Postural Orthostatic Tachycardia Syndrome, also known as POTS syndrome, is defined by orthostatic symptoms (symptoms on standing such as lightheadedness) and an accompanying dramatic increase in heart rate. The symptoms typically occur within 5 minutes of straight standing.
To find experts in POTS around the United States check out XpertDox.
POTS and Brain Fog – What Does It Mean?
Symptoms described by POTS syndrome patients are wide ranging and include fatigue, weakness, light-headedness, sleep disturbance and others. Also prominent amongst these symptoms is impairment of cognitive function, aka brain fog. Cognitive function is a term that basically encompasses intellectual processing. This complaint is a common complaint amongst POTS syndrome patients and is often called “brain fog”.
The term brain fog is, of course, imprecise, so one study set out to characterize the term brain fog further. They looked at 138 POTS syndrome patients who were aged between 14-29 years, 88% were female. Specifically designed questionnaires were used to gather information.
What Triggers Brain Fog?
Almost all of the participants reported experiencing brain fog. The most common descriptors of brain fog were difficulty focusing, thinking, and communicating. They also looked at what the triggers for brain fog were. They were fatigue (91%), lack of sleep (90%), prolonged standing (87%), dehydration (86%) and feeling faint (85%). It was also noted that the symptoms persisted after laying back down.
Treatments For Brain Fog
Over 75% of the patients had tried non-drug treatments of POTS with varying success. Lying down was found to be helpful in around 80%. Around 60% of patients found that avoiding heat, lying down, high fluid intake, and high salt diets for POTS were helpful. Around half of the participants noted that brain fog was made worse by exercise although regular aerobic exercise was listed as something that improved symptoms. 60% felt showering made it worse, and about 1/3rd found caffeinated beverages made it worse.
It was found that several different medical interventions had been tried for treating the brain fog ranging from IV saline infusions, salt tablets, B12 injections, and medicines used to stimulate blood pressure increase. IV saline was found to improve brain fog in around 80%, stimulant medicines in around 70% and salt tabs or b12 injections in around 50%. About 30% reported that some of the commonly used antidepressant medications made the brain fog worse.
Conclusions
Brain fog was found to be common in POTS syndrome and most commonly described as difficulty focusing, thinking, and communicating. Triggers included fatigue, lack of sleep, prolonged standing, dehydration and feeling faint. The most commonly helpful non-drug factors were avoiding heat, lying down, high fluid intake, and high salt diets. Of the drug treatments tried, IV saline was most effective. The study is more of an exploratory study and the design limitations of the study mean no strong conclusions can be drawn. The study is important though, because it gives us insights and ideas into POTS syndrome and its associated symptoms. Further studies are required to confirm these findings and find the most effective treatment strategies.
I was diagnosed with Addison’s disease in March of this year during an Addison’s crises. Since this time ive had a a couple trips to the Er. I have had Chronic fatigue Syndrome, mostly due to a reacurrence of Upper Respiratory Infections. Although taking the Hydrocortisone therapy for the Addison’s disease has helped with the fatigue, I still have a milder form of chronic fatigue and weakness. Something that has bothered me about my dx of Addison’s Disease is that I have never had the hyperpigmentation, weight loss, or anorexia associated with the disease. After reading about POTS, I find that I have every symptom listed, and have for some time. This has made me feel that there are answers out there for people who are suffering with rare diseases. I have also been diagnosed with Hashimoto Thyroiditis and Fibromyalgia. I’m 43 and have always been athletic and energetic, this has been a very trying year for me. I have hope though that I can get the right answers I need and keep fighting to get back some of the ” light”, that these diseases have taken from me. I thank you so much for this website, and any inquiries will be welcome.
Hi, I know you posted long ago but I’m hoping you may find this. I have exactly the same conditions as those you’ve listed, along with others as well. I am very curious as to whether you are hypermobile? (Notably flexible, or more so when you were younger if you have any issues which have caused stiffening with age??)
If you are hypermobile at all, you may consider looking up ehlers danlos syndrome (hypermobility type—hEDS) It is very common for people who live with the condition to have clusters of comorbidities which commonly include most of those you’ve listed.
I’m in a similar spot. Age 46 and over the past 3 years my symptoms increased dramatically. I am hopeful that the docs I work with take Pots into consideration. I would to get treatment on back on my way to a good quality of life. I need that “light” too.
I’m a 17 year old male and have had POTS for several years now, and i’ve used both adderall and ritalin for the brain fog as i am in school and forced to constantly keep up with everyone else. Both really work, i would recommend talking to your doctors about it. They also help with daily fatigue and how long i’m able to focus when i’m feeling especially unwell.
I take Vyvanse, an ADD drug, daily to combat my brain fog. While it doesn’t completely eliminate it, it helps significantly. I can’t function on a higher level at work without it. I agree with the previous poster, look into adderall and other ADD meds to combat the brain fog.
