Case Study: Maria’s Journey with Postural Orthostatic Tachycardia Syndrome (POTS) and Benzodiazepine Withdrawal
Maria, a 34-year-old graphic designer, began experiencing severe anxiety and panic attacks following a stressful period at work. Her primary care physician prescribed a benzodiazepine to help manage her symptoms. Initially, Maria found relief with the medication; she felt more relaxed and her anxiety seemed to be under control. However, over time, she began to notice other concerning symptoms: increased heart rate upon standing, dizziness, fatigue, and episodes of near fainting.
Despite her initial relief from anxiety, Maria’s health began to deteriorate. She noticed that her heart rate would spike dramatically when she moved from sitting to standing. Concerned, she returned to her doctor, who suggested increasing her benzodiazepine dosage, suspecting her anxiety was not fully managed. Unfortunately, this only exacerbated her symptoms, leading to a cycle of increasing drug dependency without relief.
After months of worsening symptoms, Maria sought the advice of a cardiologist specializing in autonomic disorders. She was diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS), a condition she had never heard of before. The cardiologist explained that POTS is a form of dysautonomia, a disorder of the autonomic nervous system, and her symptoms matched the classic profile of excessive tachycardia upon standing, along with fatigue and dizziness.
Maria’s new doctor proposed a possible link between her POTS symptoms and her long-term use of benzodiazepines. He explained that while benzodiazepines are effective for short-term anxiety relief, their long-term use can lead to a host of problems, including potential autonomic nervous system dysfunction. The sudden spikes in heart rate and other symptoms of POTS could be exacerbated, if not partly caused, by benzodiazepine-induced neurological dysfunction (BIND) or withdrawal.
The cardiologist and a neurologist worked together to develop a comprehensive treatment plan for Maria. This involved a slow tapering off of benzodiazepines, under strict medical supervision, to minimize withdrawal symptoms and avoid exacerbating her POTS symptoms. Additionally, Maria was prescribed medication to manage her POTS symptoms and advised on lifestyle changes, including increased salt and water intake, wearing compression garments, and gentle exercise routines tailored to her tolerance.
Maria’s journey to recovery was not linear. She experienced significant challenges during the benzodiazepine tapering process, including withdrawal symptoms and fluctuations in her POTS symptoms. However, with the support of her medical team and a patient advocacy group for POTS sufferers, she gradually began to see improvements. Over time, her autonomic symptoms became more manageable, and her reliance on medication decreased.
Two years into her recovery, Maria has made significant progress. While she still manages POTS, her symptoms are less severe and more controllable. She has become an advocate for awareness of POTS and the potential risks of long-term benzodiazepine use. Maria shares her story on social media and speaks at patient advocacy events, hoping to educate others about the importance of understanding the potential impacts of medication on autonomic health.
Maria’s case highlights the complex interplay between medication use, particularly benzodiazepines, and autonomic disorders like POTS. It underscores the importance of careful medication management, the potential for drug-induced exacerbation of autonomic symptoms, and the need for a multidisciplinary approach in treating conditions like POTS. Through her journey, Maria has learned the value of advocating for her health and the importance of a supportive medical team in navigating the challenges of POTS and benzodiazepine withdrawal.
How is Postural Orthostatic Tachycardia Syndrome connected to benodiazepine use or benzodiazepine withdrawal?
Benzodiazepines are a class of anxiety medications that work on the GABA receptors in the brain. The person who takes a benzo feels relaxed with reduced anxiety.
Additionally, the person may feel sleepy or even intoxicated, similar to the effects of alcohol. Excessive benzo use can cause reduced reaction times and short-term memory problems.
While benzodiazepines are considered to be safe for short-term use, we now know that some people will have serious consequences from taking benzos long-term. These consequences can include toxic reactions such as increased anxiety, brain fog, and even movement disorders, such as akathisia.
