In most people, laughter causes a surge of hypocretin, which maintains muscle tone. But in narcoleptics, the hormone is largely absent, and the system goes haywire.
In narcoleptics, the loss of this pleasure-seeking hormone has severe effects on mood. Narcoleptics are prone to depression, and they have a strange resistance to addiction. Some of the medications used to treat narcolepsy are notoriously addictive, like amphetamines and GHB, the so-called date-rape drug. Yet narcoleptics generally do not abuse them.
“They’re missing this working-for-pleasure system,” Dr. Siegel said. “When hypocretin is missing, you have a deficit in getting addicted and a deficiency in getting interested in things — that’s what depression is.”
So, could a sleep aid like suvorexant, which reduces hypocretin, lead to depression in a healthy person? In clinical trials involving thousands of patients, the drug helped people with insomnia fall asleep faster and stay asleep longer than placebo. And there were no signs that it induced depression or caused falls resembling cataplexy, said Dr. Darryle Schoepp, senior vice president at Merck.
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