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POTS and Anxiety
For many years, a number of usually female, healthy looking, and often young, patients have been going to see their cardiologists complaining of heart palpitations, chest tightness, anxiety, and fatigue. These patients were found to generally have elevated heart rates but their labs and scans largely looked healthy and normal.
These women were diagnosed with anxiety and were told that it was causing their heart issues and lack of energy. In these settings, the typical treatment for anxiety is an anti-depression medication, a sedative, and they may recommend counseling.
In other instances, some patients would complain to their doctor of being in pain and fatigued. They experienced burning, numbing, and/or tingling in their extremities. These patients were usually diagnosed with fibromyalgia.
Fibromyalgia became a blanket term for anyone with pain and fatigue who looked normal and whose CT scans, and blood work came back normal. Doctors would then recommend over the counter pain relievers, or they would prescribe antidepressants or an anti-seizure medication to reduce pain.
Thankfully, as time has gone on, many of these patients in both examples have since been diagnosed with POTS and better treatment options are available.
What is POTS?
POTS is short for Postural Orthostatic Tachycardia Syndrome and affects largely women between the ages of 15 and 50 years old. When a patient with POTS stands, much of the blood in their body pools in their legs and causes their heart rate to rise. Due to this phenomena, there is a cascade of other possible symptoms.
Symptoms can vary from patient to patient, but the more common symptoms include anxiety, fatigue, dizziness, heart palpitations, and brain fog. Less common symptoms include digestion difficulties, nausea, fainting, trouble sleeping, sensitivity to cold or heat, dilated pupils, sweating, headaches/migraines, chest pain, onset of new allergies, peripheral neuropathy, and blood pooling in the legs.
What Causes POTS?
Today, the common consensus is that POTS is caused by a sudden burst of adrenaline that turns into a stream of adrenaline that stays high.
Like a typical person would experience a rush of adrenaline after witnessing a car accident, and it would probably result in feeling jittery, tremulous, and having some anxiety that lasts a while, a patient with POTS could experience this constantly.
The vast majority of POTS patients also have an autoimmune component where the immune system attacks one or more of the many relays in the brain’s vestibular system which should then send signals down the spinal cord into the sympathetic nervous system to tell it to send the blood back up to the brain. Because of the autoimmune attacks however, this signal is either not sent or it is not received.
In reaction to this, the heart works harder and faster to pump blood back up to the brain because the blood has begun to pool in the legs of our patient. As a result of this, adrenaline kicks in to help out the heart beat even faster and stronger and consequently the POTS patient experiences anxiety, fatigue, heart palpitations, dizziness, possibly even Mast Cell disorders, Ehlers-Danlos, and varying types of neuropathy.
Interoception
“Interoception is a sense that provides information about the internal condition of our body—how our body is feeling on the inside. Interoception allows us to experience many body sensations such as a growling stomach, dry mouth, tense muscles or racing heart. Awareness of these body sensations enables us to experience essential emotions such as hunger, fullness, thirst, pain, body temperature, need for the bathroom, sexual arousal, relaxation, anxiety, sadness, frustration and safety.”
So imagine, if your interoception was dysfunctional and there was a lack of awareness of what is going on in your body? Or imagine that you are over aware of what is happening in your body? Either dysfunction could result in eating disorders, potty training difficulties, poor reactions to pain, etc.
A study was done to test the hypothesis that the anxiety in POTS patients has more to do with interoception than psychological stress that comes from trauma. They found that POTS patients indeed suffered from anxiety but in a physical form: stomach aches, heart palpitations, dizziness, lightheadedness, fatigue, insomnia, headache rather than concern or worry. They also found that this physical anxiety was probably caused by interoception dysregulation that actually triggers the anxiety because the POTS patient is hyper-aware of some of the body systems that are functioning abnormally.
The abnormal body functions create anxiety.
Another study was published that showed diminished gray matter volume in certain parts of the brain which suggests a link between this physical anxiety that comes from faulty interoception and an “increased vulnerability” to mental illness in POTS patients.
A further study affirmed that psychological symptoms are secondary to the physical symptoms. Anxiety is the result of POTS and not the cause of POTS.
POTS patients are not crazy, there is a very real physiological issue.
Broken down very simplistically, POTS is a disorder of adrenaline.
Here at Gates Brain Health, we fully believe that our patient’s symptoms are not imagined and that there are root causes and physiological issues to be addressed and healed. Similar to how a person would work with a personal trainer at a gym to determine the best specific exercises, diet, and lifestyle changes to meet their goals; our patients work with us to rehabilitate and re-build the density of their brain, to calm the over-reactive immune system and to regulate the flow of adrenaline through neuroplasticity exercises, diet, and lifestyle changes to reduce stress and anxiety and promote healing.
If you are ready to get your health back on track, or have any questions regarding Postural Orthostatic Tachycardia Syndrome, please contact us at (775) 507-2000 or email info@gatesbrainhealth.com
By Gemma Ward from information shared by Dr. Gates at https://youtu.be/RUIndRFJUhQ.
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