Does Lexapro help POTS? (+1 management tips)

This article will address the question, “Does Lexapro help POTS?” We will also explore the role of Lexapro in managing the symptoms of POTS and its pharmacological and non-pharmacological management.

Does Lexapro help POTS?

Yes, Lexapro does help with postural orthostatic tachycardia syndrome (POTS). Lexapro (escitalopram) is an SSRI antidepressant indicated for treating major depressive disorder and generalized anxiety disorder (1).

Postural orthostatic tachycardia syndrome (POTS) is a diverse autonomic disorder. International societies have defined POTS as a persistent increase in the heart rate of not less than 30 bpm during 10 minutes of standing upright. However, individuals aged 12-19 may experience a rise of up to 40 bpm (2).

In addition to its use in depression, Lexapro and other SSRIs have been found to be helpful in managing the symptoms of postural orthostatic tachycardia syndrome (POTS). However, Lexapro may cause some side effects when you start taking it, such as nausea, loss of appetite, tiredness, acid reflux, etc.

How does Lexapro help in the management of POTS?

It has been suggested that serotonin production and regulation disturbances may play a role in the increased heart rate and blood pressure observed in postural orthostatic tachycardia syndrome (POTS) (3).

The exact mechanism of SSRIs, such as Lexapro, is not fully understood. However, it has been suggested that SSRIs improve the symptoms of orthostatic intolerance by enhancing the nerve stimulation of the vasoconstriction reflex during standing (3).

The combination of SSRI and SNRI has been found beneficial for symptomatic patients with POTS. An NRI (norepinephrine reuptake inhibitor) such as bupropion is also beneficial in helping patients with POTS (3).

What does research suggest?

The prevalence of POTS in the U.S. has been estimated to be 170/100,000 patients. Women, particularly those between the ages of 20 and 40 who experience anxiety or stress, are at a higher risk of developing POTS (4).

There are only a limited number of reported cases that support the use of Lexapro in POTS. One case involved a 46-year-old female with symptoms of heaviness in her legs and arms, dizziness, and high head pressure (4).

A tilt-table test was performed, which revealed tachycardia and an increase in blood pressure in the orthostatic position. Based on the results, the woman was prescribed metoprolol 25mg and lamotrigine 25mg for her headaches (4).

Three weeks later, the tilt-table test was reevaluated, and her cardiologist also ordered 30-day cardiac event monitoring. Based on the results, the woman was diagnosed with postural orthostatic tachycardia syndrome (POTS) (4).

The woman was instructed to increase her sodium and water intake as well as enhance her physical activity. Her metoprolol dose was also adjusted to 25mg twice daily, and Lexapro was also started at a dose of 10mg (4).

SSRIs are usually added to the therapy to manage the psychological aspects of POTS. However, SSRIs also provide an additional benefit of stabilizing blood pressure by improving peripheral vasoconstriction (4).

What are the symptoms of POTS?

The symptoms of orthostatic intolerance that occur in postural orthostatic tachycardia syndrome include (3):

• Lightheadedness.
• Fatigue.
• Sweating.
• Tremors.
• Anxiety.
• Palpitations.
• Exercise intolerance.
• Syncope.

These symptoms typically appear while standing and resolve when the patient returns to a supine position. However, they can limit the patient’s ability to perform daily activities such as bathing, housework, and feeding (3).

POTS symptoms are more common in women following pregnancy, viral infection, fever, trauma, or any surgery. These symptoms can also result from other conditions, such as diabetes, irritable bowel syndrome, or alcoholism (3).

How is POTS managed pharmacologically?

Some of the medications that are frequently used in managing postural orthostatic tachycardia syndrome include (3):

• Fludrocortisone.
• Midodrine.
• Methylphenidate.
• Erythropoietin.
• Labetolol.
• Clonidine.
• Pyridostigmine.

The main goal of pharmacological therapy in POTS is to improve the orthostatic intolerance symptoms and manage autonomic and non-autonomic symptoms. Pharmacotherapy also helps with other co-morbid conditions such as G.I. dysmotility, immune disorder,  pain, sleep, brain fog, and headache (2).

Treatment of POTS requires a multidisciplinary approach using pharmacological and non-pharmacological interventions. Currently, there are no FDA-approved medications for the treatment of POTS (5).

However, the medication mentioned above has shown improvement in the symptoms of POTS and is also supported by research and case studies (5).

How to manage POTS non-pharmacologically?

In addition to pharmacological therapy, patients with POTS are also recommended to implement the following non-pharmacological measures to manage their symptoms (3):

• Patients are encouraged to engage in aerobic exercise for more than 30 minutes at least four days a week (2). This regimen can help increase the venous blood flow to the lower extremities.
• It is advisable for patients to avoid medications that worsen the symptoms of POTS, such as ACE inhibitors, alpha and beta blockers, calcium channel blockers, diuretics, tricyclic antidepressants (TCAs), and phenothiazines.
• Maintaining adequate fluid intake and consuming 3-5 grams of salt daily is recommended to manage the symptoms of POTS effectively.
• Patients with dysautonomic syncope are advised to wear compression stockings that extend up to the waist. These stockings can enhance the static pressure at the calf and reduce venous pooling.

Conclusion

In this article, we have addressed the question, “Does Lexapro help POTS?” We have also explored the role of Lexapro in managing the symptoms of POTS and its pharmacological and non-pharmacological management.

References