How is dysautonomia treated?
Unfortunately, just as there is no generally accepted nomenclature for the dysautonomia syndromes, just as there is no generally accepted set of criteria for diagnosing many forms of dysautonomia, just as there is no general agreement on their causes or on the precise mechanism that produces the autonomic imbalance, so there is no generally accepted approach to treatment. Possibly the most important step in treatment is to find a physician who understands the nature of the problem, is sympathetic toward it (i.e., does not consider you merely a crazy person,) and who is willing to take the prolonged trial-and-error approach that is often necessary in reducing symptoms to a tolerable level.In any case, since the underlying cause of dysautonomia is not known, treatment is largely aimed at controlling symptoms, and not at "curing" the problem.
Non-drug therapies
Physical activity: While most doctors don't realize it, the experiment as to whether restricting physical activity helps dysautonomia was done 100 years ago. The experiment failed. Big time. Thus: maintaining a daily level of physical activity is probably the most important thing people with dysautonomia can do. Some daily level of moderate activity helps to stabilize the autonomic nervous system, and in the long run makes "relapses" of symptoms more rare and of shorter duration. Physical activity may even hasten the day when symptoms go away on their own.Physical therapy and similar "alternative" treatments such as yoga, tai-chi, massage therapy, and stretching therapy have been reported to help as well.
Dietary supplements: Any time a medical condition exists that doctors treat poorly, purveyors of dietary supplements have an open field for pushing their products. Not only do patients feel they may have no better alternative, but also the medical profession, embarrassed by its failure to treat effectively, has little grounds for complaint. Consequently, thousands of unsubstantiated claims have been made about the ability of various vitamins, coenzymes and herbal preparations (all the usual suspects - you know the ones) to relieve the symptoms of dysautonomia. As a member of the embarrassed medical establishment, DrRich can only say - it's your money; try not to spend it on anything that will hurt you.
Drug therapies
A host of pharmaceutical agents have been tried in patients with dysautonomia. Those most commonly felt to be useful include:Tricyclic antidepressants - such as amitriptyline (Elavil,) desipramine (Norpramin,) and nortriptyline (Pamelor) - have been used, in low dosage, to treat several of the dysautonomia syndromes. Selective serotonin reuptake inhibitors (SSRIs) - such as fluoxitine (Prozac) sertraline (Zoloft,) and paroxetine (Paxil) - have also been used to treat these syndromes. When effective, the tricyclics and the SSRIs appear to do more than merely control any depression that might accompany the dysautonomias. There is some evidence that they might help to "re-balance" the autonomic nervous systems in some patients.
Anti-anxiety drugs - such as alprazolam (Xanax) and lorazepam (Ativan) help to control symptoms of anxiety, especially in patients with panic disorder.
Anti-low blood pressure drugs - Fludrocortisone (Florinef) helps prevent the symptoms caused when the blood pressure drops when the patient is upright (a condition called orthostatic hypotension.) Orthostatic hypotension is prominent in vasovagal syncope and in POTS.
Non-steroidal antiinflammatory drugs - Ibuprofen (Motrin, Advil,) and naproxen (Naprosen, Aleve) can help control the pains associated with the dysautonomias, especially fibromyalgia.
It is worth mentioning again that there is no tried and true treatment method that always works in treating patients with dysautonomia. A trial and error approach, requiring the patience of both doctor and patient, is almost always necessary. In the meantime, victims of dysautonomia can try to reassure themselves by remembering two facts. First, dysautonomia usually improves as time goes by. Second, the academic medical community (and the pharmaceutical companies ) have now accepted the dysautonomia syndromes as real, physiological medical conditions. Consequently, a tremendous amount of research is going on to define the precise causes and mechanisms of these conditions, and to devise treatments that are effective more often and to a greater extent than many of the treatments being used today.
