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Dysautonomia & Mental Health

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Dysautonomia is an ill defined term, but essentially it means there's dysfunction within the autonomic nervous system. It's recently gained attention given the association with both the COVID infection and also the vaccines. It may indicate failure of either the sympathetic or parasympathetic system, or even both. It can be local or generalized, and acute or long-lasting depending on the underlying cause. There is no specific treatment, but symptom management through lifestyle changes and medications may help. Most people with POTS are younger individuals to middle age, and may develop after an illness such as COVID, other viral infections, emotional trauma, or have it after pregnancy.


Dysautonomia Causes:


The condition may be either primary or secondary to another disease process. There's various types and the most common is postural orthostatic hypotension syndrome or "POTS" for short. POTS is a type of orthostatic intolerance with symptom exacerbation depending on position and most likely with standing. Patients with this form of dysautonomia cannot regulate their blood flow and commonly have changes in pulse, blood pressure, and an uneasy feeling in their chest, which may be interpreted as palpitations or flutter. Different subtypes of POTS exist such as neuropathic POTS and hyperadrenergic POTS; an overactivity of the sympathetic nervous system and illustrated by high catecholamine levels and stress hormones. This type also presents with extreme anxiety.


Dysautonomia Symptoms:


Most people suffering from this condition have changes in their autonomic system including irregular heart beat, fast or slow heartbeat, excessive sweating, or lack thereof, fatigue, exercise intolerance, shortness of breath, dizziness, headaches, lightheadedness, fainting, orthostatic hypotension, anxiety, brain fog, and depression. You can have all or none of these symptoms, technically.


Dysautonomia and Mental Health


As mentioned earlier, this condition is highly associated with anxiety, especially the hyperadrenergic form. Just having the diagnosis can bring about uncertainly which may prompt a referral to a mental health specialist. Brain fog is probably the most common presentation I've seen and affects most people with POTS and other forms of dysautonomia, The fog may lead to changes in cognition, memory, concentration, processing speed and the ability to multitask. Commonly, patients will have to focus on one task at a time and take micro-breaks throughout the day by laying down, which increases blood flow to the brain. It's best to complete high priority tasks in the morning after a restful nights sleep as patients usually fatigue in the afternoon or evening.


Dysautonomia Diagnosis:


Dysautonomia and POTS specifically, may be challenging to pinpoint. Patients usually see several doctors and specialists before arriving at an accurate diagnosis. A tilt table test is the hallmark test to diagnosis POTS, as it quantifies heart rate and blood pressure in different positions. Other testing may include an echocardiogram, blood catecholamines levels , a mental health examination, and hemodynamic testing.


Treatment/Management:


Again, it really depends on the cause and type of dysautonomia since there's so much variability. In general, compression stockings to help with circulation may help. Increasing sodium intake and balancing electrolytes. Exercise to tolerance, plenty of water and up to 2 liters per day. Breath work or Yoga to relax, and reduce sympathetic activity. My suggestion is box breathing or 4:8 breathing daily. Botanicals to support cerebral circulation may help, too. See this article here. There's many other options and strategies, but this is a start to understand the connection between autonomic dysfunction and mental health.



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