Quick Answer
POTS vs anxiety is a common question because both can cause a racing heart, dizziness, shakiness and fatigue. POTS, postural orthostatic tachycardia syndrome, involves a large heart rate rise on standing and needs medical evaluation. Anxiety can occur alongside POTS, and treating anxiety can help people cope, but it doesn't replace medical care.
Understanding POTS vs Anxiety
Postural orthostatic tachycardia syndrome, usually called POTS, is a condition of the autonomic nervous system. When someone with POTS stands up, their heart rate rises much more than expected, and they may feel dizzy, lightheaded, shaky, short of breath, nauseated or foggy. Symptoms often ease when lying down. Because a racing heart and shakiness also happen in anxiety and panic, people with POTS are sometimes told their symptoms are just anxiety. That can delay diagnosis. At the same time, anxiety can develop alongside POTS, especially when symptoms are unpredictable and frightening. Both deserve careful attention. This guide is part of Dr. Farkas's New York anxiety resources.
NIMH notes that panic attacks can include a pounding heart, sweating, trembling, shortness of breath and a feeling of impending doom, which explains why the two are easy to confuse. The key difference is often what triggers symptoms. POTS symptoms are tied to posture and standing, while panic can come on with no change in position, often with intense fear. A careful history, heart rate measurements lying and standing, and sometimes tilt-table testing help sort it out. That evaluation is done by a primary care doctor, cardiologist or autonomic specialist. Our guide on caffeine and anxiety covers another common cause of palpitations.
For New Yorkers who stand on crowded trains and climb subway stairs daily, a heart that races on standing can be both frightening and disruptive. Social isolation is common in the city: the NYC Health Department found that 40% of adults felt cut off or distant from other people in 2023. Secure video visits anywhere in New York can make it easier to start care without a commute or a long search.
Racing heart on standing, overlap with panic, and the need for medical evaluation first are the three points this guide covers.
How anxiety care can help
Anxiety treatment can help people with POTS manage fear of symptoms, reduce avoidance and cope with uncertainty. Cognitive behavioral therapy teaches ways to respond to body sensations without escalating fear. Gradual return to activities, done with your medical team’s guidance, rebuilds confidence. Medication choices need care, since some anxiety medications affect heart rate or blood pressure. Your psychiatric clinician will coordinate with your POTS treatment team. The aim is a fuller life, not just fewer symptoms.
Medication considerations
Some medications used in psychiatry can affect heart rate or blood pressure, which matters in POTS. SNRIs, for example, can raise heart rate in some people, while other medications may lower blood pressure. SSRIs are sometimes used and are generally well tolerated, but individual responses vary. Your prescriber will review your POTS treatment, including any heart rate or blood pressure medications, before choosing. Starting low and adjusting slowly helps. Clear communication between your doctors keeps treatment safe.
POTS vs Anxiety at a glance
| Feature | More suggestive of |
|---|---|
| Symptoms triggered by standing up | POTS |
| Symptoms ease when lying down | POTS |
| Symptoms triggered by worry or specific situations | Anxiety or panic |
| Sudden surges of fear with no position change | Panic |
| Both patterns present | Both may be involved |
Medical evaluation first
New or unexplained palpitations, fainting, chest pain or shortness of breath should be evaluated medically before assuming anxiety. Heart rhythm problems, thyroid conditions, anemia, dehydration, medication effects and POTS are all possible causes. A basic workup often includes an exam, heart rate and blood pressure lying and standing, an ECG and blood tests. If POTS is suspected, referral to a specialist may follow. Getting the medical side clear protects your health. It also helps anxiety, since uncertainty about what’s wrong often fuels fear.
When both are present
Many people with POTS also develop anxiety. Living with unpredictable symptoms, being dismissed by clinicians and limiting activities can all raise worry. Some people begin to fear standing, exercise or leaving the house. Anxiety can also heighten awareness of body sensations, making symptoms feel more alarming. Treating anxiety doesn’t mean POTS isn’t real. It means addressing the fear and avoidance that make life smaller. Coordinated care between your medical and psychiatric clinicians works well. Our guides on anxiety with heart disease and caffeine and anxiety cover related topics.
POTS and anxiety care for New York patients
Video visits mean no travel on days when standing and commuting are hard. Visits run by secure video anywhere in New York, while you’re physically in the state. The practice is in-network with Aetna and Cigna; confirm your New York plan with the office, and see self-pay fees on the Good Faith Estimate page.
