Panic Disorder And Pots
Posted 24 March 2009 - 06:12 AM
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.
Posted 24 March 2009 - 09:37 AM
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.
Posted 24 March 2009 - 10:03 AM
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. ;-)
Posted 24 March 2009 - 11:35 AM
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!!!
Posted 24 March 2009 - 03:58 PM
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!
Posted 25 March 2009 - 09:59 AM
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.
Posted 25 March 2009 - 10:03 AM
Thanks for raising the issue and letting all of us have opportunity to add a shout out.
Posted 25 March 2009 - 10:26 AM
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.
Posted 27 March 2009 - 03:43 AM
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
Posted 29 March 2009 - 02:59 AM
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.
Posted 29 March 2009 - 09:05 AM
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.
Posted 04 April 2009 - 03:15 AM
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.
Posted 04 April 2009 - 11:38 AM
Posted 23 January 2011 - 02:13 AM
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.