Acute hemodynamic effects of a selective serotonin reuptake inhibitor in postural tachycardia syndrome: A randomized, crossover trial
Open accessAbstract
Background: Selective serotonin reuptake inhibitors (SSRIs) are often prescribed in patients with postural tachycardia syndrome (POTS), and act at synaptic terminals to increase monoamine neurotransmitters. We hypothesized that they act to increase blood pressure and attenuate reflex tachycardia, thereby improving symptoms. Acute hemodynamic profiles after SSRI administration in POTS patients have not previously been reported. Methods: Patients with POTS ( n=39; F=37, 39 ±9 years) underwent a randomized crossover trial with sertraline 50mg and placebo. Heart rate, systolic, diastolic, and mean blood pressure were measured with the patient seated and standing for 10 min prior to drug or placebo administration, and then hourly for 4 h. The primary endpoint was standing heart rate at 4 h. Results: At 4 h, standing heart rate and systolic blood pressure were not significantly different between sertraline and placebo. Seated systolic (106±12 mmHg vs. 101±8 mmHg; p=0.041), diastolic (72±8 mmHg vs. 69±8 mmHg; p=0.022), and mean blood pressure (86±9 mmHg vs. 81±9 mmHg; p=0.007) were significantly higher after sertraline administration than placebo. At 4 h, symptoms were worse with sertraline than placebo. Conclusions: Sertraline had a modest pressor effect in POTS patients, but this did not translate into a reduced heart rate or improved symptoms.
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Selective serotonin reuptake inhibitors have not been shown to reduce tachycardia in POTS.
“They have not been shown to reduce tachycardia in POTS (110).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [110]
The Discussion conclusion reports that acute sertraline did not significantly reduce heart rate in POTS patients. The study tested one SSRI over a short period, and the Discussion says longer-duration studies are needed; it does not establish the broader claim for SSRIs generally or chronic use. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSertraline resulted in worse symptoms than placebo at 4 h.
“Sertraline, a selective serotonin reuptake inhibitor, also resulted in worse symptoms than placebo at 4 h”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Mar et al., 2014
SSRIs do not worsen orthostatic tachycardia or symptoms in people with POTS.
“Selective serotonin reuptake inhibitors (SSRIs), on the other hand, do not aggravate orthostatic tachycardia or symptoms in POTS patients [74].”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [74]
Iatrogenic inhibition of the norepinephrine transporter has been shown to engender a POTS-like state, increase upright heart rate, and exacerbate symptoms in POTS patients.
“Iatrogenic inhibition of the norepinephrine transporter has also been shown to engender a POTS-like state, increase upright heart rate, and exacerbate symptoms in POTS patients (46-49).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [47]
Administration of a selective serotonin reuptake inhibitor, sertraline, also appeared to acutely worsen symptoms in POTS patients, possibly due to nonselective inhibition of the norepinephrine transporter.
“Administration of a selective serotonin reuptake inhibitor (SSRI), sertraline, also appeared to acutely worsen symptoms in POTS patients, possibly due to nonselective inhibition of the norepinephrine transporter (47).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [47]
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References 31 · Cited by 24
- Authors
- Mar, P. L., Raj, V., Black, B. K., Biaggioni, I., Shibao, C. A., Paranjape, S. Y., Dupont, W. D., Robertson, D., & Raj, S. R.
- Affiliations
- Vanderbilt University (US)
- ORCID
- Venue
- Journal of Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2013-11-13
- Volume
- 28
- Issue
- 2
- Pages
- 155-161
- ISSN
- 0269-8811 (ISSN-L)
- 1461-7285
- PMC
- PMC3956655
- OpenAlex
- W2090580747
- Cited by
- 24
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 6 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 2
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Vanderbilt University
- National Institutes of Health (UL1TR000445)
- National Heart, Lung, and Blood Institute (R01HL071784, K23HL103976, P01HL056693, R01HL102387, P01 HL-56693)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, sertraline, selective serotonin reuptake inhibitors, hemodynamic effects, blood pressure, heart rate, pressor response, orthostatic intolerance, adverse drug reactions
- MeSH terms
- Adult, Blood Pressure, Female, Heart Rate, Hemodynamics, Humans, Male, Selective Serotonin Reuptake Inhibitors, Cross-Over Studies, Sertraline, Norepinephrine Plasma Membrane Transport Proteins, Postural Orthostatic Tachycardia Syndrome
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