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Panic Disorder And Pots


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Poll: Panic disorder and pots are they related? (78 member(s) have cast votes)

Did you experience panic attacks pre-pots?

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If 'yes', since onset has your pots:

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If 'no' , since your onset has pots:

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#1 ana_22

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Posted 24 March 2009 - 06:12 AM

I was reading about POTS and panic disorder and how sometimes they may be related. No im not saying all the symptoms are in your head, but that the same thing that causes panic disorder may cause pots (unless of course something else is causing your pots like EDS, MCAD etc.

I suffered panic attacks before pots but they weren't debilitating, just annoying. Pots for me is totally debilitating.

Just thought this would be an interesting topic. Especially after reading the anxiety thread.

#2 DelphicDragon

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Posted 24 March 2009 - 09:37 AM

I think that POTS and Panic Disorder are related, but in a slightly different way then I think you are implying.

When one has a panic attack (without an underlying condition) the sympathetic nervous system (AKA the autonomic nervous system) is activated by the brain.

In POTS, the sympathetic nervous system is overactive because of various physical signals. When the body thinks there isn't enough blood circulating, it forces the heart to beat faster. This is a survival mechanism.

Before I knew I had POTS or EDS, I always had 'panic attacks'. I would suddenly get 'stressed' - my heart would race, my hands would get cold and clammy, I would get nauseous. I told my doctor about them and he asked what I was thinking about when these occurred. Usually the answer was nothing. Truth be told, there was no trigger, other than standing too long, but I didn't know that then. I didn't have racing thoughts associated with these 'panic attacks' or fear of death, just the physical symptoms. (I think because I got these at a very young age, I got used to them and could stop the panic associated with my heart beating at 160, because it had done that before and I had lived through it)

There may be a corollary between POTS and panic attacks. I was diagnosed with generalized anxiety disorder before I was diagnosed with POTS, even though the psychologist felt that I didn't have it; but she needed to write down a diagnosis :) . Both cause the same physical symptoms - however panic attacks have an additional emotional component that POTS attacks don't. Granted, having a POTS attack can bring on a panic attack, especially if you don't know what's going on- but I think most panic attacks don't get resolved by laying down.

Sara

#3 EarthMother

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Posted 24 March 2009 - 10:03 AM

I have had both POTS and panic disorder for over 20 years. In my case my first panic attack (age 20) which the Doctor's labeled as an asthma attack came before my first medical record note (tachycardia on mild physical exersion) (age 22). They knew nothing of panic or POTS back then in the 1980's.

Having been an expert in both for decades I can tell you that there are some real differences between POTS people who develop panic disorder and the rest of the panic disordered population who are not orthostatically challenged.

Non-POTS panic people do not see a drop in heart rate when they are supine. The triggers and phobias for POTS people with panic disorder are also unique and follow particular patterns that stem from our physical challenges. While some of these conditions are also seen in the general anxiety population, the POTS panic folks tend to all exhibit these at one time or another to a greater or lessor extent.

For instance, POTS patience with panic often have accompanying agoraphobia (small wonder, who wants to pass out at the mega mart?) We tend to become worried over what we eat (because post pranial hypotension and over sensitive allergic responses send our bodies reeling.)

Moreover and perhaps most important, the types of treatment for panic disorder for someone with POTS is very different than people who have panic without POTS. For those of us in the former catigory, the treatment needs to be focused on our symptoms of dysautonomia. No amount of cognative behavior therapy or even pharmachological therapy, I believe, will "cure" panic attacks in a person with POTS unless there is also a decline in the acute crisis stage of the dysautonomia.

Sounds complicated? It's not. For everyone I've met on my healing path over the years it boils down to ... our panic is much better when our POTS is doing better. And despite what some no doubt well meaning "doctors" may claim it is NOT the other way around. If panic disorder could cause POTS there would be a drug trial list as long and wide as benzos and SSRI'S specifically geared for POTS. But there's not, because while there is often comorbidity (fancy word for two symptoms that occur at the same time) there is no causation.

Actually let me refine that slightly ... PANIC does not cause POTS. But for some of us who are perhaps genetically prone, POTS can cause an organically induced variant of panic disorder in some but clearly not all people with dysautonomia.

