What’s the Relationship Between POTS Syndrome and Anxiety?

Postural Orthostatic Tachycardia Syndrome (POTS) is a complex and often misunderstood condition that affects the autonomic nervous system. Because many of its symptoms overlap with anxiety, POTS syndrome is frequently misdiagnosed, especially early on. Patients may be told their symptoms are “just anxiety,” which can be frustrating, invalidating, and delay proper treatment.

Understanding the relationship between POTS and anxiety is important, not only for accurate diagnosis, but also for improving quality of life.

What Is POTS Syndrome?

POTS syndrome is a disorder of the autonomic nervous system, the part of the body responsible for regulating automatic functions like heart rate, blood pressure, digestion, and temperature control. In people with POTS, the body struggles to properly regulate blood flow when moving from lying down to standing.

POTS is defined by an abnormal increase in heart rate, typically 30 beats per minute or more in adults* within 10 minutes of standing, and without a significant drop in blood pressure.

Common symptoms include:

• Dizziness or lightheadedness when standing
• Rapid or pounding heartbeat (palpitations)
• Fatigue and exercise intolerance
• Shortness of breath
• Brain fog or difficulty concentrating
• Chest discomfort
• Nausea or gastrointestinal symptoms

POTS is most commonly diagnosed in adolescents and young adults, particularly women, but it can affect people of any age. Symptoms can range from mild to debilitating and may fluctuate from day to day.

*POTS in adolescents is characterized by an increase in heart rate of 40 beats or more per minute. 

What Causes POTS Syndrome?

The exact cause of POTS syndrome isn’t always clear, and many patients develop symptoms after a triggering event such as a viral illness, surgery, pregnancy, or prolonged bed rest. In some cases, however, POTS can be categorized into subtypes based on underlying mechanisms:

Neuropathic POTS Syndrome

Caused by partial dysfunction of the autonomic nerves, particularly in the lower extremities. This leads to blood pooling in the legs when standing, reducing blood flow to the heart and brain.

Hyperadrenergic POTS Syndrome

Characterized by elevated stress hormones like norepinephrine. This subtype often causes tremors, sweating, anxiety-like symptoms, and a marked increase in heart rate and blood pressure upon standing.

Hypovolemic POTS Syndrome

Associated with low blood volume, which can worsen orthostatic symptoms and make it harder for the body to maintain adequate circulation.

Secondary POTS

Occurs alongside another medical condition such as autoimmune disease, diabetes, Ehlers-Danlos syndrome, Lyme disease, or multiple sclerosis.

Understanding the subtype is important because it can influence treatment strategies.

Overlapping Symptoms of POTS Syndrome and Anxiety

One of the main reasons POTS is often confused with anxiety is the significant overlap in symptoms. Both conditions may involve:

• Rapid heart rate
• Sweating
• Lightheadedness
• Shortness of breath
• Trembling or shakiness

From the outside, and sometimes even to the patient, these symptoms can feel identical to anxiety or panic attacks. However, in POTS, these symptoms are typically triggered by posture changes, prolonged standing, dehydration, or heat, rather than emotional stress alone.

Unfortunately, this overlap means patients with POTS syndrome may be dismissed or misdiagnosed, even when their symptoms have a clear physiological cause.

Can Anxiety Cause POTS?

Anxiety does not cause POTS. While stress and anxiety can temporarily increase heart rate or worsen dizziness, they do not create the underlying autonomic dysfunction seen in POTS syndrome.

That said, chronic stress may exacerbate symptoms in someone who already has POTS syndrome. Poor sleep, dehydration, and heightened nervous system activation can all intensify symptoms, which is why addressing both physical and emotional health is important.

Can POTS Cause Anxiety?

Yes, POTS can absolutely contribute to anxiety, even in people with no prior history of anxiety disorders.

Living with unpredictable symptoms, frequent palpitations, brain fog, and the fear of fainting can naturally lead to increased worry, hypervigilance, and avoidance of certain activities. Over time, this can evolve into situational anxiety or even panic attacks.

Additionally, hyperadrenergic POTS syndrome involves elevated stress hormones that create a constant “fight-or-flight” sensation. In these cases, the anxiety-like feeling is driven by the body’s physiology rather than psychological triggers. For many patients, anxiety is a result of POTS, not the cause.

How Is POTS Diagnosed?

An accurate diagnosis is critical to avoid ineffective treatments and ensure symptoms are properly addressed. Diagnosing POTS requires more than a basic anxiety screening.

Evaluation may include:

• A detailed medical history and symptom review
• Orthostatic vital signs or tilt table testing (your heart rate, oxygen, and blood pressure are monitored from a flat position on an exam table to an elevated one)
• Blood work to assess anemia, electrolyte imbalance, vitamin deficiencies, or thyroid dysfunction
• Autonomic breathing or cardiovascular testing
• Skin nerve biopsy in select cases

Because symptoms can fluctuate, diagnosis may take time; but proper testing helps differentiate POTS from anxiety and other conditions.

How Is POTS Syndrome Treatment Different From Anxiety?

While there’s currently no single FDA-approved medication specifically for POTS, treatment focuses on symptom management and improving daily function. Treatment plans are usually individualized based on specific symptoms and may include:

• Compression garments to reduce blood pooling
• Increased fluids and salt intake (when appropriate)
• Gradual exercise and physical reconditioning
• Dietary adjustments to support blood volume and energy levels
• Medications to help regulate heart rate, blood pressure, or autonomic symptoms
  

In contrast, anxiety treatment often focuses on therapy, stress management, and medications that may not address the underlying issues in POTS and, in some cases, can worsen symptoms if POTS is missed.

Get Answers At Our Destin Primary Care

If you’ve been told your symptoms are anxiety, but feel something more is going on, you’re not alone. At The Crane Center, our primary care team takes a comprehensive, patient-centered approach to symptoms like dizziness, palpitations, and fatigue. We work to uncover the root cause, whether it’s POTS, anxiety, or both, so you can get clear answers and appropriate care. In the event it is anxiety, our skilled counselors can assist you under the same roof! Schedule a visit to take the first step toward understanding your symptoms and reclaiming your quality of life.