Autonomic Nervous System Disorders: Symptoms and Treatment

Autonomic nervous system dysfunction

Hello Dr.
Chen:
Over two months ago, I went to the emergency room due to stomach discomfort, belching, headaches, chest tightness, and a sudden increase in blood pressure.
During the medication period, I experienced intermittent symptoms such as neck tightness, difficulty breathing, depression, palpitations, weak pulse, bloating, difficulty swallowing, and insomnia.
Recently, I visited a family medicine clinic for a thyroid check, and the doctor informed me that it was normal and attributed my symptoms to autonomic nervous system issues.
I am currently taking anti-anxiety medication, medication for stomach pain, and Inderal, but I have been experiencing dizziness, especially in the evening.
Additionally, my pulse averages 60 beats per minute.
I would like to ask Dr.
Chen if my condition requires referral to another specialty clinic.
What issues should I be aware of while taking these medications? Is there a risk of developing dependence on them? Thank you.

Lao Er, 30~39 year old female. Ask Date: 2003/11/02

Dr. Chen Wenke reply Psychiatry

Before considering the possibility of autonomic nervous system dysfunction, it is essential to first confirm that there are no underlying physiological diseases causing your discomfort.
However, given your age, it is unlikely that you have any severe physiological conditions.
So, why are you experiencing symptoms such as stomach discomfort, belching, headaches, chest tightness, and sudden increases in blood pressure? These symptoms can easily arise when a person is in a state of acute anxiety.
Your physician has prescribed you anti-anxiety medication, which should help alleviate your symptoms to some extent.
However, this type of medication can have sedative effects, and some individuals may experience dizziness.
You might consider reducing the dosage by half (for example, from one pill to half a pill) and observe if the dizziness decreases.
It is important to be cautious about the potential for medication dependence with these types of drugs, so do not increase the dosage on your own.
If you need to taper off the medication, it should be done gradually; stopping suddenly can lead to discomfort.
You mentioned taking Inderal for a rapid heartbeat; you might try reducing the dosage, as Inderal can slow down the heart rate.
Additionally, many cases of autonomic nervous system dysfunction may be associated with other emotional disorders, so it would be advisable to seek further evaluation from a psychiatrist.

Reply Date: 2003/11/02

More Info

Understanding autonomic nervous system (ANS) disorders is crucial, especially when symptoms can significantly impact daily life. The autonomic nervous system regulates involuntary bodily functions, including heart rate, digestion, respiratory rate, and more. It consists of two main branches: the sympathetic nervous system (which prepares the body for 'fight or flight' responses) and the parasympathetic nervous system (which promotes 'rest and digest' activities).
From your description, it appears you are experiencing a range of distressing symptoms, including gastrointestinal discomfort, headaches, chest tightness, elevated blood pressure, and various autonomic symptoms such as palpitations and difficulty breathing. These symptoms can indeed be indicative of an autonomic nervous system disorder, particularly if they fluctuate in intensity and are accompanied by anxiety and depressive feelings.

The symptoms you mentioned, such as neck tightness, difficulty swallowing, and dizziness, can be associated with autonomic dysregulation. It's not uncommon for individuals with anxiety disorders to experience physical symptoms that mimic or exacerbate autonomic dysfunction. The medications you are currently taking, including anti-anxiety medications and Inderal (a beta-blocker), are often prescribed to help manage these symptoms. Inderal can help control heart rate and reduce anxiety-related physical symptoms, but it can also lead to side effects such as dizziness, especially when standing up quickly or during physical activity.

Regarding your question about whether you should be referred to another specialty, it may be beneficial to consult with a neurologist or a specialist in autonomic disorders. They can conduct a thorough evaluation, including tests to assess how well your autonomic nervous system is functioning. This may include tilt table tests, heart rate variability assessments, or other diagnostic procedures to rule out conditions like postural orthostatic tachycardia syndrome (POTS) or other forms of dysautonomia.

As for the concern about medication dependence, it is essential to discuss this with your healthcare provider. While some anti-anxiety medications can lead to physical dependence, others may not. Your doctor can help you understand the risks and benefits of your current medications and may suggest alternative treatments or therapies if dependence is a concern.
In addition to medication, lifestyle modifications can play a significant role in managing autonomic nervous system disorders. Regular physical activity, stress management techniques (such as mindfulness or cognitive-behavioral therapy), and a balanced diet can help improve overall well-being and reduce symptoms. It's also important to maintain a regular sleep schedule and practice good sleep hygiene, as sleep disturbances can exacerbate autonomic symptoms.

In summary, your symptoms suggest a potential autonomic nervous system disorder, and further evaluation by a specialist may be warranted. Continue to communicate openly with your healthcare provider about your symptoms, medication effects, and any concerns regarding dependence. With the right approach, including both medical treatment and lifestyle changes, many individuals find significant relief from their symptoms and improve their quality of life.

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