When a person experiences neurotoxic effects caused by benzodiazepines, their doctor may recommend benzo detox. In fact, the doctor, and the patient’s family may assume that the patient is dealing with a benzodiazepine addiction, requiring detox and rehab.
Unfortunately, a fast benzodiazepine detox, where benzos are removed from the patient’s system within a short period, such as 2-4 weeks, or less, can cause serious protracted withdrawal issues. The fact is that benzodiazepines are rarely addictive, but they do cause physical dependence, and a safe detox can take many months, or even years.
Protracted withdrawal symptoms can be complex, varying significantly from one patient to another. In many cases, there are unusual neurological changes, including dysfunction of the autonomic nervous system (dysautonomia).
What is postural tachycardia syndrome? Have you ever gotten up too quickly and felt faint or light headed?
POTS is a syndrome related to the functioning of the autonomic nervous system regulating the cardiovascular system. Inappropriate Sinus Tachycardia (IST) and sinus tachycardia are related conditions that may share some symptoms with POTS.
When you go from a laying or sitting position to standing, your body engages in a complex set of changes automatically that allow for the necessary adjustments needed for blood pressure support for the brain. Your autonomic nervous system is hard at work, making these adjustments quickly, so your brain gets proper blood flow to every blood vessel.
If something goes wrong, and the autonomic nervous system fails to adjust adequately, you may experience dizziness, syncope/fainting, lightheadedness, palpitations, fatigue, and possibly blurred vision or nausea. Many people have experienced this orthostatic hypotension reaction at some point in their life.
In fact, as we get older, our autonomic nervous systems take longer to react to fast changes in position, so we may have to take our time in going to a standing position to avoid light headedness. Additionally, there are medications that can cause orthostatic hypotension reactions more likely, where as a person stands up, their blood pressure drops and there is inadequate cerebral perfusion.
POTS, or postural orthostatic tachycardia syndrome, is a condition of chronic orthostatic intolerance where there is excessive tachycardia, or fast heart rate caused by changes in position because of a problem with the autonomic nervous system, a dysautonomia. Benzodiazepine use, or the symptoms of benzodiazepine withdrawal, can significantly exacerbate POTS symptoms as a result of long-term toxic encephalopathy or benzodiazepine-induced neurological dysfunction (BIND).
Interestingly, benzodiazepines are sometimes used as a treatment for POTS, especially in situations where POTS may have been misdiagnosed as an anxiety disorder. Of course, benzodiazepines are not ideal for treating POTS, because they do not address the underlying issues, including the effects of the stress hormone, norepinephrine on the heart and blood vessels.
POTS is a chronic condition that can cause fatigue, brain fog, and exercise intolerance, as well as anxiety. Unfortunately, patients with POTS are often confronted with difficulties functioning on a daily basis. To make matters worse, diagnosis and treatment of POTS is often delayed, due to doctors not understanding the condition.
How do Benzodiazepines cause postural orthostatic tachycardia syndrome?
The connection between benzos and POTS is poorly understood. Experts believe that benzodiazepines cause neural toxicity that can be long lasting, even after a person has tapered and discontinued benzos. While it is unlikely that benzos cause direct damage to the autonomic nervous system, there are other possible mechanisms.
For example, benzodiazepine withdrawal or toxicity could trigger an autoimmune response in the body, which could, in turn, lead to dysautonomia. Autoimmune responses in the body are thought to be a cause of POTS.
Mast cell activation syndrome (MCAS) is thought to be a possible cause of POTS. Benzodiazepines may indirectly influence mast cell activation through their effects on neurotransmitters, hormones, and individual sensitivity.
If a patient is experiencing unusual, unexplained allergy symptoms, and they are on benzodiazepines, tapering off of benzos, or in protracted withdrawal after stopping benzos, MCAS or histamine sensitivity may be the cause. For patients who experience these symptoms and also POTS symptoms, there could possibly be a connection.