Daily strategies
Medical teams often recommend strategies for POTS such as staying hydrated, increasing salt when appropriate, wearing compression garments, rising slowly and doing recumbent exercise. These are guided by your doctor. For the anxiety side, pacing activities, planning rest, keeping a symptom log and practicing calm breathing during flares help. Noting what triggers symptoms can separate posture-related episodes from worry-related ones. Over time, patterns become clearer and fear often eases.
When to seek help
Get urgent care for fainting with injury, chest pain, severe shortness of breath or a racing heart that won’t settle. See a doctor for new palpitations or dizziness on standing. Consider an anxiety evaluation if fear of symptoms is limiting your life, you’re having panic attacks, or you’re avoiding activities you used to enjoy. Thoughts of suicide need immediate help through 988. Both POTS and anxiety are treatable, and care works well when both are addressed together.
Key Takeaways
- POTS involves a large heart rate increase when moving from lying or sitting to standing.
- Anxiety and POTS share symptoms like palpitations, dizziness and shakiness.
- Medical evaluation should come before assuming symptoms are anxiety.
- People with POTS can also have anxiety, and treating both helps.
The Bottom Line
POTS vs Anxiety is common and treatable, and careful care can make daily life feel more manageable.
Frequently Asked Questions
How can I tell POTS from anxiety?
POTS symptoms are usually triggered by standing and ease when lying down. Panic can come on with no change in position, often with intense fear. Both can cause a racing heart, dizziness and shakiness. A medical evaluation with heart rate measured lying and standing helps sort it out. Some people have both conditions, and each needs its own care.
Can anxiety cause a racing heart when standing?
Anxiety can cause a racing heart, but a large heart rate rise specifically on standing suggests POTS or another medical cause. Dehydration, medications and other conditions can also play a role. That pattern deserves a medical evaluation. Don't assume it's anxiety without checking. Getting clear answers often reduces worry.
Can someone have POTS and anxiety at the same time?
Yes, many people with POTS also develop anxiety. Unpredictable symptoms, being dismissed and limiting activities all raise worry. Anxiety can also make body sensations feel more alarming than they are. Treating anxiety doesn't mean POTS isn't real. Coordinated care between your doctors addresses both conditions.
Are anxiety medications safe with POTS?
Some anxiety medications affect heart rate or blood pressure, which matters in POTS. SNRIs can raise heart rate in some people, and other medications may lower blood pressure. SSRIs are sometimes used and generally well tolerated. Your prescriber will review your POTS treatment before choosing. Starting low and adjusting slowly helps.
Who diagnoses POTS?
POTS is usually evaluated by a primary care doctor, cardiologist or autonomic specialist. Evaluation often includes heart rate and blood pressure lying and standing, an ECG and blood tests. Tilt-table testing may be used in some cases. Other causes like thyroid problems or anemia are checked too. A psychiatric clinician can help with anxiety alongside that care.
Can I get anxiety care for POTS-related fear by video in New York?
Yes, evaluations and follow-ups happen by secure video anywhere in New York, which helps on days when commuting is hard. You need to be physically in New York during each visit. Your clinician can coordinate with your medical team. The practice is in-network with Aetna and Cigna; confirm your New York plan with the office. Prescriptions go electronically to your pharmacy.
Where to go from here
- Right now, if you're not safe
- Call or text 988, or call 911.
- If you'd like an evaluation
- See how scheduling and telehealth work on the new patient page.
- If you want to keep reading
- Return to our full set of New York anxiety guides for more guides. For more help preparing and finding care, see NIMH’s tips for talking with your health care provider.
How We Reviewed This Page
Written by Steven Lockhart of Health Marketing Group and clinically reviewed by Gabriella I. Farkas, MD PhD, a board-certified psychiatrist. Clinical information comes from the sources listed below, and the page is reviewed every 180 days or when guidance changes.
What’s new: September 29, 2026. Page published.
References
- National Institute of Mental Health. Publications About Panic Disorder. https://www.nimh.nih.gov/health/publications/panic-disorder-listing
- National Institute of Mental Health. Anxiety Disorders. https://www.nimh.nih.gov/health/topics/anxiety-disorders
- NYC Health Department. The State of Mental Health of New Yorkers (2024). https://www.nyc.gov/assets/doh/downloads/pdf/mh/state-of-mental-health-new-yorkers.pdf
- 988 Suicide & Crisis Lifeline. https://988lifeline.org/
- Tips for talking with your health care provider. https://www.nimh.nih.gov/health/publications/tips-for-talking-with-your-health-care-provider