Dysautonomia: Symptoms, Causes, and Treatment Options

Q: Dysautonomia: Symptoms, Causes, and Treatment Options

Joseph： I believe that your experience with marijuana a few years ago should not be causing ongoing discomfort now. <br>You shouldn't worry too much about that. <br>Based on your description of clinical symptoms, it seems more aligned with panic disorder, which is a type of anxie

Autonomic Nervous System Dysregulation

Three years ago, I went abroad to study and occasionally smoked marijuana.
It wasn't frequent, but my sleep schedule was completely irregular.
One time, I smoked too much and suddenly experienced difficulty breathing, weakness, and numbness throughout my body, feeling like I was about to die.
After that, my body felt abnormal and weak, and I often experienced a tingling sensation in my head.
I stopped smoking after that, and my sleep schedule returned to normal.
However, even after two years, I still experience symptoms at night: I hear my heartbeat and have trouble falling asleep.
Every day, I feel weak, and my body has a slight tremor, similar to vibrations with my blood pressure (constantly).
When I go out shopping, I notice difficulty breathing, dizziness, and weakness, feeling like I might faint.
The longer I am out, the worse it gets.
After resting at home, the symptoms gradually lessen.
At their worst, I experience facial numbness, difficulty breathing, and a near-fainting sensation, with things outside appearing to flicker (for about 5 seconds).
This happens every day, and I have undergone a full body examination with no issues found.
This has made it difficult for me to travel far, and it is really distressing.
I didn't used to feel this way; I don't understand why I've become like this.
I feel so weak...
it's frightening.
Later, I went to a hospital's psychiatry department, and they prescribed Stilnox 10mg for sleep, Moclobemide 150mg for depression, and Clonazepam 0.5mg for anxiety.
Is my condition epilepsy? Don't epilepsy medications usually require increasing doses and have more side effects? Can I avoid taking Clonazepam? I'm afraid I will have to rely on this medication forever...

Joseph, 20~29 year old female. Ask Date: 2004/07/07

Dr. Chen Wenke reply Psychiatry

Joseph: I believe that your experience with marijuana a few years ago should not be causing ongoing discomfort now.
You shouldn't worry too much about that.
Based on your description of clinical symptoms, it seems more aligned with panic disorder, which is a type of anxiety disorder that can cause significant discomfort and unease.
The medication you are taking has therapeutic effects; for example, clonazepam is primarily an anticonvulsant, but it is also commonly used as an anxiolytic for patients with anxiety symptoms.
It has a strong sedative effect.
You are concerned about needing to take medication for life, and indeed, a small number of patients may need to take medication regularly to manage their anxiety symptoms.
If you are worried, it is best to make some lifestyle adjustments in addition to medication treatment.
Avoid staying up late, refrain from alcohol and smoking, and engage in regular exercise.
These seemingly simple actions are often very important.
For your reference, if you wish to reduce your use of clonazepam, remember not to stop the medication abruptly; it is best to discuss this with your physician.
Wishing you well.

Reply Date: 2004/07/07

More Info

Dysautonomia refers to a group of disorders that affect the autonomic nervous system (ANS), which controls involuntary bodily functions such as heart rate, blood pressure, digestion, and temperature regulation. Understanding dysautonomia involves recognizing its symptoms, causes, and treatment options.

Symptoms
The symptoms of dysautonomia can vary widely but often include:
- Orthostatic Intolerance: Difficulty standing up, leading to dizziness or fainting.

- Tachycardia: Rapid heart rate, especially upon standing.

- Fatigue: Chronic tiredness that does not improve with rest.

- Gastrointestinal Issues: Nausea, bloating, and changes in bowel habits.

- Temperature Regulation Problems: Feeling excessively hot or cold.

- Sweating Abnormalities: Either excessive sweating or reduced sweating.

- Cognitive Impairment: Difficulty concentrating or "brain fog."
In your case, the symptoms you describe—such as feeling weak, experiencing tremors, and having difficulty breathing—could be indicative of dysautonomia. The sensation of hearing your heartbeat while trying to sleep and the episodes of dizziness and near-fainting are also consistent with autonomic dysfunction.

Causes
Dysautonomia can arise from various underlying conditions, including:
- Genetic Disorders: Some forms of dysautonomia are hereditary.

- Autoimmune Diseases: Conditions like lupus or Sjögren's syndrome can affect the autonomic nervous system.

- Diabetes: Diabetic neuropathy can lead to dysautonomia.

- Infections: Certain viral infections can trigger dysautonomia.

- Substance Use: As you mentioned, using substances like marijuana can lead to temporary dysautonomia symptoms, especially if they disrupt normal physiological functions.

Treatment Options
Treatment for dysautonomia typically focuses on managing symptoms and improving quality of life. Options may include:
- Lifestyle Modifications: Increasing fluid and salt intake can help manage blood pressure. Regular, gentle exercise may improve symptoms.

- Medications: Depending on the symptoms, medications may include:
- Fludrocortisone: To help retain salt and increase blood volume.

- Midodrine: To raise blood pressure.

- Beta-blockers: To manage heart rate.

- Antidepressants: Sometimes prescribed for their effects on the autonomic nervous system.

In your case, the medications prescribed by your psychiatrist—Stilnox (for sleep), moclobemide (an antidepressant), and clonazepam (an anti-anxiety medication)—suggest that your healthcare provider is addressing both anxiety and sleep disturbances, which can be common in individuals with dysautonomia.

Concerns About Medication
You expressed concern about becoming dependent on clonazepam. It's important to discuss these concerns with your doctor. Clonazepam is a benzodiazepine, which can lead to tolerance and dependence if used long-term. Your doctor may consider tapering the dose or switching to a different medication that has a lower risk of dependence.

Conclusion
Dysautonomia can significantly impact daily life, and it’s understandable that you feel frustrated and concerned about your symptoms. It’s crucial to maintain open communication with your healthcare providers about your symptoms, treatment options, and any side effects you experience. They can help tailor a treatment plan that best suits your needs and may involve a multidisciplinary approach, including specialists in neurology, cardiology, and psychiatry. Remember, you are not alone in this, and with the right support and treatment, many individuals with dysautonomia can lead fulfilling lives.

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