Elsevier

Sleep Medicine

Volume 1, Issue 4, 1 October 2000, Pages 313-316
Sleep Medicine

Brief communication
The use of citalopram in resistant cataplexy

https://doi.org/10.1016/S1389-9457(00)00026-5Get rights and content

Abstract

Background: Cataplexy is a disabling component of the narcolepsy tetrad that is sometimes resistant to standard treatment.

Case reports: Three of our patients with narcolepsy, including one who had post-traumatic narcolepsy, suffered from intractable cataplexy with failure of treatment with established drugs due to unacceptable side-effects.

Results: We explored the use of citalopram (Celexa), the newest and most specific of the serotonin reuptake inhibitors, and were successful in treating cataplexy without significant side-effects. Stimulant drugs remained necessary for controlling symptoms of excessive drowsiness.

Conclusions: Citalopram was effective in relieving the symptoms of resistant cataplexy in out patients.

Introduction

The narcolepsy tetrad comprises excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. While most cases are idiopathic and in the Caucasian population associated with HLA DR2, narcolepsy is a rare consequence of head trauma [1], [2], [3]. The most common presenting symptom of narcolepsy is excessive daytime sleepiness (EDS), which usually responds well to stimulant medication, but disability may persist because cataplexy may be difficult to control. Tricyclic antidepressants such as imipramine, and more recently, serotonin reuptake inhibitors (SSRI) such as fluoxetine [4] have been shown to be efficacious but side-effects, may be intolerable in some cases. We report three patients whose cataplexy failed standard treatment because of unacceptable side-effects, whom we successfully treated with citalopram.

Section snippets

Case reports

Patient 1: a 51-year-old white male, had post-traumatic narcolepsy. He presented to us for excessive daytime sleepiness with sleep attacks occurring several times a week. The frequency of these attacks was decreased by napping regularly, twice a day or so for 15 min to a few hours. He also experienced buckling of the knees and legs without completely losing tone 4–5 times a week and occasional buckling of his arms while writing. These episodes were precipitated by strong negative emotions. He

Conclusion

Citalopram was effective and well tolerated in three of our patients with cataplexy who had difficulty tolerating other drugs. Citalopram has proven to be efficacious and safe for the treatment of depression [5], [6]. The serotonin reuptake inhibitors differ subtly in their clinical profile, especially with regard to side-effects, with varying influences on appetite and anxiety. Citalopram now merits further evaluation as treatment for cataplexy.

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