![]() Ohayon MM, Priest RG, Zulley J, Smirne S, Paiva T. ICSD-3: International Classification of Sleep Disorders, 3rd ed. In the near future, the efficacy of new wake-promoting drugs, anticataplectic agents, hypocretin replacement therapy and immunotherapy at the early stages of the disease should also be evaluated.ĪASM: American Academy of Sleep Medicine. Associated symptoms and comorbid conditions, such as hypnagogic/hypnopompic hallucinations, sleep paralysis, disturbed nighttime sleep, unpleasant dreams, REM- and non REM-related parasomnias, depressive symptoms, overweight/obesity, and obstructive sleep apnea, should also be taken into account and managed, if required. Importantly, clinically relevant subjective and objective measures of daytime sleepiness are required to monitor the treatment efficacy and to provide guidance on whether the treatment goals are met. Other psychostimulants can also be used, such as methylphenidate, pitolisant and rarely amphetamines, as third-line therapy. In recent years, narcolepsy treatment has changed with the widespread use of modafinil/armodafinil for daytime sleepiness, antidepressants (selective serotonin and dual serotonin and noradrenalin reuptake inhibitors) for cataplexy, and sodium oxybate for both symptoms. Treatment options may vary from a single drug that targets several symptoms, or multiple medications that each treats a specific symptom. Despite major advances in our understanding of narcolepsy mechanisms, its current management is only symptomatic. On the other hand, in narcolepsy type 2, cerebrospinal fluid hypocretin-1 levels are normal and cataplexy absent. Narcolepsy type 1 is characterized by excessive daytime sleepiness and cataplexy and is associated with hypocretin-1 deficiency. There is a clear need for well-designed randomised controlled trials to assess the effect of antidepressants on narcolepsy.Narcolepsy type 1 and narcolepsy type 2 are central disorders of hypersomnolence. Despite the clinical consensus recommending antidepressants for cataplexy there is scarce evidence that antidepressants have a positive effect on this symptom. There was no good quality evidence that antidepressants are effective for narcolepsy or improve quality of life. Two more trials with parallel design tested ritanserin versus placebo without finding differences of effectiveness in reducing EDS or cataplexy. In a third cross-over trial the authors inappropriately treated the trial design as a parallel study and no conclusions can be reached in favour of either drug. In a second cross-over trial (56 participants) viloxazine significantly reduced EDS and cataplexy. Mild and transient side effects were reported in the femoxetine treatment period by two participants. ![]() In one cross-over trial (10 participants) femoxetine had no significant effect in eliminating or reducing EDS but significantly reduced cataplexy. As the trials tested different comparisons, or had a different design or dealt with different outcome measures, meta-analysis was not performed. The methodological quality of all studies was unclear. Three cross-over and two parallel trials were included with a total of 246 participants. Two review authors independently assessed trial quality and extracted data. Parallel or cross-over randomised or quasi-randomised controlled trials testing the treatment of narcolepsy with any type of antidepressant drug versus no treatment, placebo, or another antidepressant drug. ![]() Unpublished randomised trials were searched for by consulting governmental and non-governmental clinical trial registers, disease-specific websites, investigators and experts in the field, pharmaceutical companies/manufacturers. Bibliographies of identified articles were reviewed to find additional references. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2007), MEDLINE (1966 to 2007), EMBASE (1980 to 2007), PsycINFO (1872 to 2007), and CINAHL (1981 to 2007). To evaluate the effects of antidepressant drugs on EDS, cataplexy, quality of life, and their side effects in people with narcolepsy. In addition, some antidepressants are also reported to improve EDS. Together with stimulant drugs (used to control EDS), antidepressants are usually recommended to counteract cataplexy. Narcolepsy has an adverse impact on people's quality of life. Narcolepsy is a disorder of the central nervous system, the main symptoms of which are excessive daytime sleepiness (EDS) and cataplexy (an abrupt and reversible decrease in or loss of muscle tone, affecting the limbs or trunk or both, elicited by emotional stimuli).
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