I’m an editor with Mayo Clinic Press and we are getting ready to publish a book on POTS by Dr. Phil Fischer, a Mayo pediatrician. I ran your question by Dr. Fischer and here's his response:

"As a pediatrician who has had the privilege of caring for literal thousands of adolescents with POTS, I appreciate your good question. Of course, adolescents are not completely like adults, and each patient is unique. But, perhaps some general comments are helpful.

The simple answer to your good question is “yes, patients with POTS can have attacks that look like panic attacks but don’t actually involve anxiety or panic.”

POTS is a result of imbalances in nerve chemicals regulating the autonomic nervous system. The adrenaline family of neurotransmitters and the serotonin chemicals are key “players” in the regulation (and dysregulation) of involuntary nervous system function. Adrenaline and related chemicals are most related to circulatory changes in POTS, and we are all familiar with adrenaline from its role with excitement and with the “fight or flight or faint reflex.”

While adrenaline and serotonin relate to autonomic dysfunction, they also relate to brain activation and anxiety and depression. So, when these chemicals are altered in the autonomic nervous system, they also potentially have effects on the brain. It is, thus, not surprising that more than a fourth of adolescents with POTS also have challenges with anxiety and/or depression. Panic attacks, in particular, relate to the adrenaline chemicals.

But, I also see lots of POTS patients who have episodes of feeling like they can’t breathe while their chests feel heavy and their hearts race. Sometimes this is so scary that it leads to actual panic, but often it is totally separate from anything going on emotionally. I call these panic attack-like spells “POTS attacks.” And, these POTS attacks usually resolve with the treatment of POTS.

You also made good comments about the diagnosis of POTS. Tilt tests are very helpful for determining if the change in heart rate with position change is excessive or not, and that excessive change is a key factor in the diagnosis of POTS. But, the other part of the diagnosis is that POTS patients have a story of months of bothersome daily intolerance of being upright (like being very dizzy when standing) in addition to whatever other symptoms they have (like nausea, fatigue, headache, and whatever else).

I hope these comments help as you move toward recovery!"

Phil Fischer

Good luck! You can find Dr. Fischer's book, Tired Teens: Understanding and Conquering Chronic Fatigue and POTS, in stores in early February, 2021.

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