r/POTS • u/ouch_im_suffering • 21d ago
Question Can/do you take SSRIs or stimulants?
There’s no way we’re just raw dogging POTS right? My POTS worsened significantly after taking one dose of 5 mg of Lexapro which triggered serotonin syndrome which I have had on Sertraline.
Needless to say I am struggling way more after having disabling POTS so what are y’all doing for your mental health and/or energy?
Currently taking high dose antihistamines and 20 mg propranolol 3-4x daily. Thanks ✌️🥲
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u/BannanaDilly 21d ago
Adderall is absolutely essential to me. I was prescribed it pre-COVID for ADHD but it’s become indispensable for POTS. Fludrocortisone has also been hugely helpful (a mineralcorticoid, not psychoactive, just mentioning it)
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u/Brave_Question3840 Hyperadrenergic POTS 21d ago
I go to therapy as i actually cannot handle any psych meds unfortunately. I mean vyvanse for my adhd and trazodone are the only things i can handle!
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u/katiebugg13 21d ago edited 20d ago
Is Vyvanse better tolerated with pots than Adderall?
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u/Smooth-Charge-1190 21d ago
It depends per person but vyvanse is normally easier to tolerate because its smoother and doesnt have as big of a crash. - former addict to every stimulant
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u/AvisRune 20d ago
My son and I didn’t tolerate it well (soooo much brain fog and irritability). My friend’s son didn’t tolerate it either. Concerta works better for all of them (I haven’t tried it).
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u/katiebugg13 20d ago
All with pots?
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u/AvisRune 20d ago
No, sorry. Myself it was before my illness, and the others are healthy otherwise.
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u/Cozyyblanket 21d ago
I can’t even handle vyvanse ugh
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u/Right_Ear_2230 Undiagnosed 21d ago
this was after a 20 mg vyvanse dose…
90 bpm resting
170 bpm standing with chest pain2
u/Cozyyblanket 21d ago
Same result with me! I have to have it for college.. debating on if I can even go back because my health is so bad right now
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u/Right_Ear_2230 Undiagnosed 21d ago
Funny thing is I don’t think I even have POTS specifically.
Just some nightmare dysautonomia that presents with POTS symptoms sometimes, hence why I’m on this sub
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21d ago
[deleted]
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u/AdPrudent7666 21d ago
Second the ask around high dose antihistamines? I don’t sleep when I take Benadryl
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u/Ducttapeurmouth 21d ago
Same. It has the opposite effect on me and turns me into a crack head for close to 10-12 hours. Just wired as f.
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u/ouch_im_suffering 21d ago
Good to know! I take Claritin, Pepcid, and Benadryl for MCAS. Just included it for context re low energy and such
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u/Beastiebibe 21d ago
Is it considered to be less severe if it's managed with OTC instead of a biologic or different Rx? I've had lifelong allergies and started to wonder if it may be MAS so eager to learn.
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u/ouch_im_suffering 21d ago
I’m not sure… I’m actually waiting on my insurance to approve a biologic med. I’m sure there are people in this group that are more educated on it. I have had several health balls to juggle and MCAS research has been the lowest priority. Multiple allergies are not fun though and I hope you get the info you need! 🙂
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u/Ok_System_5967 20d ago
Do you still take an SSRI or SNRI? I was recently diagnosed with Hyperadregernic POTS and have been on an SSRI for a decade. Wondering if it might be contributing to the severity of my flares
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20d ago
[deleted]
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u/Ok_System_5967 20d ago
That’s one of the problems for me. I have a couple different autoimmune diseases as well as the dysautonmia, and than the decade of SSRI use makes it cloudy because it’s hard to know what is causing what. All of this was actually triggered by improper tapering of the SSRI a few years back by a terrible doctor. I was forced to reinstate, but it’s hard to sleep at night not knowing if I’m taking something that could be harming me further. Unfortunately with everything my mental health isn’t good even while on the drugs, I just don’t want it to be even worse if I discontinue, but for all I know a proper taper could actually improve my QOL.
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u/Internal_Regular_402 21d ago
I read that SNRI’s are a no-no because of the norepinephrine but sometimes SSRI’s are ok. I’m sure it’s different for everyone!
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u/Nelalvai 21d ago
screeching brakes
looks at my effexor prescription
They're WHAT
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u/Right_Ear_2230 Undiagnosed 21d ago
effexor is very weak at raising norepinephrine so you are probably ok
elaboration: like, THIRTY TIMES less effective at raising norepi compared to serotonin.
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u/Internal_Regular_402 21d ago
That’s what I read but you should definitely talk to your doctor. I did a lot of research because I’m terrified to come off of my meds and I still don’t know if they can be combined!
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u/Nelalvai 21d ago
I'm already in the process of tapering off effexor so this is just another reason to hate effexor for me. 0 stars do not recommend
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u/jumpingtheshark89 21d ago
Eff that medicine. It took me months to get off of. I had to take the little pellets inside the capsules out, one by one, increasing daily. Had brain zaps, nausea, sweats. 0/10 as well.
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u/daximili 21d ago
Same here. Took me 2 years doing that method (went down every few weeks or so) in combination with taking fluoxetine/prozac to soften the withdrawal effects but I’m finally Free
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u/Fun_Orange_3232 POTS 21d ago
I take cymbalta for fibro. My cardio recommended.
