisone, plasma exchange or intravenous gamma globulin may be used in patients who are in the acute post-viral phase of the illness (Low, Schondorf, Novak, Sandroni, Opfer-Gehrking & Novak, 1997, p. 694). These treatments are most likely to be effective in patients displaying evidence of an acute autonomic neuropathy. Saline has shown to be very beneficial in decreasing POTS symptoms. It is an inexpensive treatment with few side effects. However, saline must be given through an IV, which is time consuming and may require trips to the doctor's office. Some of the most severely affected patients report having a peripherally inserted central catheter (PICC line) inserted so that IVs can be administered at home. However, some physicians do not believe the benefits outweigh the possible risks associated with a PICC line. Selective Serotonin Reuptake Inhibitors (SSRI's) are sometimes used to treat those with autonomic disorders. SSRI's are used because serotonin is the principal neurotransmitter that the brain uses to govern autonomic control, in particular to govern blood pressure (Haran, 2004). Studies have shown that some patients with autonomic disorders may have disturbances in central serotonin production and regulation (Grubb & Karas, 1998). SSRI treatment can suppress the sympathetic nervous system (Shores, Pascualy, Lewis, Flatness & Veith, 2001). Venlafaxine is particularly effective, possibly due to its actions on norepinephrine as well as serotonin. It has been reported that SSRI's may be effective in treating the chest pain that is associated with dysautonomia (Low, 2000). However, the FDA has issued a public health advisory regarding antidepressants, and they should be used with caution. Sleep medications are used by some POTS patients. A number of patients have significant sleep disturbances (Low, 2000). Some patients report successfully using natural alternatives to sleep medication. Herbal remedies should be used with caution and under a physician's supervision, as there are known risks with some OTC sleep aids. For example, the FDA has issued warnings regarding Kava Kava and melatonin supplements have been shown to worsen orthostatic intolerance. Midodrine is particularly useful in patients with peripheral denervation (Low, 2000). Midodrine is usually started at 5 mg orally three times a day and can be titrated up to 15-20 mg orally four times a day, if necessary (Grubb, Kanjwal & Kosinski, 2006). Midodrine can be used on an as needed basis. Theoretically, continuous use of midodrine could result in constriction of blood volume due to chronic sympathetic activation (Jacob & Biaggioni, 1999). Octreotide is especially useful in preventing vasodilation in the gut, thereby reducing splanchnic pooling. Its actions help to prevent postprandial hypotension (low blood pressure after meals). Octreotide inhibits the release of a variety of gastrointestinal peptides and also may reduce postural and exercise induced hypotension (Mathias, 2003). Octreotide does not often appear to enhance supine nocturnal hypertension, however one study reports that it is a possible side effect (Hoeldtke, Bryner, Hoeldtke & Hobbs, 2007).Octreotide is administered by subcutaneous injection starting at 50 µg 2-3 times a day, and dosages may be titrated up to 100-200 µg three times a day (Grubb, Kanjwal & Kosinski, 2006). A long-acting injectable form has also been deve Theophyllineis primarily used in asthma patients. One of its effects is to increase vasoconstriction, therefore theophylline is sometimes used to treat dysautonomia (Grubb & McMann, 2001, p. 116). Ritalin increases peripheral vascular resistance via alpha receptor stimulation (Grubb, Kosinski, Mouhaffel & Pothoulakis, 1996). Ritalin is prescribed by some physicians, but can be addictive. Wellbutrin (Bupropion) is a central nervous system stimulant. It is a dopamine agonist and also a weak blocker of the neuronal uptake of serotonin and norepinephrine. Wellbutrin is not habit forming and works immediately. Wellbutrin can sometimes be used to combat the fatigue that plagues POTS patients.