While it is possible to make hypothetical connections between benzodiazepine use or benzodiazepine withdrawal and POTS, at this time, we do not know precisely how benzos either cause or exacerbate POTS. Research in this field is needed, to determine the benzo and POTS connection, as well as the benzo and MCAS connection.
How do I know if I have POTS?
It is important to understand that a person who occasionally feels lightheaded after standing quickly is not definitely a POTS patient. Additionally, it is important to rule out other causes of orthostatic changes, such as medication side effects.
For example, certain blood pressure medications, and prostate enlargement medications can cause a faint feeling when the person goes from sitting or laying to standing quickly. The solution is either to adjust or change the medication, or to be aware of the issue and get up more carefully.
However, if a person has unexplained, frequent episodes of a rapid increase in heart rate, dizziness, lightheadedness, chronic fatigue, brain fog, abdominal pain, and exercise intolerance, then a POTS evaluation may be indicated. Evaluations for a POTS diagnosis should be performed by a doctor who specializes in autonomic disorders and autonomic dysfunction.
After reviewing existing medical records, the doctor will start with a medical history and physical exam, which will include specific questions about symptoms and what might trigger exacerbations. The exam may include the measurement of vital signs in different positions, including laying, sitting, and standing.
In addition to the history and physical, the doctor may perform a tilt table test, which is a standard diagnostic test for POTS. They may also perform additional autonomic function testing and blood test. Blood testing may include autoimune testing and hormone testing.
The autonomic specialist will want to identify underlying conditions, if possible. They will also want to rule out other conditions, such as vasovagal syncope and heart failure.
After the initial visit is nearly complete, the doctor may advise the patient to keep a symptom diary, tracking symptoms, when they occur, their severity, and possible triggers, such as events, foods, locations, supplements, and medications.
How do I know if my POTS is caused by benzodiazepine-related neurological dysfunction or benzodiazepine withdrawal?
The exact cause of POTS remains unclear, but it may be associated with an autoimmune disease, such as Sjögren’s syndrome, fibromyalgia, or chronic fatigue syndrome, and may be linked to an underlying psychiatric disorder in some cases. Joint hypermobility and Ehlers Danlos syndrome are connective tissue disorders that can co-occur with POTS and contribute to joint instability and pain.
Accurate diagnosis often involves comprehensive medical evaluations, including tilt table testing and autonomic function testing. Many healthcare professionals, including specialists in pediatric cardiology and autonomic disorders, are involved in diagnosing and treating POTS patients.
While an autonomic specialist may be confident in evaluating hyperadrenergic POTS, hypovolemic POTS, neuropathic POTS, and related heart rhythm issues caused by dysautonomia, they me be hesitant to attribute POTS to benzodiazepine withdrawal or toxicity.
After being diagnosed with POTS, if a patient would like to explore the possible connection with benzodiazepine use, in order to optimize treatment and assess long-term prognosis, they may want to see a benzodiazepine tapering doctor in Fort Lauderdale, FL, or a deprescribing doctor, experienced in benzo protracted withdrawal syndromes.
Ideally the doctor should be familiar with the Ashton Manual for benzodiazepine tapering. This is a good initial indicator that the doctor is familiar with protracted withdrawal and BIND and associated syndromes.
Will my benzo-induced POTS go away?
While there is little information on the connection between benzodiazepines and POTS and a lack of research on the subject, there may still be reasons to have hope if it is suspected that a case of POTS is related to benzodiazepine use or benzo withdrawal. In many cases, unusual symptoms and syndromes caused by benzodiazepine toxicity and withdrawal reactions resolve over time.
POTS is known to be a chronic condition that can last for many years, or even indefinitely. However, if a person has POTS caused by BIND, it is likely that the dysautonomia symptoms, as well as other benzo-related symptoms, will dissapate.
Additionally, when looking for therapies that may help with postural orthostatic tachycardia syndrome, a patient with BIND may want to consider focusing on therapies that help them with benzodiazepine withdrawal symptoms. By addressing the underlying condition, POTS symptoms may also improve.
