Living with POTS: Challenges, Perspectives, and Hope

Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system that affects blood flow and heart rate. When someone with POTS stands up, their heart rate increases abnormally, often by 30 beats per minute or more within 10 minutes, leading to symptoms like dizziness, fatigue, and even fainting (Raj, 2013). Though once considered rare, POTS is now recognized as a common cause of chronic disability, particularly among young women.

Living with POTS can be overwhelming. Everyday activities such as standing in line, walking across a room, or taking a shower may trigger dizziness, brain fog, and exhaustion. Research shows that the quality of life for individuals with POTS can be as impaired as those with conditions like congestive heart failure or chronic obstructive pulmonary disease (Benrud-Larson et al., 2002). Many patients face delays in diagnosis, which of course can increase frustration, isolation, and functional decline.

Why Does POTS Develop?

From a functional medicine perspective, POTS is seen not just as a cardiovascular condition but as a multifactorial disorder. POTS is not caused by a single defect, but rather by overlapping vulnerabilities that stress the autonomic nervous system. Contributors may include:

• Immune dysfunction: POTS can develop after viral infections, suggesting immune involvement (Blitshteyn, 2021).

• Connective tissue differences: A subset of patients also have Ehlers-Danlos syndrome or joint hypermobility, indicating structural vulnerabilities.

• Blood volume regulation: Many with POTS have hypovolemia (low blood volume), impaired vascular tone, or abnormal norepinephrine regulation (Shibata et al., 2012).

• Hormonal and mitochondrial factors: Dysregulated stress responses and impaired energy metabolism have been shown to be factors in POTS

Common Symptoms of POTS

• Rapid heart rate upon standing

• Lightheadedness or fainting

• Fatigue and exercise intolerance

• “Brain fog” (difficulty concentrating)

• Headaches, nausea, and abdominal discomfort

• Cold hands and feet, palpitations, tremors

Because symptoms vary, POTS can be mistaken for anxiety or deconditioning, which further delays proper treatment.

Possible Treatments for POTS

There is no single cure for POTS, but multiple strategies can help improve function. Oftentimes a tailored, multidisciplinary approach often leads to the best outcomes.

Lifestyle adjustments such as Increased fluid and salt intake, compression stockings, and graded exercise programs have proven beneficial (Fu et al., 2010). Medications such as Beta-blockers, fludrocortisone, midodrine, and ivabradine are sometimes prescribed, depending on the patient’s physiology (Raj, 2013). Other Functional supports such as addressing nutrition, sleep, and coexisting conditions (e.g., autoimmune issues, GI dysfunction) can also reduce symptom severity.

Mental Health and POTS

The impact of POTS goes beyond physical symptoms. Rates of anxiety and depression are higher among patients, but importantly, this distress often arises as a consequence of living with unpredictable and disabling symptoms—not as the cause (Anderson et al., 2014). Chronic fatigue, social isolation, and difficulty maintaining work or school contribute to mental health struggles.

How Mental Health Support Can Help

Therapy can be a lifeline for those living with POTS. Working with a trauma-informed therapist provides:

• Emotional support to process the frustration, grief, or anxiety that often accompany chronic illness.

• Coping strategies for managing fatigue, brain fog, and the stress of unpredictable symptoms.

• Practical tools for pacing, boundary setting, and maintaining relationships while living with limitations.

• Validation and advocacy from therapists can help clients feel heard and supported when navigating both medical and personal challenges.

Mental health support does not cure POTS, but it can significantly improve resilience, reduce isolation, and strengthen quality of life.

Take the Next Step

At Well Mind Body, we specialize in supporting clients facing both physical and emotional challenges. Our trauma-informed clinicians understand how chronic conditions like POTS affect daily life, mental health, and family dynamics.

You don’t have to navigate this alone. With the right tools, compassionate support, and whole-person care, it is possible to feel more empowered and connected, even while managing POTS.

Book a session today with one of our therapists at Well Mind Body and take the first step toward healing, resilience, and hope.

Thank you for being here!

Dr. E

References

Anderson, J. W., Lambert, E. A., Sari, C. I., Dawood, T., Esler, M. D., & Lambert, G. W. (2014). Cognitive function, anxiety, and depression in postural tachycardia syndrome. Frontiers in Physiology, 5, 230. https://doi.org/10.3389/fphys.2014.00230

Benrud-Larson, L. M., Sandroni, P., Haythornthwaite, J. A., Rummans, T. A., Low, P. A., & Weinshenker, B. G. (2002). Quality of life in patients with postural tachycardia syndrome. Mayo Clinic Proceedings, 77(6), 531–537. https://doi.org/10.4065/77.6.531

Blitshteyn, S. (2021). Postural tachycardia syndrome following COVID-19. Heart Rhythm, 18(10), 1766–1772. https://doi.org/10.1016/j.hrthm.2021.07.016

Fu, Q., Vangundy, T. B., Galbreath, M. M., Shibata, S., Jain, M., Hastings, J. L., ... & Levine, B. D. (2010). Cardiac origins of the postural orthostatic tachycardia syndrome. Journal of the American College of Cardiology, 55(25), 2858–2868. https://doi.org/10.1016/j.jacc.2010.02.043

Raj, S. R. (2013). Postural tachycardia syndrome (POTS). Circulation, 127(23), 2336–2342. https://doi.org/10.1161/CIRCULATIONAHA.112.144501

Shibata, S., Fu, Q., Bivens, T. B., Hastings, J. L., Wang, W., & Levine, B. D. (2012). Short-term exercise training improves the cardiovascular response to exercise in the postural orthostatic tachycardia syndrome. Journal of Physiology, 590(15), 3495–3505. https://doi.org/10.1113/jphysiol.2012.231373