The Truth About POTS And Anxiety

Is POTS (Postural Orthostatic Tachycardia Syndrome) just anxiety? Many physicians certainly seem to think so.

POTS Versus Anxiety

If you read through the dysautonomia message boards, you will likely find a massive stock of angered posts about physicians dismissing dysautonomia symptoms as anxiety. While there is definitely a difference between POTS/dysautonomia and anxiety, POTS certainly does look like anxiety at first glance.

This similarity is due to the many overlapping symptoms between generalized anxiety disorder and POTS. Fast heart rate, excess sweating, shaking, difficulty breathing, generalized nervousness and stomach upset are typical POTS symptoms that are often misunderstood as anxiety.

Having anxiety myself, I can see how the two conditions can be similar, but they are definitely separate issues.

POTS-specific anxiety-like symptoms are best described as body anxiety, whereas anxiety symptoms begin with psychological anxiety, which later produces body anxiety. POTS anxiety symptoms usually are not associated with any nervous thoughts and can be improved upon laying down.

This phenomenon is typical of adrenaline surges associated with POTS and is completely separate from a panic attack caused by a psychological trigger.

However, the two conditions can definitely become intertwined. If you have health anxiety, for example, then worsening POTS symptoms can cause psychological stress, which will then open the flight-or-fight floodgates and further worsen POTS symptoms.

The Diagnosis Barrier

As someone whose POTS was originally dismissed by doctors as having “anxiety that’s common among young women,” I understand the frustration in trying to overcome cultural barriers in healthcare that surround women to find correct diagnoses.

Dysautonomia, unfortunately, is one of those conditions that affect women disproportionately, with most cases occurring in young women. Most specifically, the female to male ratio for POTS is 5:1 and often women present with more debilitating symptoms.

When I end up in the ER for a POTS-SVT combo episode, the providers often do not believe that I have POTS. They ask me who diagnosed me and how I know I have POTS.

Well, my orthostatic vitals typically scream I HAVE POTS, as my sit to stand heart rate difference is usually over 100 when I end up in the ER. But even those vitals sometimes make them hesitate. Only after a careful comb-through of my records do they believe that I am in fact, not “crazy.”

So if physicians are so convinced that the 1 in 100 people with POTS actually just have extreme anxiety that only seems to happen while standing, where is the medical evidence? Do many people with POTS have anxiety disorders as well?

This question has been studied well in the research world, with several studies concluding that people with POTS are actually not more likely to have anxiety disorders than people without.

So essentially, despite hard evidence through a simple orthostatic vitals test that there is something physiologically, but not psychologically, wrong with these patients, physicians still may just still be caught up in the whole “nervous young women” conundrum.

So what can you do? How can you discuss the difference with your physician?

If you have POTS/suspected POTS, but not anxiety:

• Record a log of what triggers the anxiety-like symptoms.
• Does laying down help?
• Does drinking more water help?
• Is it worse in the heat or while showering?
• Is it triggered by loud noises, bright lights, jump-scares?

If you have POTS/suspected POTS and anxiety:

• Record a log of psychological anxiety triggers
• Do you feel body-anxious in the absence of these triggers?
• Does laying down help?
• Does drinking more water help?
• Do your anxiety meds not work for these situations?
• Is it worse in the heat or while showering?
• Is it triggered by loud noises, bright lights, jump scares?

If this fails, the next step is simple: switch doctors. 

After finding a POTS doctor, I actually had a harder time trying to convince them that I do have anxiety as well, that some of my symptoms weren’t just from POTS alone. The best way to navigate this confusion for me was to work with a psychologist to identify exactly what exactly triggers my anxiety and how those situations impact my POTS.

Most specifically, the main facts that helped me differentiate between the two are the presence of anxious thoughts and whether or not my heart medication works. Since I take ivabradine/Corlanor, the medication has no effect against adrenaline surges, from POTS or anxiety.

If I am feeling super body-anxious, but have no anxious thoughts and it seems like my medication has suddenly stopped working, I am having an adrenaline surge.

If I am feeling super body-anxious, am having anxious thoughts, and again, ivabradine/Corlanor suddenly took a vacation, then I am having issues with anxiety.

For more information about adrenaline surges and POTS, check out this article.