Treatment for Auxiliary Narcolepsy Symptoms

Pharmacological control of narcolepsy's auxiliary symptoms—cataplexy, hypnogogic and hypnopompic hallucinations, and sleep paralysis—may involve antidepressants and selective serotonin reuptake inhibitors (SSRIs).

Tricyclic antidepressants (e.g., imipramine, chlorimimipramine) are the most widely prescribed medications for the three sub-symptoms of narcolepsy. In some cases, these medications improve symptoms within 2 days. Antidepressant side effects include dry mouth, blurred vision, and sweating.

Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) may be used to treat cataplexy and may also reduce the frequency of sleep attacks in some cases. Cataplexy is often much worse in sleep-deprived patients with poor sleep hygiene; therefore, establishing good sleep practices may be the most important aspect of controlling cataplexy.

Sodium oxybate (Xyrem) is an oral central nervous system depressant approved by the U.S. Food and Drug Administration (FDA) to treat excessive daytime sleepiness and cataplexy in people with narcolepsy. This medication carries a black box warning and should only be used as directed. Sodium oxybate abuse can cause severe, life-threatening side effects, including difficulty breathing, confusion, and loss of consciousness.

Recent Developments in Narcolepsy Treatment

The study of narcolepsy in other animals has illuminated continuities between human narcolepsy and the condition found in dogs and mice. This information is being used to help discover the cause for the condition and develop additional treatments. Many of these studies have focused on the biochemical dissimilarities that exist between humans and other animals, which may lead to new treatments.

Currently, researchers are studying a gene that may be responsible for narcolepsy. Comparison between the human and dog gene maps has led to the discovery of a mutual deficiency in a substance called hypocretin. Hypocretin is a chemical in the brain that, when absent, corresponds to narcolepsy.

Narcoleptic dogs are being injected with this chemical in an attempt to affect the symptoms of narcolepsy and cataplexy. At this point, researchers expect that a version of this substance will be used to treat human narcolepsy in the future.

Treatment with hypocretin may effectively treat symptoms of narcolepsy, as well as the underlying deficiency that may cause the condition, perhaps providing a cure for the condition.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 30 Nov 2000

Last Modified: 25 Sep 2015