Postural Orthostatic Tachycardia Syndrome (POTS) is a complex disorder affecting the autonomic nervous system, the body’s control center for involuntary functions like heart rate, blood pressure, and digestion. A panic attack is a sudden, intense episode of fear that can trigger strong physical reactions, often without an apparent immediate cause. Many individuals wonder about a potential connection between POTS and panic attacks due to their similar, often alarming physical symptoms.
The Physiological Overlap
The autonomic nervous system has two main branches: the sympathetic and parasympathetic systems. In POTS, the sympathetic nervous system, responsible for the “fight or flight” response, often becomes overactive, especially when transitioning to an upright position. This overactivity can lead to a range of physical symptoms that closely resemble those experienced during a panic attack.
When someone with POTS stands up, blood can pool in the lower body, reducing blood flow back to the heart and brain. The body compensates by releasing stress hormones like norepinephrine and epinephrine to constrict blood vessels and increase heart rate. This physiological reaction can result in rapid heart rate (tachycardia), dizziness, shortness of breath, chest discomfort, and a feeling of shakiness or an internal tremor. These physical sensations can be misinterpreted by the brain as a threat, triggering feelings akin to panic, even though the underlying cause is physical dysregulation rather than a primary psychological panic disorder.
Disentangling Symptoms
Distinguishing between a POTS flare-up and a panic attack can be challenging due to the significant overlap in physical symptoms. A key distinction often lies in the trigger and the context of the symptoms. POTS symptoms are typically provoked or worsened by positional changes, such as standing up or prolonged upright posture, and often improve when lying down.
Panic attacks, in contrast, may occur suddenly and unexpectedly, sometimes without any clear external trigger, or they can be linked to specific stressors or situations. While both can involve a racing heart, sweating, and difficulty breathing, the presence of orthostatic intolerance (symptoms worsening upon standing and improving with lying down) is a hallmark of POTS. Psychological symptoms like an intense fear of losing control, derealization (feeling detached from reality), or a sense of impending doom without an obvious physiological trigger are more characteristic of a panic attack. However, the distress caused by POTS symptoms can also lead to anxiety, making the differentiation complex.
Managing Overlapping Symptoms and Anxiety
Managing the physiological symptoms of POTS can often reduce the frequency and intensity of panic-like episodes. Increasing fluid and salt intake is a common strategy to expand blood volume, which can help regulate blood pressure and heart rate. Wearing compression garments can help prevent blood from pooling in the lower extremities. Gradual and carefully managed exercise can improve cardiovascular conditioning without exacerbating symptoms.
Beyond these POTS-specific approaches, general anxiety management techniques can provide additional support. Practices such as deep breathing exercises, mindfulness, and gentle movement can help activate the parasympathetic nervous system, promoting a sense of calm. Reducing overall stress through lifestyle adjustments and pacing activities can also be beneficial, as stress can further activate the sympathetic nervous system. Eating smaller, more frequent meals instead of large ones can prevent blood from being diverted significantly to the digestive system, which can sometimes worsen POTS symptoms.
When to Consult a Healthcare Professional
Seeking medical evaluation is important if symptoms are persistent, worsening, or significantly interfering with daily life. If there is difficulty distinguishing between POTS symptoms and panic attacks, a healthcare professional can provide clarity and an accurate diagnosis. New or unusual symptoms, or if self-management strategies are not effective, also warrant medical attention.
A healthcare provider can rule out other conditions and develop an appropriate treatment plan. This professional guidance can address both POTS and any co-occurring anxiety or panic disorder, ensuring a comprehensive approach to managing these intertwined conditions.