Cataplexy
If cataplexy is not a serious problem for the patient, it it may not be necessary to treat it.
Avoidance of the factors known to precipitate cataplexy and ensuring a good night's sleep may be all that is required in some people. However, some individuals will require medicinal treatment.
Until recently, the drugs currently used to treat cataplexy were all antidepressant agents. This does not mean that cataplexy is related to depression but rather that one of the 'side effects' of this broad group of drugs is to inhibit the neurological pathways that cause cataplexy. There are two main classes of antidepressant used for treating cataplexy - the tricyclic agents and the Selective Serotonin Reuptake Inhibitors (SSRIs).
Currently, the most commonly used medication for the treatment of catplexy in the UK is clomipramine hydrochloride (Anafranil) - a tricyclic antidepressant which is licensed for this indication. Tricyclic drugs are toxic to the heart when taken in overdose.
More recently the SSRIs have been used to treat cataplexy. Commonly used from the group are paroxetine (Seroxat) and fluoxetine (Prozac). The SSRIs are probably less cardiotoxic in overdosage. They are not licensed in the UK for the treatment of cataplexy but doctors are permitted to prescribe them if they consider them to be of value.
Even more recently, sodium oxybate (Zyrem) has been licensed to treat cataplexy. This drug acts in a different way to the antidepressant agents. The exact mechanism by which it exerts its anti-cataplectic actions is unknown although it may be related to an improvement in the quality of night-time sleep which results from taking this drug. This medicine is taken at night, often in divided doses.
Sleep paralysis and hypnagogic hallucinations also should not be treated by medication unless they are terribly unpleasant, since they normally do not interfere with the patient's daytime functioning or ability to work effectively. Improving the quality of sleep may have a profound effect on these symptoms. In some, psychotherapy may help; however, a small number of individuals will require medical treatment. The drugs used to treat cataplexy are also effective in treating these symptoms of narcolepsy.
Before taking any prescribed medication it is very important that patients read the Patient Information Leaflet packed with the medication. This summarises, in lay people's language, information relating to the efficacy and safety of the medicine. It will also list the side effects which have been observed in patients taking the drug. Patients should avoid stopping treatment without discussion with their doctor or pharmacist. This is particularly important in the case of medication for cataplexy. Abrupt cessation of treatment can give rise to severe and prolonged cataplexy in some patients - particularly when medication from the tricyclic group of drugs is stopped.
For more detailed information on these drugs see the Narcolepsy association's booklet "Narcolepsy - a patient's guide to treatment". Click here to download an application form to purchase this booklet.