Treatment Research (Part 1)

To return to this matter of medication I had stated that the switch to Ritalin from Dexedrine was unremarkable in relation to EDS. On the other hand the effect on my Cataplexy of the switch to Imipramine was largely negative, in that it was far less effective in this regard than Dexedrine with the result that my cataplectic attacks continued unabated, if not worse. The significance of this will be appreciated when I explain that the cataplectic attacks are by far the most frightening aspect of Narcolepsy and even up to now the symptom I dread most. To elaborate; a cataplexy is a reaction to any emotion - anger, amusement or some other vague, undefined emotional response - which causes all the voluntary muscles of the body to go limp, including even the eyelids, so that the narcoleptic is unable to stand or hold anything and if there is no one around or something to lean on he is in danger of falling in an uncontrolled way and seriously hurting himself, especially his or her head. On many occasions I have had attacks when there is no one around and I have had to spend the next 10 or 20 minutes desperately trying to hang on to a counter or a wall to prevent my knees from buckling or to retain my balance. In such situations the tension has at times been so great that I will develop searing headaches, causing my head to feel as if my brain was on fire. The fear in all of these situations is that of hitting my head when I fall, and although I have managed to avoid the dreaded circumstance coming to pass for most of my life, within the last 5 or 6 years I have had on two occasions fallen and struck my forehead and had to receive stitches. I should also point out that, frequently, during my cataplexy I hallucinate that I am in a situation in which my life is being threatened and I am calling for help to someone who is not really where he seems to be in my hallucination, nor is my voice making the sound which I think it is. However, as I have grown older the life-threatening situations have gradually come to be replaced though not entirely, by socially embarrassing situations, such as the fact that I may hallucinate that there is a massive crowd present when I am experiencing my cataplexy although there is no one present. On the other hand, I have had an attack while out at a public occasion and although fortunate to be in a seated position, I had an hallucination of being attacked and, as a result, kicked wildly at concerned friends who approached me to enquire as to my well-being.

Not knowing any better, I was forced to endure Imipramine (75mg daily) for the next 12-15 years until, becoming somewhat computer literate in the late 90s, I came across Stanford University’s Website Center for Narcolepsy and in particular, its brief analysis of Narcolepsy medications. In there I saw that the website described Anafranil (Clomipramine) in relation to the treatment of Cataplexy as “Very effective, mostly used in Europe”, whereas, of Imipramine, it simply stated “Anticholinergic effects”(which I gathered suggested dry mouths and blurred vision). Thereupon, I resolved that I was going to try using Anafranil instead of Imipramine and set about persuading my doctor to switch to Anafranil. No doubt with a little research of his own, he realized that there was some point to my efforts and he switched me to three x 25mg tablets of Anafranil daily. The difference in the frequency and severity of cataplectic attacks was dramatic and ever since then, I have been on Anafranil together with Ritalin. A word of caution, however, is called for in the use of Anafranil. One of the effects of this drug is to prolong the erection of the male. I am not aware that it assists in enabling an erection but I know that it retards the advent of a climax in a man and I imagine that an overdose could cause very painful and embarrassing circumstances if not worse. Indeed, I am convinced that many men in pornographic movies use Anafranil to enable them to perform in those movies. My very moderate lifestyle has never created any situation in which I was tempted to take an overdose of Anafranil.