Ok, EM is stepping down from her podium...lecture over. ;-)

#4 all4family

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Posted 24 March 2009 - 11:35 AM

Hi,

Good description EM and sara. I am usually a little wary of posting about anxiety subjects, because the last time I said the word "anxiety" I was given pills, and got very sick. But I just happened to be looking through my medical paperwork this morning, (wow what a job!) And I found something that fits into this subject perfectly. In 2001 I wasn't "sick" yet. But this was right after the terrorist attacks, and I had been like most people very upset about them. Then there was the anthrax in the mail thing which further made me feel "anxious". So I went and got some counseling to help me through this tough time. Well of course I was also prescribed ativan, Which I think I had less then 20 pills. I think it was 14, just enough for one pill every day for 2 weeks. I freely admitted being anxious at the time. Then I got a sinus infection, and broncitis to go with it. So they put me on some medications for those. This is when I became "sick" with all kinds of strange physical symptoms. (some of the same ones I have now.) Vomiting, visual, changes, headache, etc. etc. Well apparently I thought these physical symptoms may have been due to some of my medications, because I hadn't had them BEFORE I took the medications. So I was reading in my paper work, and it said that they took me off of one of them because I could get the headaches etc. from that. But I continued on feeling bad, and having "anxiety, or panic attacks" Until I was through taking the medications. Then within the next couple of weeks I started feeling better, and though the whole terrorist attack thing was still there I no longer had the physical problems. What is most interesting here is I just found I cannot metabolize drugs correctly, and I believe that at least contributes to my dysautonomia. In another words I was having the feelings of anxiety which everone does feel at times in there life, but I did not have the physical symptoms that would go with the "panic or anxiety attacks" until after I took the medicine. And if this is what causes, or at least triggers my POTS, then that was probably a POTS attack. When I was done with the medications I began to feel better, and eventually went back to life as normal, even though I did still worry about the terror attacks I had NO physical symptoms. I think being so sick is hard, and we just want to feel better, and if someone tells us it is a panic attack, and we can do something about that, that is better then something there is no answer to. We all just want a way to make ourselves feel better, and hope that just "calming down" will do it. I hope one day we will all find an answer to the way we feel!!! :)

Suzy

#5 ana_22

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Posted 24 March 2009 - 03:58 PM

Thanks guys for your input!

I definitely didn't means panic causes PoTS! i just meant that those susceptible to panic attacks may be susceptible to POTS. Thats all! And i wanted to see whether it can play a role in recovery. Thats all!

And i guess i will never know if my panic attacks were POTS or just panic attacks. my first one was after id climbed a round of stairs, but then i would get them situationally later (on long bridges and waiting in traffic). So its hard to say.

Im sorry if i offended anyone. i really didnt mean it!

#6 DelphicDragon

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Posted 25 March 2009 - 09:59 AM

Ana_22-

I'm not offended at all, just trying to clarify things for you. This is a touchy subject for a lot of people because we were diagnosed as "crazy" even though there was something physical going on, simply because the doctor didn't have the knowledge to look for something out of the ordinary that might be causing our symptoms.

I truly wonder how many people out there are being treated for panic attacks when they really have dysautonomia. (Ex- A friend of mine gets "panic attacks" that go away when he lies down; he was being treated with Benzo's not Florinef and surprisingly the attacks still occur - now he just lays down if he feels an attack coming on - his official diagnosis is panic disorder!)

I would have to say that POTS causes panic - any person would panic with a heartrate of 160+! I don't know if you'll ever know which came first (chicken or the egg type of thing). Personally, because I have EDS as well, I think POTS is just part of the picture of the disorder. I didn't know what to call it when I was little - hence I called it feeling "stressed", now I know it's a POTS attack.

Sara

#7 EarthMother

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Posted 25 March 2009 - 10:03 AM

Likewise, I wasn't offended at all. Sorry if my soapbox rant seemed personal, it was not my intent. Its brave to talk about these things ... we often don't mention panic symptoms for the exact reasons Suzy described -- we get meds pushed on us and end up a lot worse than when we started. My severe POTS crash last summer was predicated in exactly that manner.

Thanks for raising the issue and letting all of us have opportunity to add a shout out.

~EM

#8 all4family

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Posted 25 March 2009 - 10:26 AM

I second what sara and EM said here. I am not offended at all. I just went through a lot of mis-treatment that should not have occured because I wasn't willing to accept the psychological diagnoses I was given. I was treated very badly because they believed I had a mental disorder. I do not think people with true mental disorders should be treated like I was. I feel very bad for them.

I hope you find an answer for your "panic attacks" I think many times feeling bad, or sick, for me, did leave me to feel scared, or "panic" simply because I didn't know what was wrong, and because it does feel scarey to feel like this. Getting the dignoses took much of my fears away.

