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Antidepressants, because of their REM-sleep suppressing effects, are used to treat cataplexy, sleep paralysis and hypnagogic hallucinations. Tricyclic antidepressant such as clomipramine and protryptiline are efficacious at low doses but frequently induce unacceptable side effects. Serotonin specific reuptake blockers typically require larger doses to control cataplexy but are better tolerated. Major side effects include sexual disturbances and weight gain. Their use is often limited to patients with severe cataplexy. These compounds inhibit adrenergic and serotoninergic reuptake.
Disturbed nocturnal sleep may be treated using sedative antidepressants, benzodiazepine like hypnotic medications or gamma Hydroxybutyrate (GHB). This last compound is especially interesting as it not only consolidates nocturnal sleep but also reduces cataplexy (without sexual side effects) and possibly daytime sleepiness following long term administration. Thanks to its short half-life however, the compound must be administered several times during the night to ensure continuous efficacy. The compound is an unusual anesthetic agent known to increase slow wave sleep and REM sleep. It acts via its own (probably non GABAergic) receptors and dramatically reduces dopamine release in vivo. It is also difficult to use as it toxic at high dose and is abused by the general population. Illegal uses include administration as a rape drug, recreational use because of its euphoric effects and abuse by athletes for its growth hormone releasing effects in association with slow wave sleep induction.
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