The Prevalence of Anxiety and Depression in Children With Postural Orthostatic Tachycardia Syndrome (POTS): A Retrospective Study.

Introduction: Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance characterized by various symptoms such as dizziness, lightheadedness, and increased heart rate. Conflicting reports exist regarding the prevalence of anxiety and depression in adults with POTS, while data on pediatric POTS remains scarce.

Method: A retrospective analysis of pediatric patients aged 11-17 years with POTS, who underwent autonomic testing at Nemours Children's Hospital in Orlando, Florida, was conducted. The patients were screened for anxiety, using the Severity Measure for Generalized Anxiety Disorder-Child Age 11-17 years (GAD-7) questionnaire, and depression, using PHQ-9 Modified for Adolescence (PHQ-A) for depression. The prevalence rates of anxiety and depression in the study cohort were compared to historical data from similar age groups in the existing literature. The study was approved by the Nemours Children's Hospital Institutional Review Board.

Results: The cohort comprised 27 children with POTS (26 females, age 15.8±1.6 years). Overall, 74% exhibited moderate-to-severe anxiety, depression, or both, with 44% having comorbid anxiety and depression. In total, 4/27 (14%) had pure depression and 4/27 (14%) had pure anxiety. Six patients had no depression or anxiety. On average, POTS symptoms began 1.9±1.3 years before diagnosis. Eleven patients took stable doses of psychotropic medications. After a follow-up period of 5.1±1.7 months of POTS therapy, seven patients had follow-up questionnaires. In 4/7 patients, the depression severity improved, and in 3/7 patients, the anxiety severity improved. Patients were not actively treated for depression and anxiety during this time.

Conclusion: Anxiety and depression are prevalent among pediatric patients with POTS. While preliminary data suggests POTS therapy may alleviate these psychological symptoms, further longitudinal studies are warranted to explore the therapeutic impact in greater detail.