Suzy

#9 ana_22

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Posted 25 March 2009 - 08:20 PM

no worries guys.

x

#10 ramakentesh

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Posted 27 March 2009 - 03:43 AM

I can inform you that they ARE related.
If POTS in patients is caused by faulty reuptake of norepinephrine due to hypermethylation of the NEt gene promoter then that is a definitive connection because faulty reuptake of NE has already been implicated in Panic disorder itself (Esler, et al.)
That being said - all forms of POTS result in an increase in sympathetic nervous system activity - which results in increases in NE and E - and all patients of POTS display some level increased anxiety or hypervigilance (its part of the description nowdays).
its like having an overactive thyroid - it results in anxiety and panic type symtpoms - and anxiety and stress can trigger POTS symptoms creating a nasty little vicious cycle :blink:

#11 Ernie

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Posted 29 March 2009 - 02:59 AM

Hi,

I asked this same question to Dr Goldstein who said that they are totally different. In POTS the catecholamines go way over the normal range. In true panic attack catecholamines stay within the normal range.

And as the other have mentioned for POTS triggers are orthostatic and for panic triggers can be all sorts of things.

#12 vemee

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Posted 29 March 2009 - 09:05 AM

In an earlier thread Ramakentesh stated that some pots patients try to regulate their symptoms through their carotid artery which involves releasing a lot of adrenalin and norepinephrine ( this is not a direct quote so forgive me if I am off a little. The thread it can be found in is titled anxiety.) I found this to be very interesting since years ago I was told that even though I am not diabetic my body manages my blood sugar the same way; the glucose levels never go out of the normal ranges but my body overreacts to dropping levels by sending in adrenalin and then thinks I have too much so it dumps glucose into the urine. I wonder if it does the same in pots because my norepinephrine levels are high and so are my irritation levels.

Ramakentesh, where can I find the research that you have found on pots and the fight and flight syndrome? I would like to show it to my doctors . Presently it is being treated as a bipolar problem but I really do not think I am bipolar. I was diagnosed while having a reaction to coming off cymbalta which increases norepinephrine. I don't have the mood swings but I do have the irritation that neither tegretol or effexxor (they couldn't get it through their heads that my norepinephrine levels were too high) controlled. I am off all psych drugs now to see what exactly I am like . I feel the problem is related to pots but once you get labled with a psychotic disorder that is all doctors see. Fortunately, I have a pots doctor who believes my problem are from the high amounts of norepinephrine the body puts out in trying to control my severe pooling.

#13 ramakentesh

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Posted 04 April 2009 - 03:15 AM

Ernie summed it up. Excessive norepinephrine to orthostatic stress is a clear indicator that some is wrong that goes beyond just panic disorder.
nearly all the research available about what they call the hyperadrenergic variety of POTS mentions the excessive norepinephrine so that would be a good place to start.
The stuff by the Baker Institute on excessive adrenalin was not published.

#14 doctorguest

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Posted 04 April 2009 - 11:38 AM

There is currently a debate about a relationship between POTS and anxiety disorders. As someone here pointed out, the Baker institute researchers contend that these two disorders are on the same spectrum. However, more studies are coming out against it than for it. In fact, it's been shown by other researchers that patients with POTS DO NOT have a higher prevalence of anxiety disorders than the general population and that POTS and panic disorders have different symptoms and can be distinguished. Obviously, some patients have both POTS and panic disorder, in the same way as some patients have both POTS and Irritable Bowel Syndrome. However, at this point there is no scientific evidence to claim that patients with POTS are more likely to have anxiety or panic disorders. Yes, some well-known ANS specialists claim through their obvservation that patients with POTS have increased somatic vigilance and appear to be anxious, but that does amount to scientific evidence - rather it is anecdotal evidence that has not been substantiated in clinical studies. Until such studies appear in literature, nobody can conclusively state that POTS and anxiety disorders are related.

#15 sugartwin

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Posted 23 January 2011 - 02:13 AM

I feel really sensitively toward the idea that POTS and anxiety disorder are on some sort of spectrum. They are related, but not as on a spectrum with POTS being tantamount to a severe anxiety attack. A woman who comes in from the cold with her eyes streaming tears is not "crying." People who release large amounts of adrenaline into their blood to maintain perfusion are not "anxious."

It was this assumption that nearly killed me. My doctors saw me hyperventilating and gave me a cocktail of psychiatric medications to 'calm me down.' My circulation collapsed and I de-saturated.

So not only do I consider such research to be misguided, I also find it irresponsible.