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Narcolepsy treatments

Category: Medicines

Type

Involuntary and voluntary

Introduction and description

 

I have provided a description on this website for the illness of narcolepsy. Briefly, however, narcolepsy is a sleep disorder which causes excessive daytime sleepiness, irresistible sleep attacks, cataplexy (loss of muscle control) and hypnagogic hallucinations.

 In our western based society, where there is the emphasis all the time on the need to contribute and function ‘normally’ [whatever that means], to work and do things, in other words not to be sleepy or fall asleep a lot, there has been a lot of work done on so called ‘treatments’.

For people with narcolepsy the symptoms are obviously distressing in a society in which one is expected to ‘function’, possibly in another type of society where they were simply left to sleep and accepted, then things may be different, but ‘treatment’ it has to be …

In the USA in particular, where there is the constant drive to compete, to do ‘better’, to keep going and pass exams and be top dog and be the best and so on, demand for these ‘treatments’ is much higher. Being sleepy or being a day dreamer, being jet lagged, or wanting just to sit quietly at peace, are not options in the American culture [a culture that has sadly seeped perniciously into Europe as well]. So any form of relaxed attitude can be diagnosed as a ‘sleep disorder’ and treated with the same drugs.

Background

 

 

The following abstract provides both a good summary explanation of these ‘treatments’ – in actuality drugs - that have traditionally been used to ‘help’ narcolepsy in particular.

None of them cures the disease.

 

Emerging treatments for narcolepsy and its related disorders - Nishino S, Okuro M  Stanford University School of Medicine, USA

IMPORTANCE OF THE FIELD:  Narcolepsy is a chronic sleep disorder, characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis and nocturnal sleep disruption. Non-pharmacological treatments (i.e., behavioral modification) are often helpful for the clinical management of narcoleptic patients. As these symptoms are often disabling, most patients need life-long treatments. Over 90% of diagnosed narcoleptic patients are currently prescribed medications to control their symptoms; however, available treatments are merely symptomatic.

AREAS COVERED IN THIS REVIEW:  This review presents a description of the clinical symptoms of narcolepsy, followed by a discussion of the state-of-the-art knowledge regarding the disorder and related emerging treatments. In preparing this review, an extensive literature search was conducted using Pubmed. Only selected references from 1970 to 2008 are cited.

WHAT THE READER WILL GAIN:  This review focuses on emerging treatments for human narcolepsy, and the reader will gain significant knowledge of current and future treatment for this and related disorders. Traditionally,

  • amphetamine-like stimulants (i.e., dopaminergic release enhancers) have been used for clinical management to improve EDS, and
  • tricyclic antidepressants have been used as anticataplectics

However, treatments have recently evolved which utilize better tolerated compounds, such as

  • modafinil (for EDS)
  • adrenergic/serotonergic selective reuptake inhibitors (as anticataplectics)
  • gamma-hydroxybutyrate [GHB], has been used for the treatment for EDS and cataplexy

As a large majority of human narcolepsy is hypocretin peptide deficient,  hypocretin replacement therapy may also be a new therapeutic option;  yet, this option is still unavailable. In addition to the hypocretin-based therapy, a series of new treatments are currently being tested in animal and/or humans models. These potential options include novel stimulant and anticataplectic drugs as well as immunotherapy, based on current knowledge of the pathophysiology of narcolepsy with cataplexy.

TAKE HOME MESSAGE:  We expect that more pathophysiology-based treatments, capable of curing and/or preventing narcolepsy and related diseases, will be available in near future. As cases of EDS, associated with other neurological conditions (i.e., symptomatic narcolepsy or narcolepsy due to medical conditions), are often linked with hypocretin deficiency, these novel therapeutic options may also be applied to treatment of these disabling conditions.

PMID: 20166851

 

So if I summarise, the treatments used for narcolesy are amphetamines and other stimulants, GHB, and TCAs.

Pharmaceutical companies do not call them amphetamines or stimulants and they certainly do not use the name GHB which is a street drug with an appalling reputation,  because it would not be good marketing practise. They give them coy names like ‘wakefulness’ treatments’ and ‘attention improvers’. But they are amphetamines and stimulants and all of them are also by definition releasing agents.

Releasing agents are hostile agents in our bodies. The serotonin receptor RAs and the Dopamine receptor RAs in particular seem to be particularly hostile. They do all sorts of damage to the cells which can lead to cell death. There is a list as long as your arm of the appalling side effects both long and short term to your health.

Narcolepsy is caused by a form of cell death, as such one wonders why a type of drug that itself causes cell death and which is illegal as a ‘recreational’ drug is administered to people with the problem already.

Furthermore, the effects of these drugs gradually becomes less – release agents over time gradually kill off the receptors they target, so eventually there aren’t as many to bind to. So you need more and more and more drug to get any effect – and the destruction continues. So you become addicted. So all these drugs are addictive.

The withdrawal symptoms from drugs of this type can be ferocious – truly ferocious.