Hi Freddie-
I’ve had this stuff all my life, though I didn’t know what it was early on. The brain fog is the worst. How do you respond to these medications? Do you feel a sense of well-being or just much more clear thinking? If I could get rid of this, I’d be grateful. I’ve been searching a long time.
Thanks,
CW
When I developed this after having COVID in December 2021 I had no idea what was going on. I thought long COVID? The brain fog was the worst part! I draw blood at work and now I had this feeling like someone had their hand in front of my face almost. It was strange and I felt like maybe I would pass out. I would have to ask someone else to draw the blood for me.
My neurologist told me that a low dose of a stimulant in the morning, before I got out of bed was shown to help with brain fog.
I took 5mg of ritalin in the morning before getting up. It worked for that part of the symptoms. No more brain fog! I eventually discovered that if I took 5 mg every 4 hours all the symptoms would go and stay away!
After a year of being pretty much symptom free, I took my morning meds as usual. (I have them ready to go from the night before)
I got to work and then started feeling faint/lightheaded. I had taken medicine, I had plenty of sleep I wasnt sure what was happening. Then all of the other symptoms started to appear…heart beating, ears ringing, feet cold, headache and eyelids that felt super heavy. Couldnt focus. I hadnt experienced it in a year but was very certain that this is what was happening. I had a 1030 dose that I took, and then took another at 1100. I noticed at 1100am the “fog” was gone although the other symptoms were still hanging around. Even though I took the 3 other doses it never quite resolved. When I got home I looked by my meds and saw that one 5mg dose sitting on the floor. I had not missed a morning dose in a year..I will never miss one again! I was sure I had taken it. Its hard to believe that one little 5mg tablet could totally disrupt my day. The next day went back to my normal routine and felt fine, slight headache maybe but nothing bad.
To those students with POTS who take stimulants such as adderall or vyvanse – does this aggravate tachycardia? Anyone have experience with Straterra, a non stimulant ADD med? Thanks
Yes, my son (almost 14), was dx with ADD in the 1st grade….. and after the common trial of stimulant meds (( which made his “heart have hiccups” and go “boom boom boom” )) he started Straterra. He has been holding at 60 mg doses for the last couple of years now with positive results. His Psyc Drs rotate yearly and in the years prior to his official “heart problem diagnosis“ the newer MDs would sometimes suggest changing to a stimulant med (usually due to cost/ insurance formulary list issues). I just always made sure that they knew of his previous rapid heart complaints in addition to the family history of Tachycardia and that I would rather not chance putting him through it again to just save me a few dollars in out of pocket cost. He’s newly diagnosed with POTS which finally gives me an official medical leg to stand on when Insurances question the need for the higher costing prescription. Others have successfully used stimulant meds but when even drinking a low caffeinated soda has his resting HR at 110, I’m not going to chance it. Hope this helps.
I tried Ritalin, but the come-down afterward was too intense. Brain fog and fatigue like a ton of bricks. Never again.
I find POTS-specific therapies such as increased water and salt intake, compression etc more effective and address not only the brain fog but all POTS symptoms.
I tried Adderal one time and it sent my system into overdrive. I could barely drive. Heart palpatations were worse. It was a rough day.
I actually take Straterra everyday. I’ve been taking it for about 3 years now.
I find it helps considerably but I still need a 20 min wind down in the afternoon every afternoon.
Yes it can have that effect. Try taking BodyBio PC, phosphotidlecholine and serenes. Get Dave Aspreys book – Headstrong”.
Strattera exacerbated my POTS symptoms massively, as did guanfacine, another non-stimulant treatment for ADHD. I could not function on either of these meds, to the point where I could not safely drive my car.
Adderall has worked great for me and has not increased my tachycardia. I take it along with ivabradine and the combination treats the majority of my POTS symptoms
I am a 50 year old female, and though I have not been formally diagnosed with POTS, I have had these symptoms all of my life. I especially experience dizziness, heart palpitations and brain fog. I have had two seizures, one 18 years ago and another 2 years ago, and I sometimes feel like I will faint after eating or taking a hot shower. Some things that have helped reduce symptoms are taking magnesium supplements, drinking electrolyte solutions, and running 3-5 miles a few times a week. I used to feel dizzy after running, but now that has stopped as long as I keep drinking a lot of electrolyte drinks. When I have brain fog at work, I drink electrolytes and make sure I eat salty food, and though that sounds bad to eat a lot of salt, it makes me feel better. Within the last two years, I have also started taking Adderall extended release, and that also seems to help reduce brain fog.
so is it yes or no?? I’m a poor english
My 10 yr old pediatrician believes my daughter has pots. She becomes dizzy when standing and complains of eyesore going dark. When she complained of being dizzy something told me give her salt. This has always worked for her. She has not had any testing. Dr going by her symptoms. I’m trying to learn as much as I can. Her father would always tell me I need salt so I assume she got it from him. She has fallen of the jungle gym from getting lightheaded and fractured her shoulder.