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Diagnosing while on antidepressants

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Diagnosing while on antidepressants

Postby tuxedocat » Thu Aug 15, 2013 7:32 pm

I just had a first appointment yesterday, and my doctor suspects I have narcolepsy. However, he says that it's impossible to test for it while I'm on Cymbalta, as Cymbalta masks certain symptoms.

Is this true? I tried to do some research, but the most I could find was that antidepressants can result in a false negative, but that it's not impossible to test for it.

Going off my Cymbalta is absolutely not an option.

I'm not sure what I should do at this point - should I try to ask him for a test anyway? I'm completely unable to function anymore because I can't stop falling asleep during the day, and even when I'm awake my brain is so foggy I can't do anything. I feel drunk all the time.
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Re: Diagnosing while on antidepressants

Postby Chalotte » Thu Sep 12, 2013 11:57 pm

I'm in pretty much the same situation as you are, but with an SSRI. I think what your doctor means is that any result from the Multiple Sleep Latency Test or overnight sleep study will always have a question mark because it could result in a false positive (say, if the Cymbalta was actually the thing making you sleepy) or a false negative. Anti-depressants often suppress REM sleep, and one of the main criteria for diagnosing narcolepsy is abnormally-quick entry into REM sleep. So even if you meet all other criteria for narcolepsy, if you didn't have the abnormally-quick entry into REM, you couldn't technically get a diagnosis of narcolepsy - even though you might actually have it. I'm not sure what the specific side-effects are for cymbalta, but some anti-depressants can give people insomnia, so if you can't sleep or don't sleep as much or as well or as deeply as you could if you weren't on Cymbalta during the MSLT or overnight sleep study, is it because you don't have narcolepsy, or is it because of the drug? On the other hand, some anti-depressants have a tendency to make people sleepy. Are you sleepy because of the drug or is it narcolepsy? To add more complication, some people react in the opposite way to what you would expect from an anti-depressant, and are sleepier when the typical side-effect is the opposite, and vice versa.

I'm guessing you don't have cataplexy? Because clear cataplexy would make diagnosis easy. However, antidepressants are often prescribed to narcoleptics because they prevent or lessen the frequency of cataplexy because they interfere with REM sleep. If you were on anti-depressants from about the time you started developing narcolepsy symptoms, you could theoretically have had cataplexy all along, but the anti-depressants suppressed the symptom so that you've never actually displayed it.

According to my sleep doc, pretty much ALL narcoleptics with cataplexy have indetectable hypocretin/orexin in their cerebrospinal fluid, while narcoleptics without cataplexy have very depleted levels, but still detectable. From my research, the jury might still be out on the latter claim, as there has been far less testing done with the CSF levels of narcoleptics without cataplexy. However, if true, you could theoretically have a spinal tap (lumbar puncture) to test your hypocretin levels (it's the only method for testing it). If you had undetectable levels or near-undetectable levels, you've pretty much got your diagnosis right there. However, apparently CSF testing for narcolepsy is mostly only done for research purposes (like at the Stanford Center for Narcolepsy), because it is so invasive. It might not even be possible for you to get one done.

You could still have an MSLT and overnight sleep study, but any results they provided, even if they definitely suggested narcolepsy, might still be considered debatable because you were on anti-depressants at the time. Has your doctor considered other sleep disorders, like sleep apnea or breathing problems? Because if you happened to have one of those disorders, which could also result in extreme daytime sleepiness, the overnight sleep study would show breathing problems regardless of whether you are on anti-depressants, as far as I understand. An overnight sleep study would still be useful in ruling out other sleep disorders, unless they've already been ruled out.

Also, has your doc considered just putting you on the drugs prescribed to narcoleptics, like odafinil, and seeing if they work? S/he might not want to do that unless pretty much all the other major causes of daytime sleepiness have been ruled out. Like, if s/he prescribed drugs that masked your sleepiness, but the sleepiness was actually caused by some serious disease, you'd be in trouble (and so would the doctor).

It is an extremely complicated issue.
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Re: Diagnosing while on antidepressants

Postby OCDhelp » Sat Feb 08, 2014 5:56 am

I was on cymbalta pre testing and went off it for the test. Results were still inconclusive. But I also have rem specific sleep apnea. I had to wear my cpap and they had me at full pressure for the naps. I cant do full pressure and fall asleep bc its painful.

Also going off cymbalta was horrible. I threw up daily for over a month and had weird electric shock sensations across my forehead and down my arms. Plus weepy. Surprisingly tho, my mood has been fine once it was fully out of my system.

Anyways, now on provigil, bc my doc decided to try it and it makes a huge difference for me. Not on the cymbalta anymore either. No cataplexy in my case.

-- Fri Feb 07, 2014 9:59 pm --

also my vitamin d levels were super low, so im doing supplements for that. when my levels are normal were gonna try stopping the provgil for a few days to see if the vitamin d was the cause or not.
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