When a person becomes symptomatic with postural orthostatic tachycardia syndrome (POTS), they can experience the physical symptoms of anxiety or a panic attack, and therefore be misdiagnosed with an anxiety disorder. Also, if a patient is diagnosed with POTS (or any other dysautonomia related condition), the symptoms of anxiety or panic attacks may evolve into a real anxiety disorder over time if they don’t get the proper psychological treatment.

Postural orthostatic tachycardia syndrome is still relatively unknown to most medical professionals and can be difficult to diagnose. Due to symptoms displayed, POTS is often misdiagnosed as anxiety and confused with a generalized anxiety disorder (GAD) or panic disorder. Individuals with this condition may struggle with symptoms for months or even years before they are finally diagnosed with POTS.

POTS and Anxiety Symptoms that Overlap

If you have POTS, you will suffer from at least two or more of the following symptoms:

Racing heart rate

Fainting

High/low blood pressure

Nervousness, feeling fidgety

Blurred vision

Troubles focusing

Nausea

Fatigue

Excessive or lack of sweating

Chest pain and racing heart during sleep

Insomnia

Tremors

Headaches

Body pains and aches

High levels of norepinephrine while standing (increased sympathetic nervous system activation)

As many of these symptoms can be seen in people with an anxiety disorder and/or panic attacks, signs of POTS and anxiety can be difficult to tell apart. While anxiety does not cause POTS and vice versa, it is not uncommon that people experience anxiety before they are diagnosed with POTS (because they don’t understand the cause of the symptoms) or after diagnosis (when a person is worried about the illness and its impact on their day-to-day life).

Anxiety is a very common condition. According to the Anxiety and Depression Association of America, anxiety disorders affect 40 million adults in the US every year, threatening to become the second most common cause of disability in the world by 2020.

Also, the parasympathetic nervous system which calms and relaxes the body by decreasing respiration and slowing down heart rate, may not be functioning normally in people with POTS. While science and medicine may not yet have the answer to treating postural orthostatic tachycardia syndrome, there are lots of strategies and treatments available to help with anxiety that is often intertwined with POTS.

Known Causes of POTS

Besides the myriad of symptom clusters that a dysfunctional autonomic nervous system (dysautonomia) causes, blood pressure and heart rate work together to keep the blood flowing at a normal pace. In people with POTS, there is too little blood returning to the heart when changing their position from lying to standing (orthostatic intolerance). This causes abnormally increased heart rate along with the feelings of lightheadedness or dizziness. The cause of postural orthostatic tachycardia syndrome is unknown. However, POTS episodes often begin after pregnancy in women and may increase right before menstruation. Also, the condition may occur after major surgery, viral illness, certain autoimmune conditions, mononucleosis, or trauma.

Relaxation Techniques and Exercise

You can alleviate anxiety by practicing relaxation and regular physical activity. Daily relaxation practice arouses your parasympathetic (calming) nervous system. Relaxation techniques like deep breathing, meditation, and yoga and exercise can boost happiness hormones (endorphins, dopamine, and serotonin) that help manage stress. This can be extremely helpful with conditions like POTS. However, make sure to choose the types of exercise that won’t cause post-exercise fatigue.

Overcoming Negative Thoughts

Our inner critic can sometimes generate anxiety by producing unhelpful thoughts. Once you recognize these negative thinking patterns you can begin to change them. Cognitive Behavioral Therapy (CBT) is one of the best techniques to challenge self-destructive thoughts and develop more successful coping strategies. Also, mindfulness meditation that involves paying close attention to experiences in the present moment with acceptance can help you alleviate anxious ruminations and build mental strength to refocus on something else.

The Quality of Life with POTS

Although each person has different experiences with POTS, in most cases, proper medications, physical activity, and adjustments in diet can improve the quality of your life. Also, addressing underlying anxiety issues can help you understand the impact anxiety may have on your condition and develop effective coping strategies.

How is Postural Orthostatic Tachycardia Syndrome Diagnosed?

Postural orthostatic tachycardia syndrome is still relatively unknown to most medical professionals and can be difficult to diagnose. Due to symptoms displayed, POTS is often misdiagnosed as anxiety and confused with a generalized anxiety disorder (GAD) or panic disorder. Individuals with this condition may struggle with symptoms for months or even years before they are finally diagnosed with POTS. To be diagnosed with POTS, you need to have a heart rate increase of 30 beats per minute or more within the first 10 minutes of standing.

If you often feel lightheaded or faint, your doctor may suggest a Tilt Table Test. This test measures how your heart rate and blood pressure will react to the gravity force. While you are lying on a table, the table is slowly tilted upward. A technician or nurse records if and how your blood pressure and heart rate change during the test.

Brent P. Goodman, M.D., discusses Postural Orthostatic Tachycardia Syndrome (POTS).

The Tilt Table Test is the most commonly used test for POTS diagnosis. However, sometimes the Tilt Table Test may not be available. In that case, a doctor may take bedside measurements of heart rate and blood pressure in the lying down and standing position at two, five, and ten minutes intervals.

It is estimated that postural orthostatic tachycardia syndrome affects between 1.000,00 and 3.000,00 Americans and millions of people worldwide each year.

Other tests for postural orthostatic tachycardia syndrome may include:

Echocardiogram

Blood and urine test

Autonomic breathing test

Thermoregulatory Sweat Test (TST)

Conclusion

So, many people happen to have both anxiety and POTS at the same time. Although POTS symptoms are not harmful and life-threatening, they can still feel very scary. Adding frightening thoughts, worry, and apprehension can aggravate the symptoms. Also, concern about your illness and worry about what the future will bring can cause stress and feelings of hopelessness and sadness. Furthermore, a constant low mood can over time turn into depression. Talk to your doctor or mental health professional if you experience these type of overlapping symptoms.