Dr Boylan describes a woman with dysautonomia and paroxsmal depression, with the latter responding to an antidepressant. Of interest, the patient's episodes of depression were not accompanied by blood pressure spikes. This may represent the flip side of my observations in terms of the reciprocal nature of affective and autonomic manifestations. In Dr Boylan's case, the affective manifestation dominated, and autonomic manifestation was absent. In my cases of paroxysmal hypertension, the autonomic manifestation dominated, with a striking absence of affective manifestation. In both circumstances, severely distressful emotions, which threatened to overcome psychological defenses against awareness, were at play. And in both, antidepressant agents provided a very effective intervention.
Mann SJ. Mutual Influences Between Paroxysmal Hypertension and Psychiatric Disturbance. Arch Intern Med. 1999;159(17):2091–2092. doi:
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