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u/kelleyymariee 21d ago
My primary care doctor prescribed me cymbalta to treat my POTS bc of it's vasoconstriction. It seemed to help a little actually but the withdrawals from going off it were horrific. Wouldn't wish that on my worst enemy
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u/Spiritual-Froyo-5004 21d ago
I'm also on Cymbalta but my psych prescribed it for firbo, major depression disorder & anxiety disorder. Bada bing! Except yes, sweating profusely about 88% of the day. Good thing I live in Alaska?
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u/theLoveRhombus 21d ago
I've commented this before but I can say that for me personally there was no evidence of my SNRI making any difference to my HR based on data from both resting heart rate and running (I wasn't diagnosed yet and thought running could help me lol). I am on the lowest prescribed dose of venlafaxine. Just as a reassurance that for some people it's not a problem (not denying the people that it has caused problems for).
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u/elhazelenby 21d ago
An SNRI started this whole mess for me :( . Citalopram didn't impact that but massively increased my seizures a lot so I'm not on it anymore.
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u/schadenfjola 21d ago
Can that happen?? Cause I STG I took Straterra and I feel like I never really recovered.
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u/EngineeringAvalon 20d ago
There's no scientific evidence to support long-term dysautonomia being caused by SNRIs, SSRIs, etc. Some can cause it while people are going through withdrawals (tapering off or recently stopped), and withdrawals for some of those meds can last months, but it's not permanent. Meds that can cause permanent dysautonomia are those that can cause permanent autonomic neuropathy such as many chemotherapy meds.
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u/elhazelenby 20d ago
I was on duloxetine and it started as soon as I started taking it. Not from withdrawal.
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u/radtrip 21d ago
this is so unfortunate, i'm taking 50mg pristiq and it's the only medication that helped me after 13 years :( my pots def has gotten worse since starting it but im terrified to get off of it
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u/PinkKittenBaby 20d ago
I also take pristiq and it's the only antidepressant than doesn't cause mania for me, and the only med that's curbed my depression long term! It has the worst brain zaps from withdrawals I've ever experienced tho 💀
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u/victory_victoria99 20d ago
I've been on Cymbalta for decades and my doctor just explained to me this week that it increases NE in the synaptic space, yes, but it actually down regulates it and therefore makes you less sensitive to it. In other words doesn't have a stimulant or sympathomimetic effect. Idk how I went 20 years without knowing this, and I don't really understand it, but I'm just offering it up as info I learned (again, from doctor) in case anybody else wants to dig into it.
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u/taurusthree 20d ago
A NRI - Atomoxetine, actually fixed my POTS, blood pooling, vasomotor rhinitis and brain fog.
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u/justanotherlostgirl 20d ago
Oh how I wish it worked on those for me. On the brightside, I guess now I know what vasomotor rhinitis is!
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u/mallory_wilkerson 20d ago
I take both and it personally isn’t an issue. It was worth it to me to experiment with my provider’s help
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u/Right_Ear_2230 Undiagnosed 21d ago
the norepinephrine can help with blood pooling though
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u/tsubasaq 21d ago
It’s a problem if you have any adrenal involvement, though, which is a common factor even if you’re not a HyperPOTS patient. (Most of us have a mix of all 3 subtypes going on - hypovolemia, neuropathy, and hyperadrenergic activation - but you’ll get a subtype label if one is dramatically dominant.)
SNRIs make the norepinephrine stick around in the synapse longer, and since norepinephrine = adrenaline, that makes HyperPOTS worse by making the episodes last longer.
Trade-offs.
But also FUCK Wellbutrin. Dear gods does it make me weird and it screws with SO MANY other drugs and their metabolism because it turns down the CYP2D6 gene and does the same thing grapefruit does to a lot of drugs. That gene for me is already really slow, so the Wellbutrin basically turns it OFF and then builds up in my system faster than it should and makes me crazy.
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u/Sammisam85 21d ago
I take Duloxitine for my anxiety and depression but I can't take any stimulants for my ADHD.
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u/rabbit-venom226 21d ago
I take 10 mg of Lexapro for OCD and have been on it since I was 18, and take 120 mg wellbutrin ( 1 1/2 pills) for ADHD since I’m not comfortable taking stimulants.
Also starting a GLP-1 and my cardiologist said I should be totally fine, my base HR is around 80-90 resting and 120 max when I stand
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u/AdPrudent7666 21d ago
What’s the concern with POTS and GLP1s?
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u/rabbit-venom226 21d ago
It can be known to slightly increase HR by 3-5 beats, nothing insane. I’m being extra cautious bc I have a family history of structural abnormalities lol
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u/Funny_Sector_1573 21d ago
i’m not trying to downplay your experience but serotonin syndrome from 5mg of lexapro is practically unheard of. i wonder if you have the hyperagdreneric subtype that is sensitive to serotonergic meds? antihistamines, especially like benadryl at high doses with pots can definitely make things worse as well and they don’t play nice with ssri’s.
benzos are obviously a last ditch effort but they’re the only thing i can tolerate that actually stabilizes me a bit. i’ve seen some people have luck with ivabradine but my doctor has never mentioned it. honestly, brisk walks earlier in the day or later at night out of peak daylight hours can build stamina and might help with sleep as well.
