Autonomic Nervous System Disorders: Symptoms and Treatment Options

Q: Autonomic Nervous System Disorders: Symptoms and Treatment Options

Hello, Jiang： <br>1. <br>Jianfu enteric-coated tablets belong to the class of selective serotonin reuptake inhibitors (SSRIs). <br>When you first start taking them, you may experience gastrointestinal side effects such as nausea, vomiting, and bloating. <br>Therefore, the increas

Autonomic nervous system dysfunction

Hello Doctor, initially, my symptoms felt like a sensation of air rushing into my nasal cavity, similar to the feeling of having consumed a lot of carbonated drinks and then burping, which causes a sensation in the nose.
This is accompanied by dizziness, a strong heartbeat, and numbness in my fingers, but the symptoms disappear after about five seconds.
At first, I thought it was gastroesophageal reflux disease (GERD), and after seeing a traditional Chinese medicine practitioner for six months, my condition did not improve.
Recently, I have also experienced waking up at night, but I can go back to sleep.
I then consulted a psychiatrist, but the doctor did not clearly explain my condition.
I was prescribed Mindere "Jing'an" enteric-coated tablets 10 mg, which I took for four weeks without noticeable improvement.
I then switched to Delixit enteric-coated tablets 10 mg, which I took for two weeks without improvement, and then to Tofranil enteric-coated tablets 25 mg (Imipramine hydrochloride), which I also took for two weeks without improvement.
Recently, I switched to Jianfu enteric-coated tablets 50 mg, and after one week, the frequency of episodes seems to be increasing.

1.
Is there a transitional period when switching medications? It feels like this time the medication change has led to a more severe trend.

2.
Do my symptoms fall under autonomic nervous system dysfunction?
3.
How long should I expect to try different medications?

Jiang, 20~29 year old female. Ask Date: 2022/06/13

Dr. Lin Mianzhang reply Psychiatry

Hello, Jiang:
1.
Jianfu enteric-coated tablets belong to the class of selective serotonin reuptake inhibitors (SSRIs).
When you first start taking them, you may experience gastrointestinal side effects such as nausea, vomiting, and bloating.
Therefore, the increased frequency of your symptoms could be related to the medication's side effects, which typically diminish after a period of continued use.
2.
Since you have not consulted a gastroenterologist, we cannot make a definitive conclusion yet.
If the gastroenterology examination reveals no issues, it is likely that you are experiencing autonomic nervous system dysregulation.
3.
The first three medications you are taking are actually at low doses, which are usually intended for sleep aid and may not effectively improve depression or anxiety.
To address autonomic nervous system dysregulation, medications that can treat depression and anxiety are typically required.
Jianfu is an antidepressant and is classified as a selective serotonin reuptake inhibitor.
It usually takes more than two weeks to see significant effects, and this is contingent upon taking an adequate dosage.
Currently, you are only taking 50 mg, which may not be effective.
If you do not notice significant improvement, you may consider increasing the dosage.
In summary, standard antidepressants can be used to treat autonomic nervous system dysregulation, but noticeable effects typically take more than two weeks to manifest.
Wishing you peace and health!

Reply Date: 2022/06/13

More Info

Understanding autonomic nervous system disorders can be quite complex, especially when symptoms overlap with various other medical conditions. Based on your description, it appears that you are experiencing a range of symptoms that could indeed be related to autonomic nervous system dysfunction, commonly referred to as dysautonomia. This condition can manifest in various ways, including cardiovascular symptoms, gastrointestinal issues, and neurological disturbances.

Symptoms and Their Implications
The symptoms you mentioned—such as the sensation of air rushing into your nasal cavity, dizziness, palpitations, and tingling in your fingers—are indicative of autonomic nervous system involvement. The autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate, blood pressure, and digestion. When the ANS is not functioning properly, it can lead to a variety of symptoms:
1. Cardiovascular Symptoms: Palpitations and a racing heart can occur when the sympathetic nervous system (the "fight or flight" part of the ANS) is overactive. This can be triggered by stress, anxiety, or even certain foods and beverages.

2. Neurological Symptoms: Tingling or numbness in the extremities can be a sign of nerve involvement or poor circulation, which can also be influenced by autonomic regulation.

3. Gastrointestinal Symptoms: The sensation you described, akin to the effects of carbonated beverages, could be related to gastrointestinal reflux or dysregulation of the digestive system, which is also controlled by the ANS.

Treatment Options
You mentioned trying various medications without significant improvement. It’s important to understand that finding the right medication for autonomic dysfunction can be a process of trial and error. Here are some considerations regarding your treatment:
1. Medication Transition: When switching medications, it is common to experience a transitional phase where symptoms may temporarily worsen before improvement occurs. This is sometimes referred to as a "washout" period, where the previous medication is leaving your system while the new one is taking effect.
2. Duration of Trials: Generally, it is recommended to give each medication a fair trial, which can range from 4 to 6 weeks, depending on the specific drug and its mechanism of action. However, if you are experiencing worsening symptoms, it is crucial to communicate this with your healthcare provider, as they may need to adjust your treatment plan sooner.

3. Lifestyle Modifications: In addition to medication, lifestyle changes can significantly impact autonomic function. Regular physical activity, stress management techniques (such as mindfulness or yoga), and a balanced diet can help regulate symptoms. Staying hydrated and avoiding excessive caffeine or alcohol can also be beneficial.

4. Further Evaluation: If your symptoms persist or worsen, it may be worthwhile to seek further evaluation from a specialist in autonomic disorders or a neurologist. They may recommend additional tests, such as tilt table testing or autonomic function tests, to better understand your condition.

Conclusion
In summary, your symptoms may indeed be related to autonomic nervous system dysfunction. The process of finding the right treatment can be challenging, and it is essential to maintain open communication with your healthcare provider. They can help guide you through medication adjustments and recommend additional therapies or lifestyle changes that may improve your overall well-being. Remember, managing autonomic dysfunction often requires a comprehensive approach that includes both medical and lifestyle interventions.

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