Autonomic Nervous System Dysregulation and Its Treatment

Autonomic nervous system dysfunction

Hello Doctor, I have issues with obesity and hypertension.
Recently, I experienced episodes of rapid heartbeat accompanied by feelings of fear and cold extremities during the night, which lasted intermittently for about half an hour.
For the past three weeks, I have been feeling my heartbeat in my chest throughout the day, which has even caused insomnia.
I visited the cardiology department at Changhua Yuanlin Christian Hospital, where tests showed no abnormalities.
I am continuously taking antihypertensive medications (Lisinopril, 5 mg of Concor, and 5 mg of Metoprolol) to control my blood pressure.
Later, I consulted a psychiatrist in Changhua, who prescribed me fluoxetine capsules and quetiapine, which I have been taking for six days.
This week, I returned to work in Pingtung and went to the psychiatric department there for autonomic nervous system testing (HRV).
The results indicated premature aging of the autonomic nervous system (55-60 years), overall autonomic function was low (-2.08), sympathetic function was slightly low (-1.57), parasympathetic function was normal (-0.59), and the NN interval standard deviation was abnormal (SDNN 19.70 ms), with a general tendency towards parasympathetic dominance.
The doctor prescribed CARDOLOL 10 mg to be taken twice a day (half a tablet each time), ERISPAN-S 0.25 mg twice daily (one tablet each time), and before bed, I take half a tablet of Alpragin 2 mg and 10 mg of Brintellix.
I also have ALPRAZOLAM 0.5 mg as needed.
I would like to ask a few questions: 1.
Does this indicate that I have autonomic dysfunction? 2.
Can these medications improve my symptoms? How long might it take? 3.
I have been taking antihypertensive medications for nearly a year, including Entresto prescribed by my cardiologist, which seems to contain a beta-blocker component.
Could this affect the sympathetic function values in the HRV test? 4.
Is the premature aging of the autonomic nervous system reversible? Thank you for your answers, Doctor.

Mr. Lin, 30~39 year old female. Ask Date: 2022/03/02

Dr. Qiu Junda reply Psychiatry

Hello.
1.
There is indeed a possibility of autonomic nervous system dysfunction.
It is treatable, so please do not worry.
2.
Medications can help improve the condition.
The duration of the treatment should be discussed with your primary physician.
3.
It may have an impact, but the physician will take this issue into consideration during evaluation.
4.
It is reversible.
I want to emphasize again that it is not a complicated or rare condition, so please rest assured.

Reply Date: 2022/03/02

More Info

Autonomic Nervous System (ANS) dysregulation is a complex condition that can manifest through various symptoms, including heart palpitations, anxiety, cold extremities, and sleep disturbances, as you've described. Your situation, characterized by obesity, hypertension, and episodes of increased heart rate accompanied by fear, suggests a significant interplay between your physical health and the functioning of your autonomic nervous system.

1. Diagnosis of ANS Dysregulation: Based on your HRV (Heart Rate Variability) results, it is evident that your autonomic nervous system is not functioning optimally. The findings indicate early aging of the ANS, with a total function score that is below normal. This aligns with the symptoms you are experiencing, such as anxiety, insomnia, and physical discomfort. Therefore, yes, it can be concluded that you are experiencing autonomic nervous system dysregulation.

2. Medication and Symptom Improvement: The medications prescribed to you, including fluoxetine (an SSRI), alprazolam (a benzodiazepine), and brintellix (vortioxetine), are aimed at managing anxiety and depression, which can significantly affect the autonomic nervous system. Beta-blockers like Cardolol are also used to manage heart rate and blood pressure, which can help alleviate some of the physical symptoms associated with ANS dysregulation. The timeline for improvement can vary widely among individuals; some may notice changes within a few weeks, while others may take several months to experience significant relief. It is crucial to maintain open communication with your healthcare provider about your symptoms and any side effects you may encounter.

3. Impact of Other Medications on HRV: Your ongoing use of blood pressure medications, particularly beta-blockers, can indeed influence HRV readings. Beta-blockers work by inhibiting the effects of the sympathetic nervous system, which can lead to a decrease in heart rate and potentially alter HRV metrics. Therefore, it is essential to consider these medications when interpreting your HRV results, as they may not fully reflect your autonomic function in the absence of these drugs.

4. Reversibility of ANS Aging: The concept of "premature aging" of the autonomic nervous system is concerning, but it is important to note that many aspects of ANS function can be improved with lifestyle modifications and appropriate medical treatment. Engaging in regular physical activity, managing stress through techniques such as mindfulness or cognitive behavioral therapy, maintaining a balanced diet, and ensuring adequate hydration can all contribute to enhancing autonomic function. Additionally, weight loss can significantly improve both hypertension and overall cardiovascular health, which may positively impact your autonomic nervous system.

In summary, your symptoms and HRV results indicate a clear case of autonomic nervous system dysregulation. The medications you are taking can help manage your symptoms, but it is essential to monitor their effects and adjust as necessary under the guidance of your healthcare provider. Lifestyle changes, including weight management and stress reduction techniques, can also play a crucial role in improving your condition. Regular follow-ups with your healthcare team will be vital in tracking your progress and making any necessary adjustments to your treatment plan.

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