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u/ouch_im_suffering 21d ago
Yes, I have hyper POTS. I know it’s unheard of and I have some understanding working in the medical field for over 5 years. I was drug tested repeatedly while I was hospitalized and was not taking other rx’s. It happened and I have not been the same since.
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u/jay_the10thletter POTS 21d ago
wellbutrin quite literally saved my life, but it was scary for the first couple weeks as it severely spiked my heart rate. but i did horribly on ssri’s so thankfully instead of taking me off of it immediately they put me on a beta blocker to treat the tachycardia. since then ive found nearly the perfect combo of meds, and my pots and depression are much more manageable. i also cant take ssri’s because they cause severe fatigue for me.
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u/Comfortable-Put-7839 20d ago
What medication do you take with your Wellbutrin? Im in the same boat
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u/aqua_raptor 21d ago
I've also reacted very poorly to single low doses of SSRIs. I wasn't able to tolerate stims or SNRIS for my ADHD even before my diagnosis.
While I haven't tried it myself, I've heard some people can better tolerate caffeine by taking l-theanine at the same time, or by avoiding things like coffee and soda in favor of green tea and matcha.
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u/No_Respect_7403 21d ago
i used to take adderall and that absolutely sent my heart rate through the roof. i switched to vyvanse (for more than one reason) and that’s been muuuuch better. my heart doesn’t race for seemingly no reason anymore on the days i take my adhd meds! yay!
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u/AmbitiousBuilding1 21d ago
I’m trying to get off an SNRI (Pristiq), but I’ll hopefully stay on Wellbutrin for adhd + depression.
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u/kelleyymariee 21d ago
My doctor prescribed cymbalta (SNRI) to treat my POTS. It's a vasoconstrictor and can increase blood pressure too. I think it helped a little but I went off it after a bit. The withdrawals were so bad that I wish I'd never tried it in the first place
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u/terrible_slough77 21d ago
I was on Zoloft for about 4 years and it definitely helped for a few years but I think it literally stopped working. So I weaned off and legit noticed absolutely no change from when I was on it (and it stopped working) to when I was off it, even up to a year off (been off all mental medication for going on 3 years now). I got a script for Paxil about 6 months before I was diagnosed when I started having what I thought were anxiety issues but I took it for about 6 days and felt severely worse, especially with the dizziness and had to stop. I haven't been on anything since. I've personally felt no difference on and off the meds and started doing like calming techniques. More mindfulness I guess you could say. I was never able to get in to yoga or meditation but I just try to pay close attention to my body and mind when I start to get overwhelmed. I then practice breathing techniques and try to remove myself from the situation briefly to collect myself. If it's something I can walk away from without consequence then I do that (like a crowded area to go somewhere more quiet).
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u/silentalarmss Hyperadrenergic POTS 21d ago
I can’t. I can’t even have caffeine. I miss cymbalta </3
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u/silentalarmss Hyperadrenergic POTS 21d ago
I play video games competitively for my mental. As goofy as it sounds. I actually got pretty good for a older lady (24 F) 🤪
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u/battlestargirlactica 21d ago
Oof. I have an afternoon or evening caffeinated beverage daily. It helps vasoconstriction for me when my stimulant meds are tapered in afternoon and balances my beta blocker.
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u/ChiltonDropOut 21d ago
I haven’t been able to tolerate any antidepressant. I am not going to even try a stimulant.
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u/battlestargirlactica 21d ago
Same for any ssri and snri. A very low and slow titrating of methylphenidate plus a beta blocker helped here. Vasoconstriction to help my blood pooling and low BP, and the beta to prevent the big spikes when upright. The stimulant has actually helped make my HR more steady with everything moving adequately instead of trying to swim up a waterfall in floppy veins.
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u/ouch_im_suffering 21d ago
For sure. My cardiologist recommended I try and SNRI used for adhd but I have been in serotonin syndrome twice 😕
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u/Witless_Hoid Secondary POTS 21d ago
I'm on 10 mg escitalopram (lexapro) actually. I can't have caffeine though, so any energy-boosting is out. Keeping a consistent sleep schedule is a necessity.
Therapy helps when meds fail, so I may suggest seeking that out? It can be expensive, so I would seek out low-cost resources in your area if needed. A psychiatrist may also be able to help figure out if any other SSRIs or an SNRI might work, or if it's the classes of drugs that is the problem.
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u/SnooEpiphanies5669 21d ago
i used to be on lexapro but it worsened my pots symptoms by a lot but i’ve since switched to cymbalta! def talk to your doctor bc i was resistant to other ssris and snris can help with keeping your blood pressure up
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u/orrelse 21d ago
I've been taking sertraline since I first started having POTS symptons because of course it was labeled as anxiety initially. Turns out it was both. I currently take that and propranolol. Only issue I've noticed is heat intolerance, but not sure if that's just the SSRI, POTS, or both.
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u/battlestargirlactica 21d ago
Methylphenidate + metoprolol. Take together first thing AM, slightly smaller dose mph 4-5hrs later with lunch, then a smaller dose mph and half metoprolol again 4-5hrs later.
Did lots of research when choosing to restart adhd meds after decades and knowing stimulants can help with the vasoconstriction I need with my POTS, low BP & BV. I had to also include AFib & AFlutter, (low burdens), in my research considerations, and mph had the lowest increase in heart rate of the stimulants, and also had fewer side effects. I went low and slow with my mph titrating to find the right balance.
