Question and Answer Forum

SSRIs for Postural Orthostatic Tachycardia Syndrome

By David S. Bell, MD, FAAP

Published in Lyndonville News, May 2001

Question:

Dr. Bell,

I have a quick question for you. What are the common dosage scheme's for SSRI's in people that have POTS? I tried the standard Starting dose of Celexa (20 mg I think it was) several months ago, and it just seem to make me worse. I have read in several places On the Net that the typical starting dosages need to be a lot lower than what is used for depression, but haven't really seen any Clear dosage ranges. Can you enlighten me? My cardio here wants to try Paxil, and I don't want it to be a failure because the initial dosage is too High.

Thanks,

Justin

Answer:

Dear Justin,

The question about SSRI¹s is a good one. I like to use SSRI¹s because they can be energizing, may help orthostasis, and can help any depression that is tagging along. My favorite is good old fluoxetine (Prozac) although I do not know if this is really any better than the others. There is a good way to tell if you can tolerate it. There are two thypes of CFS: One is hypersomnolence - always tired, can fall asleep at the drop of a hat, no insomnia, drinks lots of coffee. This type can start with full dose of 20 mgs fluoxetine. The other type, and the worse type is insomnia till 4 am, can't tolerate coffee, tired but unable to nap. These unfortunate souls will have a bad time with full doses, and can start on the liquid, about 5 mgs, and move up until an effect is noted.

Celexa, Paxil, Zoloft, and the others are a little different, even though the insurance companies don¹t think so. In general, start with a lower dose, it can always be raised after a couple of weeks.

Dr. Bell

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