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Vegetative-Vascular Dystonia (VVD)

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What is somatoform autonomic dysfunction?

Somatoform autonomic dysfunction (SAD) or vegetative-vascular dystonia (VVD) is a clinical syndrome that includes disorders of human systems and organs with various origin and manifestations. The vegetative (autonomous) nervous system that has two main branches, the sympathetic branch and the para-sympathetic system, provides innervation of internal organs. These systems produce an opposite effect on a human body. Normal systems are balanced, whereas the somatoform autonomic dysfunction disturbs the balance and the effect of either sympathetic or parasympathetic system predominates.

What is the cause of the disease?

Genetic predisposition is one of the basic causes of the disease. The hereditary factor makes a child more likely to have the disease. Excessive nervousness and stresses during the first trimester of pregnancy can already produce an effect on a child’s brain activity. Other reasons of somatoform autonomic dysfunction include discrepancy between the rate of physical development and maturity level of a child’s neurohormonal system. In adolescence, the disease can be caused by conflicts, emotional stress, endocrine disturbances, chronic diseases, increased mental burden and other factors. In adults, SAD can result from hormonal changes, particularly, in women during pregnancy and menopause (that’s why the disease is more frequently found in women), sleep disorders (insomnia, difficulties falling asleep, early awakening). Other factors can include general exhaustion due to previous diseases, change of climate or time zone, intense physical loads or hypodynamia (restricted activity), irregular imbalanced diet and/or excessive weight.

What are the forms of the disease? How is it manifested?

SAD can have several clinical forms. Every form has its distinctive features. In a hypotonic type of the disease, blood pressure drops below 100 mm Hg, weakness, dizziness and sweating develop. On the contrary, a hypertonic type is characterized by inconsistent and instable rise in blood pressure. Patients sometimes report a headache, weakness and increased fatigue. In case of a cardiac type, patients often complain of pains in the heart or chest, cardiac arrhythmias that resolve on their own without using any drugs. A mixed type of the disease includes the symptoms mentioned above: instable level of blood pressure, increased or decreased heart rate, weakness, dizziness, increased fatigability.

There are various symptoms though the cardiovascular syndrome which can be fast (90 beats per minute and more) or slow (60 beats per minute or lower), change in blood pressure, inadequate reactions of the peripheral vascular bed (anemia, mottled skin, flushes and chills) develop more frequently. The cardiovascular signs are accompanied by the syndrome of hyperventilation (increased breathing rate), hyperhidrosis (increased sweating of palms and feet), disturbed regulation (insignificant increase or decrease of temperature without aggravation of general well-being), and irritable bowel syndrome (pain in the lower part of the abdomen, unstable stool, abdominal distention). The disease can be manifested through headache, dizziness, general weakness, tinnitus, syncope, mood swings, panic attacks, anxiety.

What is the treatment?

Patients with SAD basically need no medicinal treatment. Their treatment is based on the methods focused on life change, normal functioning of the nervous system, correction of daily activity with rational differentiation between rest and labor. It is enough to use natural tranquilizers in the beginning of treatment.

In drug treatment, a lot of attention is paid to treatment of concurrent diseases. Therapy must be aimed at the elimination of a symptom, if needed. Thus, vascular agents, neurometabolic agents including peptides, that produce a positive effect on many compensation mechanisms of pathological processes in SAD are used to improve blood supply and brain metabolism. Complexes of vitamins and microelements are used to improve the nervous conductivity. Tranquilizers, including the ones of vegetable origin, will eliminate the episodes of panics and anxiety.

Physiotherapeutic methods of treatment involve exercise therapy, massage, reflex therapy (needle therapy), balneotherapy (hydrotherapeutic procedures). Individually tailored psychological trainings and methods are recommended for use in patients with mood swings, fears, anxiety and low mood.

O. V. Bykova
Doctor of Med. Sc., Principal Researcher of the Centre for Applied Research in Pediatric Psychoneurology
of Moscow Health Department

Non-drug treatment is the treatment of choice in somatoform autonomic dysfunction. However, course doses of drugs that improve metabolism and blood supply of the brain and multivitamins taken up to 4 times a year also improve the general state.

Patients should keep regular hours and have a good rest. They should sleep for no less than 8–9 hours every day. However, long sleep is not recommended. The room where the patient has a rest must be well ventilated and regularly mopped. The bed must also be nice and comfortable; orthopedic mattresses and pillows are preferable.

Periods of rest and labor must be evenly distributed. Physical and mental training must be combined. Reduce screen time. If it is not possible, take a break every 1–1.5 hours.

Spend enough time outdoors. Adequate physical exertion which is optimal for every patient depending on the type and character of the disease is important. Physical outdoors exercises should be combined with swimming. In winter it’s better go skiing or skating. It is important to remember that you should not overstress your cardiovascular system with physical load.

Consultations of a psychotherapist who will tell you how to breathe properly and reveal the methods of relaxation and sedation can be useful in a tendency towards anxiety and fears and low mood. It is useful to have a hobby that will distract from unnecessary thought and emotional experience.

It is important to keep to a diet having food high in potassium and magnesium. The food includes cereal porridges (buckwheat and oatmeal porridges), bean cultures, potatoes, carrots, eggplants, nuts, dried fruits, and greens. Salty and spicy food, strong tea and coffee should be avoided by patients with hypertensive SAD. They need products that increase vascular tone, for example, green tea, and natural coffee, though consumption of the latter must be limited.

Courses of physiotherapeutic procedures including hydrotherapeutic procedures produce a positive effect. Contrast baths, shower and swimming are recommended for patients with SAD. Patients with sleep loss and anxiety are indicated massage and reflex therapy that help relax.

Change of scene is useful as well. Patients are advise to leave the city from time to time.

O. V. Bykova
Doctor of Med. Sc., Principal Researcher of the Centre for Applied Research in Pediatric Psychoneurology
of Moscow Health Department

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