A Cochrane review [Abstract] 1 included three cross-over and two parallel trials with a total of 246 subjects. As the trials tested different comparisons, or had a different design or dealt with different outcome measures, meta-analysis was not performed. In one cross-over trial (10 participants) femoxetine had no significant effect in eliminating or reducing excessive daytime sleepiness (EDS) but significantly reduced cataplexy. In a second cross-over trial (56 participants) viloxazine significantly reduced EDS and cataplexy. However, the measure of effect is of doubtful clinical significance and the result is burdened by a possible attrition bias. In a third cross-over trial fluvoxamine versus clomipramine the authors inappropriately treated the trial design as a parallel study and no conclusions could be reached in favour of either drug. Two more trials with parallel design tested ritanserin versus placebo without finding differences of effectiveness in reducing EDS or cataplexy.
Despite the clinical consensus recommending antidepressants for cataplexy there is scarce evidence that antidepressants have a positive effect on this symptom.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment, inadequate follow up) and by imprecise results (few patients and wide confidence intervals).
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