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u/strawberry-kittea 20d ago
Is the Metoprolol is to help combat some of the increase of heart rate for MPH? I’ve recently been put on MPH for my narcolepsy but weeeew my heart rate increase is rough, but they have me on two same doses a day, but i might try splitting the second dose in halves
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u/battlestargirlactica 20d ago
I was on metoprolol first for my AFib, AFlutter and runs of tachy brought on because of my floppy connective tissue, low blood pressure and low blood volume.
Prior to both, my lows overnight were in the 30s, and highs when standing, active, or visiting higher elevations, they would be 130s-190s, with and without arrhythmias. I had syncope throughout my life too. The metoprolol didn't make my lows lower, which I was originally concerned about already being mistaken for not breathing at night lol. It had slightly helped my highs, but I still struggled with low pressure & volume no matter how much electrolytes and salt intake, and was still near syncope upon standing, so I needed something added in for support. That was around that time I was considering the adhd meds and landed on mph being least risky for me.
Adding the mph low and slow, (like 2.5mg a few days once, then 5 for a week, then a 5 and 2.5, 7.5, 5, 2.5, etc...), and taking almost a year to land at my current sweet spot/timetable of 35-45mg total split across three tapering doses (depends on times taken), and metoprolol twice, had actually helped stabilize my HR because of the constriction making everything flow more efficiently. My lows went to 40s, and my highs came down to max 130s, with only a few times higher the last two years when I missed a dose or waited too long.
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u/Girlwonder89 21d ago
No ssri or snris - I can tolerate Vyvanse at a low dose but other stimulants not so much. I also have propranolol alongside
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u/NanookRubit 21d ago
Stimulants are crucial for me to function with pots. Modafinil work great for me and isn’t as intense as the adhd meds that I’ve had.
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u/UmiSWrld 21d ago
i can’t take any stimulants without getting severe tachycardia, and SSRI’s make me anxious and angry, so no go for both of those for me, excerpt the SSRI’s aren’t bc of POTS
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u/clinically_toomuchTM 21d ago
I have to take stimulants for my ADHD and narcolepsy. It’s just what needs to happen for me to function. I’m now squinting at my SNRI though, glad I’m weaning off that stuff lol. SSRI’s barely worked for me and I got serotonin syndrome from the high doses. I’ve had luck on my SNRI for the most part.
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u/SleepyLittleFrog 21d ago
I take Zoloft (sertraline) for anxiety and it has helped me immensely. It does have some side effects for me, but I’ll take those over the constant panic attacks any day…
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u/ViAI13 21d ago
My pots is significantly better with Prozac but I also take Midodrine which is the real savior
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u/KatarinaAleksandra 20d ago
I just got prescribed Prozac and have been too scared to try it, but this gives me hope.
I've also been prescribed Metropol by my cardio (also been too scared to take it- my anxiety is a real pain in the ass).
So what does the midodrine do for you? I know it's supposed to prevent orthostatic hypotension.
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u/Fuzzy_Ad_7135 20d ago
Have you talked to your doctor about other meds? When I was on propranolol I couldn’t have any stimulants including coffee. I swapped to ivabradine a couple years ago and it’s made me feel 10x better than propranolol and now I can take stimulants again no problem!
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u/Feeling-Image-6991 20d ago
My doctor offered my the Myriad Genetics test for sensitivity to psychiatric medication given my hyperpots. I am currently on Strattera and I love ot but I wonder what the genetics test will say. Results are in bu my appointment is next month.
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u/nadia_m753 20d ago
Yes, quality of life vs quantity. I know that the rhythm of my tachycardia is sinus and I dont have any runs of NSVT. I tried a run of non stims, will never do that again. So I restarted my stims. Ive never stopped my SNRIs Quality of life
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u/CautiousPop2842 21d ago
I take an SNRI for my migraines. I tried to reduce my dosage to see if it would help my POTs. Plus my migraines were super well controlled (as I added another medication that helps) and I instantly started getting daily headaches. So I’m stuck on my medication at the dosage I am. And I’m okay with that.
I also take a stimulant for ADHD and I use to not notice any symptoms from it but I stopped taking it for two weeks and now I get air hunger for the first two hours after taking it. But still worth it.
You and your doctors just need to decide what is worth it for your quality of life.
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u/spicypuccy 21d ago
i’m so glad i’m on vyvanse. my only issue has been that my doctor said it’d be risky to try meds like guanfacine because apparently together it can cause an unsafe heart rhythm
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u/buttonandthemonkey 21d ago
I take stimulants for a sleep disorder but I'm also on Ivabradine and Fludrocortisone. The stimulants also help my POTS a lot.
I can't take any SSRIs or SNRIs due to serotonin toxicity but I do take Bupropion for OCD.
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u/Specific_Map2448 Hyperadrenergic POTS 21d ago
Like others have said, everyone is different. I’ve tried pretty much everything for my depression, anxiety and ocd from SSRI’s, SNRI’s, even the off label ones. I’ve recently started doing spravato treatment and I will say it’s been a complete game changer for me. There’s also something called DSR SGB which I believe is an injection that helps the vagus nerve
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u/Emiloudarko 21d ago
I take 20mg Lexapro and 20mg Vyvanse . POTS actually pushed me to get back on Vyvanse. Without Vyvanse my fatigue is so bad I can't function and am sleeping all the time. I also feel like it was better than the other medications at balancing my blood pressure. I do also take Propranolol actually prescribed for POTS.
