Does Sertraline help POTS? (3+ strategies)

In this article, we will answer the question, “Does Sertraline help POTS?”. We will discuss what research is available in this regard, what role Sertraline plays in the management of POTS symptoms and other pharmacological and non-pharmacological ways to manage the symptoms of POTS.

Does Sertraline help POTS?

Yes, Sertraline may help manage the symptoms of postural orthostatic tachycardia syndrome (POTS). Sertraline is a selective serotonin reuptake inhibitor used for the treatment and management of various depressive illnesses.

Sertraline (also known as Zoloft) is approved by the FDA to treat major depressive disorder (MDD), panic disorder (PD), posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD) and premenstrual dysphoric disorder (PMDD) (1).

Postural orthostatic tachycardia syndrome (POTS) is a common form of autonomic dysregulation of an autonomic disorder which is characterised by excessive tachycardia during upright posture in the presence of orthostatic intolerance. The diagnostic criteria is a heart rate of 30 bpm or more within an initial 10 minutes of standing (2,3).

In addition to its use in depressive illnesses Sertraline and other antidepressants, particularly SSRIs like Lexapro and Prozac are found to help manage the symptoms of POTS. However, Sertraline may cause some side effects like nausea, vomiting, dizziness, drowsiness, diarrhoea, fatigue, and acid reflux once you start therapy.

How does Sertraline help in the management of POTS?

The increase in blood pressure and heart rate seen during postural orthostatic tachycardia syndrome (POTS) is attributed to serotonin production and regulation disturbances within the body (4).

The exact mechanism through which Sertraline helps in the management of the symptoms of POTS is not yet known. However, the improvement in symptoms of orthostatic intolerance of POTS seen with Sertraline use may be associated with the increase in nerve stimulation of the vasoconstrictor reflex during standing (4).

Combination treatment with SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs) can help symptomatic patients of POTS. Bupropion, which is a norepinephrine reuptake inhibitor (NRI) can also help with the symptoms of POTS. Both SNRIs and NRIs can be used in combination with SSRIs like Sertraline for managing POTS (4).

What does research suggest?

Not many studies have been published specifically assessing the effect of Sertraline on POTS symptoms. However, other SSRIs like escitalopram and fluoxetine have shown promising results.

One study assessed that the addition of an SSRI or NRI to a symptomatic patient with POTS is beneficial for the management of symptoms. NRIs like bupropion are more beneficial (4).

Another study used the combination of venlafaxine and duloxetine in POTS patients. Patients given this combination showed good tolerance and minimal side effects of the combination of medications (5).

A study assessing the effects of Sertraline on POTS patients concluded that Sertraline did have moderate effects on improving blood pressure in POTS patients but did not show a significant change in heart rate or blood pressure. This study suggested further research to be conducted with higher doses at a prolonged administration to analyse the efficacy of Sertraline in POTS (6).

One case study of a 46-year-old woman reported the improvement of symptoms of POTS when started on an SSRI, escitalopram 10mg daily. Antidepressants are normally prescribed to overcome the psychological aspects of POTS, but they also tend to provide improvement in blood pressure (7).

What are the symptoms of POTS?

The commonly occurring symptoms of orthostatic intolerance in individuals with POTS include the following (2):

• Fatigue
• Light-headedness
• Cognitive impairment
• Palpitations
• Syncope
• Weakness
• Sweating
• Anxiety
• Tremors
• Dizziness
• Sleep disorder

These symptoms appear or worsen while standing and usually resolve when the individual lies down in a supine position. These symptoms can decrease the quality of life of the individuals causing hindrance in all their routine tasks.

POTS is more common in women after pregnancy, trauma, stress, sepsis, fever or surgery. Sometimes these symptoms can occur due to diabetes, heavy metal poisoning, irritable bowel syndrome, alcoholism and hypermobility syndrome (4).

What are the pharmacological treatments for POTS?

Symptoms of POTS can be managed pharmacologically with the following medications (2,3,4):

• Fludrocortisone
• Midodrine
• Methylphenidate
• Erythropoietin
• Labetalol
• Clonidine
• Pyridostigmine
• Alpha-methyldopa
• Ivabradine
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine reuptake inhibitors (NRIs)

Keep in mind that none of the above medications are approved by the FDA for the management and treatment of POTS symptoms. Also, the choice of medication for individuals experiencing POTS symptoms depends on the individual characteristics and the underlying aetiology of POTS.

The primary goal of pharmacological treatment is to improve symptoms of orthostatic intolerance and sometimes relieve any underlying causative factors.

What are the non-pharmacological ways to manage POTS?

The combination of pharmacological and non-pharmacological strategies is crucial in the management of POTS. Some non-pharmacological strategies to help with POTS symptoms are as follows (2,3,4):

To the best of my knowledge and according to research, Sertraline can help with POTS but under specific circumstances only. Sertraline is not exclusively prescribed for the treatment of POTS. However, it may be used to manage the accompanying symptoms.

In my opinion, you should always consult a healthcare professional before starting any treatment. Your healthcare provider will determine the underlying cause and the most suitable treatment options to manage your symptoms effectively.

References