Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of autonomic dysfunction defined by an excessive increase in heart rate (>30bpm within 10 minutes) upon standing and symptoms such as lightheadedness, palpitations, and, in some cases, syncope. Because many POTS symptoms overlap with those of anxiety and depression, psychiatric medications are commonly considered, but there’s a risk they may affect the heart rate and blood pressure.
Objective: To summarize how common psychiatric medication classes may impact autonomic function in patients with POTS.
Methods: This project reviewed the autonomic effects of antidepressant classes (SSRIs, SNRIs, TCAs) from peer reviewed articles. Additionally, data from two separate experiments was used to prepare an indirect head-to-head comparison. The primary outcome was ΔHR (main difference in sitting-standing heart rate), which is the comparison between medication vs placebo at 2- and 4-hours including placebo-adjusted differences used to compare atomoxetine (SNRI) to sertraline (SSRI).
Results: Sertraline did not significantly change ΔHR compared with placebo (2 hours: -1 bpm, 95% CI -6.4 to +4.4; 4 hours: -3 bpm, 95% CI -8.4 to +2.4). Atomoxetine showed a trend toward increased ΔHR versus placebo (2 hours: +5 bpm, 95% CI -2.2 to +12.2; 4 hours: +2 bpm, 95% CI -4.7 to +8.7), though results were not statistically significant. Indirect placebo-adjusted-adjusted comparisons suggested higher ΔHR with atomoxetine than sertraline (2 hours: +6 bpm; 4 hours: +5 bpm), but CI crossed zero.
Conclusion: This review appears to show SSRIs as the most favorable psychiatric medication class for patients with POTS, and sertraline seemed more neutral on tachycardia, related to standing, than atomoxetine in limited short-term data. Certainly, larger, independent studies are needed to better guide medication selection when anxiety/depression and POTS occur together.
Limitations: Low study power, largely female samples, inability to include TCAs due to limited data, and possible participant overlap between studies.
Embargo Period
6-1-2026
Included in
Critical Analysis of Psychiatric Medications, and Their Effects on Patients with Post-Orthostatic Tachycardia Syndrome(POTS)
Suwanee, GA
Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of autonomic dysfunction defined by an excessive increase in heart rate (>30bpm within 10 minutes) upon standing and symptoms such as lightheadedness, palpitations, and, in some cases, syncope. Because many POTS symptoms overlap with those of anxiety and depression, psychiatric medications are commonly considered, but there’s a risk they may affect the heart rate and blood pressure.
Objective: To summarize how common psychiatric medication classes may impact autonomic function in patients with POTS.
Methods: This project reviewed the autonomic effects of antidepressant classes (SSRIs, SNRIs, TCAs) from peer reviewed articles. Additionally, data from two separate experiments was used to prepare an indirect head-to-head comparison. The primary outcome was ΔHR (main difference in sitting-standing heart rate), which is the comparison between medication vs placebo at 2- and 4-hours including placebo-adjusted differences used to compare atomoxetine (SNRI) to sertraline (SSRI).
Results: Sertraline did not significantly change ΔHR compared with placebo (2 hours: -1 bpm, 95% CI -6.4 to +4.4; 4 hours: -3 bpm, 95% CI -8.4 to +2.4). Atomoxetine showed a trend toward increased ΔHR versus placebo (2 hours: +5 bpm, 95% CI -2.2 to +12.2; 4 hours: +2 bpm, 95% CI -4.7 to +8.7), though results were not statistically significant. Indirect placebo-adjusted-adjusted comparisons suggested higher ΔHR with atomoxetine than sertraline (2 hours: +6 bpm; 4 hours: +5 bpm), but CI crossed zero.
Conclusion: This review appears to show SSRIs as the most favorable psychiatric medication class for patients with POTS, and sertraline seemed more neutral on tachycardia, related to standing, than atomoxetine in limited short-term data. Certainly, larger, independent studies are needed to better guide medication selection when anxiety/depression and POTS occur together.
Limitations: Low study power, largely female samples, inability to include TCAs due to limited data, and possible participant overlap between studies.
Comments
Presented by Michael Gibson.