Diagnosing and Treating Dysautonomia

The dysautonomias are a family of medical conditions characterized by an imbalance in the autonomic nervous system. Symptoms are often extremely variable from person to person, and over time in the same person, and may consist of various pains, fatigue, weakness, gastrointestinal symptoms, dizziness and syncope (passing out). Obviously, symptoms like these can be quite distressing, and often disabling.

To make matters worse, getting the correct diagnosis if you have dysautonomia can be very challenging. Because the symptoms with dysautonomia are often far out of proportion to any objective physical or laboratory findings, it can be quite difficult to get a healthcare provider to take your symptoms seriously. 

Treating dysautonomia can also be challenging, and it can take some time and a lot of patience, both on your part and your healthcare provider’s, to find the right combination of therapies to get your symptoms under acceptable control. 

28 years old man is exercising outdoors. He have a headache, and he is lying down and trying to relax
Flux Factory/Getty Images

Diagnosing Dysautonomia

In modern medical practice, when patients have the audacity to complain of symptoms without providing the objective medical findings to back them up, they are often written off as being hysterical.

If you think you may have dysautonomia, by all means, suggest that possibility to your healthcare provider. You may just see a light bulb going off, and find that your healthcare provider is suddenly refocusing his/her efforts in a more fruitful direction. Once a healthcare provider focuses on the possibility, taking a careful medical history and performing a careful physical exam often leads to the correct diagnosis. If your healthcare provider is unwilling to take the possibility of dysautonomia seriously, consider seeing another healthcare provider.

Patients lucky enough to be taken seriously by their family healthcare providers are likely to be referred to a specialist.

The type of specialist usually depends on the predominant symptom they are experiencing, or on the symptoms that most impress the family healthcare provider. And the specific diagnosis they are ultimately given depends on their predominant symptoms and which specialist they end up seeing.

For instance: Those whose main complaint is easy fatigability are likely to be diagnosed with chronic fatigue syndrome.

Those who pass out are labeled as having vasovagal syncope. Those whose resting pulses are noticeably high are said to have inappropriate sinus tachycardia. If dizziness on standing up is the chief problem, postural orthostatic tachycardia syndrome (POTS) is the diagnosis. Diarrhea or abdominal pain buys you irritable bowel syndrome. Pain elsewhere ends up being fibromyalgia. Whatever the diagnosis, however, a dysfunctional autonomic nervous system almost always plays a major part in causing the symptoms.

By all means, keep in mind that the dysautonomia syndromes are real, honest-to-goodness physiologic (as opposed to psychologic) disorders. While they can make anybody crazy, they are not caused by craziness. So if you think you may have dysautonomia, by all means, suggest that diagnosis to your healthcare provider. If your healthcare provider isn’t at least willing to take you seriously enough to consider that diagnosis, find a different healthcare provider.

Treating Dysautonomia

Possibly the most important step in treating dysautonomia is to find a healthcare provider 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 for reducing symptoms to a tolerable level.

Since the underlying cause of dysautonomia is not well understood, treatment is largely aimed at controlling symptoms, and not at "curing" the problem.

Non-Drug Therapies

Physical Activity: Maintaining an adequate daily level of physical activity is a very important thing people with dysautonomia can do to improve symptoms. Regular physical activity helps to stabilize the autonomic nervous system, and in the long run, makes "relapses" of symptoms rarer 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 healthcare providers 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 to relieve various forms of dysautonomia. There is really no evidence that any of this stuff works. However, as a member of the embarrassing medical establishment, I can only say, it's your money; try not to spend it on anything that will hurt you. Before you try any alternative therapy, you ought to read all the objective information on it you can find.

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 Elavil, Norpramin, and Pamelor have been used, in low dosage, to treat several of the dysautonomia syndromes.
  • Selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and 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 Xanax and Ativan help to control symptoms of anxiety, especially in patients with panic disorder.
  • Anti-low blood pressure drugs such as Florinef help prevent the symptoms caused when the blood pressure drops when the patient is upright (a condition called orthostatic hypotension), a prominent symptom in vasovagal syncope and in POTS.
  • Non-steroidal anti-inflammatory drugs such as Advil and Aleve can help control the pains associated with the dysautonomias, especially fibromyalgia.

A Word From Verywell

It is worth mentioning again that a trial and error approach, requiring the patience of both healthcare provider and patient, is almost always necessary in treating dysautonomia. In the meantime, people with dysautonomia can try to reassure themselves by remembering two facts. First, dysautonomia usually improves as time goes by. Second, the academic medical community (and pharmaceutical companies) have now accepted that the dysautonomia syndromes are real, physiological medical conditions. Consequently, a lot 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.

Was this page helpful?
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Autonomic neuropathy or autonomic dysfunction (syncope): information and instructions. Updated November 30, 2016.

  2. Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines. Pain Med. 2013;14(2):180-229. doi:10.1111/pme.12033

  3. MedlinePlus. Chronic fatigue syndrome/systemic exertion intolerance disease. Updated April 12, 2018.

  4. Cleveland Clinic. Vasovagal syncope. Updated May 14, 2019.

  5. Cleveland Clinic. Postural orthostatic tachycardia syndrome (POTS). Updated June 12, 2017.

  6. MedlinePlus. Fibromyalgia. Updated January 29, 2018.

  7. Khurana RK. Visceral sensitization in postural tachycardia syndrome. Clin Auton Res. 2014;24(2):71-6. doi:10.1007/s10286-014-0227-0

  8. Dysautonomia International. Research update: more proof POTS is not “all in your head." Updated February 11, 2014.

  9. Cleveland Clinic. Dysautonomia. Updated August 11, 2015.

  10. Dysautonomia International. Exercises for Dysautonomia Patients.

  11. Kizilbash SJ, Ahrens SP, Bruce BK, et al. Adolescent fatigue, POTS, and recovery: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care. 2014;44(5):108-33. doi:10.1016/j.cppeds.2013.12.014

  12. Cleveland Clinic. Living with dysautonomia. Updated May 16, 2018.

  13. Abed H, Ball PA, Wang LX. Diagnosis and management of postural orthostatic tachycardia syndrome: a brief review. J Geriatr Cardiol. 2012;9(1):61-7. doi:10.3724/SP.J.1263.2012.00061

Additional Reading
  • Furlan R, Barbic F, Casella F, et al. Neural Autonomic Control In Orthostatic Intolerance.Respir Physiol Neurobiol. 2009 Oct;169 Suppl 1:S17-20.
  • Staud R. Autonomic Dysfunction In Fibromyalgia Syndrome: Postural Orthostatic Tachycardia. Curr Rheumatol Rep. 2008 Dec;10(6):463-6.