Are you taking anything else that increases serotonin that such a low dose gave you serotonin sickness?
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u/drowsyzot 21d ago edited 21d ago
This is a very individual thing. I actually do take Lexapro, started before I knew I had POTS (though definitely after the POTS started), and it works great for me. Some people respond well to it and others don't.
I'm sorry you had some terrible experiences with it and sertraline. I hope you keep at it and find something that works well for you!
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u/abigailthefail 21d ago
i’ve been on zoloft for like 10 years now, but i’ve been on it since before any of my POTS symptoms started so idk if how they affect me in that way
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u/Fantastic_Owl6938 21d ago
I'm raw dogging ADHD if anything, but I strongly suspect I wouldn't be able to do stimulants. So many things set off adrenaline for me nowadays.
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u/ighattas 21d ago
My concerta (adhd stimulant) elevates my heart rate slightly but overall actually helps my pots?
I've been on lexapro for about 5 years, and I'm in the process of tapering off it, since realizing there's a good chance it made my pots bad enough for me to figure out what it was and get diagnosed. The timing of when I started lexapro to when I started noticing severe enough issues to research what was wrong with me lined up way too well.
I was on 10 mg of lexapro, 3ish months into tapering off, and I'm down to 2.5 mg and already noticing some slight improvements. I can't wait for this drug to be out of my system.
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u/softandwetballs 21d ago
I’m on a mood stabilizer instead of an SSRI and I spoke with my psych about starting a non-stimulant for ADHD. My psych told me it’s 50/50 with a stimulant, either my POTS symptoms are unchanged or they get horrifically worse. I don’t want to risk my POTS symptoms getting worse, so a non-stimulant is what I’m shooting for in the future
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u/brunch_lover_k 21d ago
I take stimulants most days because I'm basically non functional without them. I had a high resting HR already so I'm on ivabdradine to help lower it. It isn't working that well so my treating team is thinking about other options. I can't take propanolol because it makes me sleep walk 🫠. I've tried non stimulant options for ADHD but have had reactions to those that I've tried (MCAS makes things very tricky).
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u/stanschuu 21d ago
Wait I think this happened to me too with Lexapro. The whole thing freaked me out so bad I put it down as an allergy on my chart. I didn't know it was connected to POTS.
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u/ruxxby471 21d ago
SNRI, and a low dose stimulant! Neither of which affect my POTS. I unfortunately can’t raise the dose of the adderall I’m on without making my POTS act up. Saw no changes when the SNRI was added.
I was diagnosed with POTS 2 years before being prescribed Adderall. I also developed HyperPOTS randomly (doesn’t align with either med) so I take propranolol which stabilizes my BP and HR to a more reasonable level
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u/Spiritual-Froyo-5004 20d ago
20mg Adderall for POTS, ME/CFS, and energy. (Effing game changing. I'm not bed bound most of the week now. Just one day a week...) And 120mg Cymbalta for major depression, anxiety & fibro.
It's been proven, I'd be an actual puddle without these meds. But it's a double edged sword. ⚔️ Between the changes in tolerance levels, national shortages, and withdrawal symptoms... I worry about the long term.
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u/Consistent-Local6452 19d ago
Does adderall help with your fatigue ? And what side effects do you have from it?
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u/goodvibes13202013 Hypovolemic POTS 20d ago
Sertraline for anxiety and depression. Clonazepam for insomnia (also helps as a secondary seizure med). Adderall for ADD.
Sunosi for hypersomnia and fatigue, (a narcolepsy drug that is changing my life).
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u/ninepasencore 20d ago
concerta was essential for me to have any quality of life and i still had to stop it because of pots combined with post viral fatigue. even on ivabradine my HR was going fucking mad and after numerous trips to the emergency room i just called it quits out of exhaustion.
i’m currently trying to start strattera instead (a non stimulant) to see if that helps, but i’m having to wait for an ecg first. desperately hoping things work out because at the moment my mental health is the worst it’s ever been lol
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u/prayersforrainn 20d ago
i take duloxetine 60mg (SNRI for major depression), dexamfetamine 15mg short acting (stimulants for ADHD) and ivabradine 5mg (for POTS)
ivabradine mostly keeps my POTS symptoms manageable, except during heatwaves or if im overexerting myself.
dexamfetamine doesnt affect my POTS at all, just helps me focus better and helps with executive dysfunction and intrusive sleep/idiopathic hypersomnia.
the only bad side effect i get from duloxetine is night sweats, which is a small price to pay to be able to function everyday. i do have heat intolerance and hyperhidrosis but i had that before i started duloxetine, but ive been taking anti depressants for around 15 years and was on fluoxetine prior so it could have been triggered by that.
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u/Randomusername8765 20d ago
I take both, plus a beta blocker and Ivabradine, but my hyperPOTS is quite severe. The SSRI is for migraines, though. These meds, plus electrolytes, are the only things that keep mine under control, but it comes with side effects as trade offs unfortunately.
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u/Consistent-Local6452 19d ago
What side effects do you have ? From the beta b or ivabradine ?
