Key result
Antidepressants show no benefit for orthostatic symptoms or vital signs in POTS.
Why the study?
Antidepressant medications are widely utilized in patients with POTS despite standard treatments focusing on decreasing heart rate and increasing blood pressure and plasma volume, motivating an evaluation of the published evidence on their use and efficacy.
Do antidepressant medications improve orthostatic vital signs or orthostatic symptoms in patients with postural orthostatic tachycardia syndrome (POTS)?
Do antidepressant medications improve orthostatic vital signs or orthostatic symptoms in patients with postural orthostatic tachycardia syndrome (POTS)?
Despite nearly half of POTS patients being prescribed antidepressants in clinical practice, this scoping review demonstrates there is currently no clinical evidence supporting their efficacy for improving orthostatic tachycardia or symptoms in POTS.
Answers are grounded in this paper and cite their sources.
Antidepressants lack evidence for orthostatic benefit in POTS; challenges their frequent use and leaves open need for larger RCTs.
Background Postural orthostatic tachycardia syndrome (POTS) is one of the most common autonomic disorders with increasing prevalence and incidence after COVID-19 pandemic. Despite standard treatment of POTS consisting of nonpharmacologic and pharmacologic therapies that decrease heart rate and increase blood pressure and plasma volume, antidepressant medications are widely utilized in patients with POTS. Methods We conducted a scoping review of literature to examine the published studies on the use of antidepressants and their efficacy in patients with POTS. Results We found only 2 studies, one retrospective chart review involving bupropion and second study of a randomized placebo-controlled crossover trial of a single dose of sertraline 50 mg. Both studies showed no benefits of these medications on orthostatic vital signs or orthostatic symptoms. A third study involving retrospective chart review did not examine medication efficacy, but found that nearly half of 120 patients with POTS were taking some type of antidepressant or antianxiety medication while only 15.7% were taking cardiovascular medications for treatment of POTS. Conclusions Based on very limited available data, we conclude that antidepressants show no efficacy for treatment of POTS despite being widely utilized. Education of healthcare professionals regarding proper diagnosis and appropriate treatment of POTS is essential to instituting the right treatment and avoiding inappropriate use of antidepressants in this patient population.
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Blitshteyn et al. (2026) conducted a review in Postural orthostatic tachycardia syndrome (POTS) (n=206). Antidepressants (bupropion, sertraline 50 mg, SSRIs, SNRIs) vs. Placebo (in 1 crossover RCT) or none was evaluated on Orthostatic vital signs (standing heart rate) and orthostatic intolerance symptoms. Antidepressants showed no benefit on orthostatic vital signs or symptoms in POTS across 2 efficacy studies, despite 48.3% of POTS patients taking psychotropics.
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