{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:42:51Z","timestamp":1777660971101,"version":"3.51.4"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"S1","license":[{"start":{"date-parts":[[2014,11,18]],"date-time":"2014-11-18T00:00:00Z","timestamp":1416268800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CNS Spectr."],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:p>The medications used to treat narcolepsy are targeted toward alleviating symptoms such as excessive sleepiness and cataplexy. The cause of this neurological sleep disorder is still not completely clear, though a destruction of hypocretin\/orexin neurons has been implicated. The destruction of these neurons is linked to inactivity of neurotransmitters including histamine, norepinephrine, acetylcholine, and serotonin, causing a disturbance in the sleep\/wake cycles of narcoleptic patients. Stimulants and MAOIs have traditionally been used to counteract excessive daytime sleepiness and sleep attacks by inhibiting the breakdown of catecholamines. Newer drugs, called wake-promoting agents, have recently become first-line agents due to their better side-effect profile, efficacy, and lesser potential for abuse. These agents similarly inhibit reuptake of dopamine, but have a novel mechanism of action, as they have been found to increase neuronal activity in the tuberomamillary nucleus and in orexin neurons. Sodium oxybate, a sodium salt of gamma-hydroxybutyrate (GHB), is another class that is used to treat many symptoms of narcolepsy, and is the only U.S. Food and Drug Administration (FDA)-approved medication for cataplexy. It has a different mechanism of action than either stimulants or wake-promoting agents, as it binds to its own unique receptor. Antidepressants, like selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), have also been used, as similar to stimulants, they inhibit reuptake of specific catecholamines. In this article, we seek to review the mechanisms behind these classes of drugs in relation to the proposed pathophysiology of narcolepsy. Appropriate clinical strategies will be discussed, including specific combinations of medications that have been shown to be effective.<\/jats:p>","DOI":"10.1017\/s1092852914000583","type":"journal-article","created":{"date-parts":[[2014,11,18]],"date-time":"2014-11-18T06:54:22Z","timestamp":1416293662000},"page":"25-34","source":"Crossref","is-referenced-by-count":22,"title":["Mechanism of action of narcolepsy medications"],"prefix":"10.1017","volume":"19","author":[{"given":"Chandan R.","family":"Gowda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie P.","family":"Lundt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2014,11,18]]},"reference":[{"key":"S1092852914000583_ref10","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410430115"},{"key":"S1092852914000583_ref8","first-page":"557","article-title":"Narcolepsy: current treatment options and future approaches","volume":"4","author":"Billiard","year":"2008","journal-title":"Neuropsychiatr Dis Treat"},{"key":"S1092852914000583_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)05582-8"},{"key":"S1092852914000583_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2009.02.008"},{"key":"S1092852914000583_ref19","doi-asserted-by":"crossref","DOI":"10.4324\/9780203338254","volume-title":"Sleep Psychiatry","author":"Golbin","year":"2004"},{"key":"S1092852914000583_ref15","doi-asserted-by":"crossref","first-page":"596","DOI":"10.5664\/jcsm.27994","article-title":"The nightly use of sodium oxybate is associated with a reduction in nocturnal sleep disruption: a double-blind, placebo-controlled study in patients with narcolepsy","volume":"6","author":"Black","year":"2010","journal-title":"J Clin Sleep Med"},{"key":"S1092852914000583_ref20","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2008.036"},{"key":"S1092852914000583_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.npep.2007.01.003"},{"key":"S1092852914000583_ref17","first-page":"704","article-title":"Pharmacotherapy in narcolepsy","volume":"21","author":"Akimoto","year":"1960","journal-title":"Dis Nerv Syst"},{"key":"S1092852914000583_ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-012-0150-9"},{"key":"S1092852914000583_ref21","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/29.7.939"},{"key":"S1092852914000583_ref5","volume-title":"Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications","author":"Stahl","year":"2008"},{"key":"S1092852914000583_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1935.02760510023006"},{"key":"S1092852914000583_ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.351"},{"key":"S1092852914000583_ref9","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-199508000-00002"},{"key":"S1092852914000583_ref13","doi-asserted-by":"publisher","DOI":"10.2165\/11317740-000000000-00000"},{"key":"S1092852914000583_ref12","doi-asserted-by":"crossref","first-page":"8620","DOI":"10.1523\/JNEUROSCI.20-22-08620.2000","article-title":"Hypothalamic arousal regions are activated during modafinil-induced wakefulness","volume":"20","author":"Scammell","year":"2000","journal-title":"J Neurosci"},{"key":"S1092852914000583_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/B0-72-160797-7\/50017-3"},{"key":"S1092852914000583_ref3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.2009.02012.x"},{"key":"S1092852914000583_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2007.03.004"},{"key":"S1092852914000583_ref2","first-page":"190","article-title":"Etiopathogenesis and neurobiology of narcolepsy: a review","volume":"8","author":"Kumar","year":"2014","journal-title":"J Clin Diagn Res"}],"container-title":["CNS Spectrums"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1092852914000583","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,26]],"date-time":"2020-08-26T23:46:57Z","timestamp":1598485617000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1092852914000583\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11,18]]},"references-count":21,"journal-issue":{"issue":"S1","published-print":{"date-parts":[[2014,12]]}},"alternative-id":["S1092852914000583"],"URL":"https:\/\/doi.org\/10.1017\/s1092852914000583","relation":{},"ISSN":["1092-8529","2165-6509"],"issn-type":[{"value":"1092-8529","type":"print"},{"value":"2165-6509","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11,18]]}}}