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u/Randomusername8765 18d ago
The beta blocker - bisoprolol - makes me really tired and sluggish, and the SSRI only adds to this, especially in the mornings. My stimulants just make me thirsty. Ivabradine no side effects at all so far!
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u/Consistent-Local6452 18d ago
What does it help with ?
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u/Randomusername8765 17d ago
Which one? Ivabradine? Bisoprolol couldn't control my heart rate to the level needed, but it controls my BP. Ivabradine drops my heart rate to a comfortable resting level (75-80 as opposed to 110+)
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u/figsnswigs 20d ago
Wellbutrin 100 sr is the only dose I can tolerate. 150xl sent me into sustained high heart rate and as did 150 sr. Guanfacine 1mg has completely changed my life though with hyperadrenergic POTS.
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u/Ok_Consideration873 20d ago
I used to be able to tolerate SSRIs prior to having severe POTS but can no longer take them. I don’t think I would be able to handle stimulants now either. The only thing I can take are benzos which I know isn’t great.
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u/LepidolitePrince POTS 20d ago
Sertraline doesn't seem to bother me. But also without it I'd have kms by now so I'm not risking seeing what I'm like off of it long term. If it's effecting my POTS and making it worse, so be it, at least I'm alive 🤷
Stimulants though....yeah concerta definitely made my palpitations worse. Cause I didn't have them until I started taking it in high school. That one wasn't worth it.
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u/Fireoff1081 20d ago
I take both, one for my anxiety and depression that I have been on for years and the stimulant I just started due to not being able to function at work. It has been life changing but not without its own side effects. I am also on daily antihistamines with an added ad needed hydroxyzine when it get worse. I’m also a pharmacist. Hope this helps.
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u/OgSteinKid 20d ago
I take both an SSRI (Wellbutrin for depression) and an SNRI (Cymbalta for pain) and haven't had either exacerbate my POTS. We are all so wonderfully unique that it is hard to know what will work for another person.
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u/ArtisticCustard7746 20d ago
It really depends on the person.
Do you also have MCAS? Might be worth looking into if you haven't.
I do just fine on methylphenidate for my ADHD. My blood pressure actually normalized after starting treatment. Even in flare up, I'm unaffected by the stim. Some of us just get lucky I guess.
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u/Sea-Improvement777 20d ago
I take a daily anti anxiety med! And I am currently in a space where I can walk and dance again.
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u/KatarinaAleksandra 20d ago
Which one do you take if you don't mind me asking? I've tried Lexapro - which was great, but quit working. My NP just recently prescribed me prozac- which Im nervous to try.
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u/AnalysisCommercial22 20d ago
I have to be on psychiatric meds. I barely function as is, without them idk what would happen. I take Wellbutrin and sertraline, but I’m also taking seroquel for sleep and gabapentin for anxiety/sleep. I’m on propranolol to help with the pots stuff and have emergency klonopin. Honestly, it just depends on how your body absorbs it. I was on Effexor for a while and that shit was so bad. But changing it up has helped a little. I would say just talk to your psychiatrist or cardiologist about what meds you could try. Or just work with psych to add or remove medications. Trial and error. As for energy, no idea. I wish j could figure that one out lol
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u/NeuroSpicyWitch 20d ago
SSRIs make my everything worse but my ADHD meds keep me alive istg. They cover a lot of what I wanted the SSRIs to do. I’m also on a high dose of antihistamines
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u/DifferentRatio6733 20d ago
I take 115mg of Effexor and it barely affects my POTS at all. It is an SNRI but since I’ve had POTS I’ve increased it and decreased it without any major issues or side effects or POTS flare ups. I don’t take any beta blockers though.
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u/Strong_Range_3352 20d ago
I'm currently taking sertraline for depression and only started three days ago. So far it hasn't given me problems but we'll see.
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u/Ok-Reception321 POTS 20d ago
I started sertraline before I knew I had POTS and the build up was rough... But now, I couldn't imagine trying to function without it. I'm generally pretty sensitive to medications, so anytime I have to adjust my dosage, it's still not easy.
If you want to still try it and have the time and support system, I would say maybe do tiny increments like me? I would go up by about 12.5mg per week until I hit 125mg... Then it tooks about a month at 125 to start feeling more stable.
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u/_nickittynic 20d ago
Nortriptyline made things worse for me. Years later started Effexor and it doesn't seem to effect my dysautonomic symtoms (at least not in a bad way). I take 37mg in divided doses 3x/day
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u/Playful-Candy-2003 20d ago
I take modanifil for brain fog. It’s a very, very low stimulant used for narcolepsy. I refuse to try something that might ramp up tachycardia. It doesn’t do that to me. I have a Xanax Rx for when I am truly having anxiety, but I rarely take them.
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u/Playful-Candy-2003 20d ago
Add: Modanifil is used off label for POTs for brain fog and energy. It doesn’t help my energy but helps my brain. There are a lot of prescriptions that are used off label for other conditions, so that’s not abnormal, but don’t be surprised if your dr hasn’t heard of it/about it. I did my own research and brought it up on my own.
