Neurocardiogenic Syncope is a form of autonomic failure.
While SSRI's with stimulating properties may be of some benefit (Lexapro, Prozac), they do not address the issue directly, but rather indirectly by stimulating the autonomic nervous system. SSRI's also act specifically on neurotransmitters in the brain, and this may not be a desirable effect in your situation. In short, better options are available.
The front-line treatment is to induce a state of sodium retention, which results in plasma expansion, and, consequently, a rise in orthostatic blood pressure.
Fludrocortisone 0.05 - 0.1 mg, b.i.d. is a corticosteroid typically prescribed for folks with neurally mediated syncope and neurocardiogenic syncope. The drug induces a state of sodium retention, which raises orthostatic blood pressure, and thus, minimizes or prevents syncope episodes - particularly those occurring with abrupt changes in posture.
Would suggest seeking the opinion of a cardiologist or neurologist who specializes in Dysautonomia. A baseline Isuprel tilt-table test will establish the diagnosis. A repeat tilt-table test would assess your response to the Fludrocortisone.
Would also suggest a 30-day cardiac event monitor, which you may trigger with the press of a button when you feel an "event" occur. This will exclude any abnormal cardiac rhythm that could potentially explain your symptomatology (ie: Wolf-Parkinson-White, Lown-Ganong-Levine Syndrome, Brugada Syndrome).
I have taken Lexapro for 9 years now to control my NCS. My doctor tried various other things including salt pills, support hose, beta blockers, and other SSRIs. Lexapro is the only thing that worked for me.
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