Side-effects

If we take a drug like dextroamphetamine as an example and use the information from eHealthme, we find that the most frequent reported side effects of this drug are as follows :

Most common side effects by gender  :

Female Male
Drug Ineffective Depression
Nausea Suicidal Ideation
Paraesthesia Aggression
Withdrawal Syndrome Dizziness
Disturbance In Attention Organic Erectile Dysfunction
Balance Disorder Feeling Abnormal
Depression Loss Of Libido
Dizziness Erection Increased
Irritability Blood Testosterone Abnormal
White Blood Cell Count Decreased Ataxia

 Death

 

Again, using the information from eHealthme which uses the Adverse Drug Reports from doctors, if we now look at the figures for deaths - the ultimate spiritual experience -  we find the following:

 

 

 

 

Doxepin - On Aug, 3, 2015: 500 people reported to have side effects when taking Doxepin hydrochloride. Among them, 7 people (1.40%) have Death.

Endep - On Jul, 25, 2015: 433 people reported to have side effects when taking Endep. Among them, 9 people (2.08%) have Death

Modafinil - On Jul, 28, 2015: 1,759 people reported to have side effects when taking Modafinil. Among them, 46 people (2.62%) have Death

Provigil - On Aug, 5, 2015: 9,435 people reported to have side effects when taking Provigil. Among them, 143 people (1.52%) have Death

Nortriptyline hydrochloride - On Aug, 5, 2015: 988 people reported to have side effects when taking Nortriptyline hydrochloride. Among them, 16 people (1.62%) have Death

 Mirtazapine - On Aug, 8, 2015: 17,120 people reported to have side effects when taking Mirtazapine. Among them, 406 people (2.37%) have Death

Remeron - On Jul, 31, 2015: 12,154 people reported to have side effects when taking Remeron. Among them, 270 people (2.22%) have Death

Tofranil - On Aug, 2, 2015: 1,344 people reported to have side effects when taking Tofranil. Among them, 15 people (1.12%) have Death

Imipramine hydrochloride - On Jul, 30, 2015: 279 people reported to have side effects when taking Imipramine hydrochloride. Among them, 1 people (0.36%) has Death

Wellbutrin - On Jul, 16, 2015: 49,378 people reported to have side effects when taking Wellbutrin. Among them, 416 people (0.84%) have Death

Zyban- On Aug, 8, 2015: 6,961 people reported to have side effects when taking Zyban. Among them, 87 people (1.25%) have Death

Bupropion - On Jul, 26, 2015: 5,557 people reported to have side effects when taking Bupropion hydrochloride. Among them, 59 people (1.06%) have Death

Adderall - On Jul, 29, 2015: 11,425 people reported to have side effects when taking Adderall. Among them, 77 people (0.67%) have Death

Armodafinil - On Aug, 14, 2015: 634 people reported to have side effects when taking Armodafinil. Among them, 13 people (2.05%) have Death

Concerta - On Aug, 12, 2015: 8,757 people reported to have side effects when taking Concerta. Among them, 57 people (0.65%) have Death.

Desoxyn - On Jul, 26, 2015: 399 people reported to have side effects when taking Desoxyn. Among them, 17 people (4.26%) have Death

Dexedrine - On Aug, 7, 2015: 1,454 people reported to have side effects when taking Dexedrine. Among them, 3 people (0.21%) have Death

Methamphetamine - On Jul, 23, 2015: 686 people reported to have side effects when taking Methamphetamine hydrochloride. Among them, 32 people (4.66%) have Death

Nuvigil - On Aug, 4, 2015: 3,832 people reported to have side effects when taking Nuvigil. Among them, 35 people (0.91%) have Death

Ritalin - On Jul, 25, 2015: 9,724 people reported to have side effects when taking Ritalin. Among them, 132 people (1.36%) have Death

Vyvanse - On Aug, 14, 2015: 5,708 people reported to have side effects when taking Vyvanse. Among them, 30 people (0.53%) have Death

How it works

 
 

The descriptions of how they work can be found with each class of drug - TCAs, amphetamines, GHB etc

Generally speaking they don’t give you a spiritual experience. Stimulants taken at moderate levels, for example,  simply stimulate you and stimulation does not give you a spiritual experience. However if you overdose on any of these, people get hallucinations and near death experiences, as well as out of body experiences via over-stimulation caused by overdose of the neurotransmitters.

It should be noted that overdosing on these classes of drugs results in permanent brain damage, liver damage, and heart problems. You can also become permanently psychotic. It is a form of poisoning.

see also Serotonin imbalance

Observations

The following table summarises the number of observations as of 2010.  The link takes you to the eHealthme site and the side effects section on this site for each medication.  There you will be able to obtain both the up-to-date figures for hallucinations, but also all the other side effects of these drugs.

Medicine

Total number of hallucinations

Dextroamphetamine

34

Doxepin

42

Endep

287

Modafinil

49

Provigil

50

Nortriptyline hydrochloride

33

Pemoline/Cylert

10

Mirtazapine

235

Remeron

474

Tofranil

32

Imipramine hydrochloride

12

Wellbutrin

1235

Zyban

221

Bupropion

220

Xyrem

20

Adderal

167

Armodifinil

5

Concerta

212

Daytrana

9

Desoxyn

26

Dexedrine

37

Methamphetamine

7

Nuvigil

32

Ritalin

164

Vyvanse

99

TOTAL

3,712

Related observations