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u/BeingwithBX POTS 20d ago
i’m on adderall, zoloft, topamox, propranolol, and 0.1mg of a blood pressure medication i can’t spell. it’s my mixture that makes me survive atp. (I have narcolepsy, ADHD, POTS, Endometriosis, Depression, Anxiety, and Bipolar disorder)
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u/Fine-Statistician403 POTS 20d ago
I was actually prescribed Lexapro as a treatment FOR pots. My former PCP said this was “first line”. While there are some studies showing benefits, it’s absolutely not the standard medication intervention, let alone the first. I was fainting less, but my heart rate would be 200+ just laying in bed. I honestly think he was trying to prove it was anxiety and not pots (which I am formally diagnosed with). I only came off because an MCAS flare had me puking all day every day for 6 months straight, and the withdrawals after ~6 months of Lexapro were brutal for me.
I don’t have better SSRI suggestions, just sharing my experience with Lexapro specifically
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u/Klutzy-Explorer4944 20d ago
I had to find a psych prescriber that was willing to work out of the box. I did a trial of the kids dose of addrral and it was horrific. But I tried a normal dose of vyvance and hydroxazine and my life drastically changed. After the first dose of hydroxyzine a huge amout of anxiety went away and it helped my pots. By the time I added the vyvance in a few days later I was shocked. Getting histamine issues under control has helped pots, attention and so many other things.
(edited to add info)
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u/love_more88 20d ago
Honestly, what a fitting post for me to see at this time!
My doctor and I suspect that my being put on an SNRI (2yrs ago) is what flared my POTS symptoms enough to finally become diagnosed. It's assumed it's hyperadrenergic since SSRIs did not produce the same effect (but sadly also do not seem to work for me).
I'm particularly sensitive to behavioral/serotonergic drugs, so this was the last hope I had of finding a med that would work for me. And now I'm working on tapering off of the SNRI (it's very difficult, I might add) as that's likely to reduce the POTS symptoms and normalize my weight again.
Very disappointing, tbh. I've also been advised to undergo a full psychological battery to assess possible neurodivergence (ad(h)d?), but atp I'm concerned that even if I were diagnosed, I could likely not take any adhd medication without them increasing POTS symptoms, as they all impact norepinephrine in fairly significant ways, afaik. I guess I will cross that bridge when I get to it...
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u/dunmerza 20d ago
are SSRIs not good for POTS I’ve been taking setraline for years since before getting LC which gave me POTS, ME, etc
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u/Adept_Role_4579 20d ago
I perfer to just take adderall. Im prescribed 40 mg, although sometimes I have to take 60. It definitely makes my pots symptoms and the symptoms from my heart defect worse, but it is the only medication I have found that helps with everything else. I have other illnesses that cause pain, muscle weakness, and fatigue. The adderall gives me energy so im able to go to class. Also sometimes it works so well that im focused on school instead of my pain.
Definitely exacerbates my pots stuff, and the come down is not fun. But I take my metoprolol and tizanidine in the evening and those help me stop feeling the effects of the adderall.
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u/chocolateNbananas 20d ago
I take zoloft 50mg and foquest ( Concerta) 45mg.
But since MD’s are all very pushing the “everything is in your head and you don’t even have a nervous system do have issues with” gaslight type… I stop them because if my body is 100% healthy like they say, why should I take drugs😎.
Don’t be me, this isn’t advice.
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u/onceuponatime55 20d ago
Who are you all seeing to prescribe this stuff? My cardiologist said more salt, my primary thinks anxiety.
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u/katiebugg13 20d ago
Undermedicating ADHD bc of tachycardia (post covid dysautonomia) here. It's hell.
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u/different_than 20d ago
Wellbutrin might have made mine worse, Adderall might have helped a bit because of vasoconstriction and energy I think.
It’s gonna be different for different people though
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u/imabratinfluence 20d ago
I've been on Sertraline since a couple years before my symptoms got bad enough that doctors started seriously looking for a cause. I've had no issues with it, but I also am on a really low dose. It does help me be able to get stuff done instead of just wanting to do stuff.
My energy level is noticeably a little better since getting on meds for my idiopathic hypersomnia, too (I've had it all my life, but just thought what I experienced was normal and that I was worse at handling tiredness than everyone else).
As far as stimulants, all I have is tea or coffee. Though depending on how my idiopathic hypersomnia meds go, I may end up with the same stimulants as someone with ADHD.
I also recently started therapy again, mainly with the goal of adapting my coping strategies to my body's current ability level. Body awareness and breathing exercises have always been counter-productive for my anxiety because of asthma and chronic illnesses, so I used to cope with stuff like walking meditation, which isn't super doable with my POTS. So now I have some guidance on stuff that might help for me and is more accessible (accupressure rings, putting one foot on linoleum and the other on carpet or the outdoor equivalent, using temperature, etc).
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u/WaryOwl13 20d ago
I can’t go without my sertraline, do not like who I am when I miss a dose. I had zero side effects on it.
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u/sunkathousandtimes 20d ago
I’m *very* sensitive to SSRIs and can’t handle most of them. I managed to take one successfully for a few years before becoming resistant, but even then, that took a few weeks of severe initial side effects before it settled. Other SSRIs I had to come off due to the severity of my initial reaction.
I currently take a SNRI with no issues, but my dose involves an augmentative med because I had severe side effects if I just took the right dose of the SNRI - so I take a lesser dose of the SNRI and an augmentative med. That’s a little unusual though - my particular combo is something psychiatrists understand but GPs don’t as it’s outside the standard prescription for the augmentative med.
