For many patients struggling with symptoms like dizziness, rapid heart rate, fatigue, and brain fog, a common explanation from healthcare providers is simple: anxiety. While anxiety is a real and impactful mental health condition, this diagnosis can become a frustrating detour when the actual issue is Postural Orthostatic Tachycardia Syndrome (POTS). Misdiagnosis between POTS and anxiety is increasingly common, particularly among young women, leading to years of ineffective treatment and unnecessary suffering.
In this blog, we’ll walk through the maze of misdiagnosis, break down the overlap between POTS and anxiety, and highlight how you can advocate for the right diagnosis and care.
What Is POTS?
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia — a disorder of the autonomic nervous system, which controls functions like heart rate, blood pressure, digestion, and temperature regulation. People with POTS experience an abnormal increase in heart rate when they move from lying or sitting to standing.
Common symptoms include:
- Lightheadedness or dizziness upon standing
- Rapid heartbeat (tachycardia)
- Brain fog
- Nausea
- Fatigue
- Shaking or tremors
- Palpitations
- Exercise intolerance
- Sweating abnormalities
These symptoms often mimic or overlap with generalized anxiety disorder or panic attacks, making diagnosis tricky without specialized evaluation.
The Overlap Between POTS and Anxiety
POTS and anxiety share multiple symptoms:
- Increased heart rate
- Shortness of breath
- Dizziness
- Shaking
- Nausea
- Chest discomfort
However, their causes and treatments are very different. POTS stems from a malfunction in the autonomic nervous system. Anxiety, on the other hand, is rooted in mental health and often linked to external stressors or psychological patterns.
Because the body goes into a fight-or-flight-like response during POTS episodes, patients often appear anxious even when they are not emotionally distressed. This leads to frequent mislabeling of their condition.
Why Are So Many POTS Patients Misdiagnosed?
1. Symptom Similarity
POTS symptoms often resemble those of panic attacks. Without proper testing (like a tilt table test), it’s easy for providers unfamiliar with POTS to default to a psychiatric diagnosis.
2. Gender Bias
The majority of POTS patients are women between ages 15 and 50. Studies show women are more likely to have their physical symptoms attributed to anxiety or stress.
3. Lack of Awareness
Many general practitioners and even some cardiologists have limited training on autonomic nervous system disorders. POTS may not be top of mind, especially in primary care settings.
4. Time Constraints
Busy clinics may not allow enough time for detailed patient histories. Quick diagnoses can lead to patients being placed on anti-anxiety medications without further investigation.
The Cost of a Misdiagnosis
Mislabeling POTS as anxiety can have serious consequences:
- Delayed proper treatment: Patients go years without effective POTS treatment.
- Inappropriate medications: Anti-anxiety drugs, especially benzodiazepines, can worsen symptoms or mask them.
- Emotional toll: Being told “it’s all in your head” invalidates a patient’s experience, causing frustration, fear, and mistrust in the medical system.
The average delay in POTS diagnosis can range from 4 to 6 years, with patients often seeing multiple specialists before getting an accurate diagnosis from a knowledgeable POTS doctor or dysautonomia clinic.
POTS Diagnosis: What to Ask For
If you suspect your symptoms are due to POTS and not anxiety, ask your provider about:
- Tilt Table Test: This is the gold standard for diagnosing POTS. It measures your heart rate and blood pressure as you change from lying down to standing.
- Active Stand Test: A simpler alternative that can be done in-office. You lie down and then stand, with heart rate and BP monitored.
- Holter Monitor: Worn for 24-48 hours to record heart activity.
- Autonomic Testing: Comprehensive evaluation of autonomic nervous system function.
If your current provider dismisses your concerns, consider seeing a POTS specialist MD or a POTS doctor in Maryland if you are located in that region. Several clinics now offer evaluations specifically for dysautonomia and related conditions.
How to Tell POTS From Anxiety: Key Differences
| Symptom | POTS | Anxiety |
|---|---|---|
| Heart rate increase | Triggered by standing | Triggered by stress or panic |
| Blood pressure changes | May drop upon standing | Usually stable |
| Brain fog | Common and persistent | Episodic |
| Symptom triggers | Positional (standing, walking) | Situational (stress, conflict) |
| Treatment | Salt, fluids, exercise, meds for HR | Therapy, anti-anxiety meds |
Another major difference is duration. POTS symptoms can last for hours or be persistent throughout the day. Anxiety symptoms often spike quickly and then gradually decrease.
Patient Advocacy Tips
- Track Your Symptoms: Use an app or notebook to record your heart rate, BP, and symptoms throughout the day. Note how they change with posture.
- Educate Yourself: Bring reputable resources to your appointments (e.g., Dysautonomia International, Cleveland Clinic guides).
- Ask for Autonomic Testing: Be specific about what tests you want and why. Describe the exact physical sensations you experience.
- Seek a Second Opinion: If dismissed, seek care at POTS clinics MD or providers listed in dysautonomia directories.
- Be Persistent but Polite: Avoid confrontation, but be firm about your symptoms being physical, not psychological.
Treatment Paths Diverge
Once accurately diagnosed, treatment for POTS often includes:
- Increased salt and water intake
- Compression garments
- Physical reconditioning (recumbent biking, rowing, etc.)
- Targeted medications (e.g., beta blockers, fludrocortisone, midodrine)
In contrast, anxiety treatments involve cognitive behavioral therapy (CBT), relaxation techniques, and sometimes SSRIs or benzodiazepines. While anxiety may coexist with POTS, treating one will not automatically resolve the other.
If you’re in Maryland and seeking care, look for a POTS doctor accepting new patients MD who has experience distinguishing between autonomic disorders and psychiatric conditions.
Real Lives, Real Struggles
Countless patients have shared stories of being told their symptoms were “just anxiety” for years, only to later be diagnosed with postural orthostatic tachycardic syndrome MD. These stories are common among teens, young adults, and women with EDS or other chronic health conditions.
The mental and emotional burden of feeling unheard can be just as debilitating as the physical symptoms. That’s why changing the narrative around POTS is critical for the future of compassionate, accurate healthcare.
Final Thoughts
If you or someone you love has been struggling with symptoms like dizziness, fast heart rate, fatigue, or lightheadedness — don’t settle for an anxiety diagnosis without deeper evaluation. POTS is real, and it requires real testing and tailored care.
Getting a diagnosis can feel like navigating a maze, but with the right tools, specialists, and self-advocacy, you can find the way out.
If you are in the Maryland area, consider connecting with a POTS specialist MD who understands the intricacies of autonomic disorders and is accepting new patients.
