Antidepressants Instead Of Xyrem

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I had another question about treatment options for narcolepsy.

I have little to no problem falling asleep and staying asleep at night, save for the occasional times when stress triggers my SP. I don't have cataplexy, so so far I have not tried Xyrem. My doctor asked me about it - and I have several reasons for avoiding it - and my neuro agrees that I shouldn't be on Xyrem unless my conditions get worse. My three biggest reasons for avoiding it?

1. Cost. If I lose my health insurance, the drug is ridiculously expensive. Also $25/month (the copay for a non-generic drug) is ... well, it's a LOT for me, on top of my medication for wakefulness.

2. The warning label. Beyond side effects, I am concerned about taking a drug that can have effects on me at night. I live alone (or sometimes with temporary roommates) and don't want to risk something happening at night with me being unable to react (ie escape from a fire, hide from someone who has broken in, use my cell phone to call for help, etc.) Even if there isn't an emergency situation, when I am first taking the drug, it seems wrong to do this without anyone around to help if something goes wrong.

3. My life is fairly boring, yet remains unpredictable. There is usually not a problem with my schedule, but the idea of taking a drug that is so inflexible really bothers me. A lot of people are of the opinion that not eating 2 hours before bedtime or going to bed at the same time every night is easy - but, well, let's just say that living in the confines of a completely rigid schedule is just not possible for me, I will mess it up... I have also heard that you need to be weaned off the drug, so stopping it, or skipping a dose by accident or incident, is not okay.

Since I sleep through the night and my sleeping test show that I have 92 sleep efficiency (YES! an A- in sleep!) at night, I don't think Xyrem would be a great choice for me. Especially with my propensity for messing up the dosage, which is actually quite high. Yikes...

I have read, however, that some patients have been prescribed antidepressants to help with sleep paralysis and hypnagogic hallucinations. Since the symptoms haven't bothered me enough to take something like Xyrem, I hadn't considered the other treatments used. Have you ever taken Xyrem? Or antidepressants? Has it worked out for you well? If I can be on a drug that is less high-maintenance medicine that helps me avoid SP during stressful week, it might be worth it...


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Any drug that reduces REM will reduce SP. Drugs that reduce REM include your standard "benzos" like lorazepam or clonazepam. Another option is an SSRI like Lexapro or fluoxetine (aka Prozac). Fluoxetine generally is the most stimulating of the SSRIs. Lexapro is probably the least sedating of the SSRIs but will cause some anyways so you may find it helpful to only take it in the evening. The problem with both of these classes of drugs is they do have side effects that many people find troublesome. SSRIs, as an intrinsic property of inhibiting seratonin reuptake will cause some sedation and decrease in libedo (in both genders, not just men)which can result in sexual dysfunction/loss of desire. Benzos can cause decreased memory and mental acuity the next day and are addictive. Ambien may decrease REM sleep, but I can't recall having seen any data on that. Personally, that stuff makes me super tired the next day if I take Ambien CR or if I take the standard instant release Ambien I wake up after four hours and can't fall back asleep. I also know non-narcolepts that have tried it and they still are tired /foggy the next day by it as well.

The primary advantage of Xyrem in those without cateplexy is that it can reduce the need for stimulents and reduce EDS. But, the disadvantages (which you correctly described), to some people (like me), out weigh any advantage if what they are using for EDS works. For others it is a God send.

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