A Man with Depression, Anhedonia, and Fatigue

He reported intermittent use of benzodiazepines, ketamine, and alcohol and was maintained on buprenorphine for opioid use disorder. He had a history of major depression. His antidepressants, including venlafaxine and escitalopram, had been adjusted, but this did not improve his fatigue. Additionally, he reported focal hand weakness triggered by laughing, as well as sleep paralysis and hallucinations while falling asleep, so he was referred for polysomnography. During testing, he fell asleep an average of 1.6 minutes after lying down, and he frequently went straight into rapid eye movement sleep. These findings are diagnostic of type 1 narcolepsy.

Figure 1

Pentad of Symptoms of Narcolepsy Type 1.