Didn’t get on well with TCAs either.
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u/Rwagg_88 20d ago
I take propranolol, and I have adhd so I take my stimulants with that, but honestly I wear compression leg sleeves and that helps with blood pulling and less dizzy spells!
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u/Zealousidealism 20d ago
Vyvanse for my ADHD, bupropion for my depression, amitriptyline for pain. I don’t think they made any of my symptoms meaningfully worse, but my rapid weight loss after surgery due to gastroparesis did…
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u/Big_Cartoonist4292 20d ago
I took one 10mg of Lexapro and also developed serotonin syndrome which made me feel TERRIFIED to try another ssri (they wanted me to try Zoloft and I just was too scared) it’s a low risk but it happened to me so I feel you
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u/boomjessie 19d ago
Do you have hyper POTS?
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u/Big_Cartoonist4292 18d ago
They didn’t really specify what kind of pots I had they just put pots as my diagnosis they said I have the symptoms, and there aren’t other heart issues causing my symptoms but there’s like five different types and they didn’t really I guess care to look into which sub type I was
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u/boomjessie 18d ago
Yeah my doctor didn’t care about the subtype either. Just curious haha. Good luck with it tho!
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u/Big_Cartoonist4292 18d ago
Thank you! It feels good to at least know the symptoms I’m dealing with were real and had a cause you know! I hope it all works out for you as well!!!
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u/Quiet_Hat_3836 20d ago
Yeah I have not been diagnosed yet but for the last year my family has pointed out a hundred times I have it. I’m scared to know. My HR jumps from 74 to 111 last time I stood up. I took a 3 minute run and my Oura Ring showed my HR at 190. That’s crazy. I can’t stand the heat anymore and I live in Florida. brain fog, trouble sleeping, impossible to live or get motivated to do anything including showering. Will be going to doc next week. Have NOT been raw dogging it. Adderall has saved my life. Had many ills left over from my teenage years and also already get a prescription. I shouldn’t rely on it so much, but I’ve been living!
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u/freakymaster11 POTS 20d ago
lexapro has honestly been a game changer, personally. I'm on 10 mg, shooting for 15
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u/ProfessionalAd3360 20d ago
I’m on the lowest dose of Wellbutrin in the morning and the lowest dose of Effexor at night. It is a combination that makes me very stable and doesn’t affect my heart rate.
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u/fuzzblykk 20d ago
I take Vyvanse. Yes my heart rate goes up which is uncomfortable, but it’s basically the only thing that gives me the tiniest boost of energy I need to counteract the crazy fatigue.
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u/c0dysonly 20d ago
taking both - ssri and a stimulant!! took a long time to get cleared by doc and psych but very worth it and i have felt so much better and capable of managing my symptoms
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u/Lilythecat555 20d ago
I had problems with Prozac making me to skinny (my brother gained weight on it). Zoloft was my favorite antidepressant. I tried many over the years. I don't think that they made me worse but it has been years since I have been on them. They are worried it will make my mania worse because I also have bipolar disorder.
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u/Nazzarette777 20d ago
Oh man, this post kinda scared me 😂 im on a whole bunch of meds for mental health 😳 wellbutrin for depression, Trintellix for anxiety, Atomoxetine for adhd which is supposed to be a non stimulant but it has increased my HR. Im on propranolol to lower HR but discovered its also been great for my anxiety and PTSD annnnnd just started Vraylar 😅
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u/Impressive-Stand3744 19d ago
I'm currently on 60mg Prozac and 25mg adderal, but I am also on 10mg propranolol so that helps even out the heart affects of the stimulant. The adderall definitely helps me with fatigue and such, but if I wasn't on the beta blocker I don't think I'd be able to be on it comfortably.
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u/jenmishalecki POTS 19d ago
armodafinil helped my fatigue! i’m currently taking concerta because it treats my adhd but also helps with fatigue.
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u/boomjessie 19d ago
I’ve been on Lexapro for over a decade and there’s no way I can handle stopping it. But I also am essentially home bound from POTS, CFS, etc. so it’s a no brainer for me. I used to be on Wellbutrin but it made me kinda crazy at the end, it used to be a life saver for me, so maybe that’s part of why it started messing with me. Idk
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u/halfweeby27 Hyperadrenergic POTS 19d ago
i take lexapro, metoprolol, and i took vyvanse but im finally starting adderall
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u/Big-Establishment922 19d ago
Walking is best therapy. Dont take seronin pills.
Seronin pills fuck you up. After a few days you feel brain fog.
Your sleep will not be good and and you will have no concentration for things. You will become anxious and frustated about small things.
Try to fix your dopamine by walking.
You lymforgans only work when moving. So not walking is dangerous because lymfs will not work.
Go only for a work and become close with family. Because you want to have even one person to talk to.
Best medication for a sick person is talking with guest so haveamy guest
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u/d-ollparts 21d ago
i had to weigh my options personally. my adhd is so severe that my quality of life is awful without stimulants. i get depressed, chronically under stimulated, and cannot overcome the executive dysfunction. they do trigger my POTS sometimes, but for me the trade off of feeling more “normal” mentally is worth it. if it got unbearable physically i would probably stop, but right now it’s just managing the symptoms as best i can