Objective of the BOND Study
This aspect of the Study concentrated upon identifying any Psychiatric Comorbidities (mental health illnesses) that PWN (people with narcolepsy) may experience.
Subjects
As already mentioned in the first part of this research series, the BOND Study involved 55,871 subjects with records of 9,312 patients with narcolepsy being compared to 46,559 without narcolepsy. Every one PWN was compared to 5 without the condition and matched according to gender, age and payment of health care. Of the 9,312 PWN, 20% were identified as having narcolepsy with cataplexy and 59% were female. The ages of subjects ranged from 18-93 years old, with the average age being 46.
Brief Conclusion
The study found high rates of depression and anxiety amongst individuals with narcolepsy, with it concluding that "Narcolepsy should be included in the different diagnosis of mood and anxiety disorders, particularly in patients with fatigue or daytime sleepiness and in those unresponsive to standard treatment" (Bond Psychiatric Comorbidity Poster, 2013).
Psychiatric Comorbidity Results
Illness
| Subjects with Narcolepsy | Subjects without Narcolepsy |
|---|---|---|
| Mood Disorders |
37.9%
|
13.8%
|
| Anxiety Disorders |
25.1%
|
11.9%
|
| Other Misc Psychiatric Disorders |
14.5%
|
4.0%
|
Illness
| Subjects with Narcolepsy | Subjects without Narcolepsy |
|---|---|---|
| Attention Deficit, Conduct and Disruptive Disorders For example Disruptive Behavioural Disorders |
7.3%
|
5.4%
|
| Adjustment Disorders Refers to an inability to adjust/cope with a particular source of stress |
11.2%
|
5.4%
|
| Delirium, Dementia, Amnestic and other Cognitive Disorders For example Huntington’s disease, Parkinson’s, Alzheimer’s, Vascular Dementia due to a medical condition such as AIDS, head trauma |
4.6%
|
1.5%
|
| Substance-related Disorders |
4.0%
|
1.2%
|
| Schizophrenia and other Psychotic disorders "Illnesses that alter a person's ability to think clearly, make good judgements, respond emotionally, communicate effectively, understand reality, and behave appropriately" (WebMD) |
3.4%
|
0.9%
|
| Personality Disorders For example OCD, Dependent Disorders, Avoidant Disorders |
1.1%
|
0.2%
|
| Suicide (attempted) and Intentional Self-Inflicted Injury |
1.0%
|
0.2%
|
| Alcohol-related disorders |
1.9%
|
1.3%
|
| Impulse Control Disorders not elsewhere classified Disorders where impulse control issues are the primary symptom, such as addictions eating disorders |
0.2%
|
0.1%
|
Psychiatric Drug Exposure Results
These results refer to individuals who had sought professional help for mental health symptoms and had filled at least one prescription in the 5 year period that the research concentrated upon.
Medication | Subjects with Narcolepsy | Subjects without Narcolepsy |
|---|---|---|
| SSRI's Typically used as antidepressants in the treatment of depression, anxiety disorders and personality disorders |
36%
|
17%
|
| Anxiolytic Benzodiazepines Typically used as anxiety counteracting medication |
34%
|
19%
|
| Non Benzodiazepine Sedative-Hypnotics A newer breed of sedative/sleep inducing medication used to treat insomnia. Often the preferred choice as there's less chance of causing dependency than its Benzodiazepine counterparts |
23%
|
10%
|
| SNRI's Antidepressants typically used to treat mood disorders, including depression. Occasionally used to treat anxiety disorders, chronic neuropathic pain and fibromyalgia syndrome |
21%
|
6%
|
| TCA Antidepressants extensively used to treat depression before the development of SSRI medication |
13%
|
4%
|
| Misc Sedative-Hypnotics Tranquilizers, sleeping pills and sedatives |
10%
|
4%
|
| Hypnotic Benzodiazepines Sleep inducing medication often used to treat Insomnia |
6%
| 2% |
| Stimulants Medication typically used to promote alertness and energy levels. |
53%
|
12%
|
Final Thoughts
Although I was pleased to see a psychiatric comorbidity aspect to the BOND Study, I'm of the opinion that it fails to provide an accurate, realistic picture of mental health issues possibly experienced amongst PWN; particularly in regards to symptoms of depression and anxiety. The above figures only represent patients who have sought professional medical advice regarding mental health issues AND been prescribed medication at least once as a result of this disclosure. It therefore doesn't include those who experience mental health problems silently or even those who have sought professional advice, but decide upon a non-medicated approach to symptom management.
The stigma associated with mental illness sadly still exists. Feelings of embarrassment and general negative opinions regarding mental health, continue to be the main reasons why individuals are reluctant to seek professional help (Barney et al, 2005, Roness et al, 2005). When you consider that PWN may already be experiencing feelings of shame, fear and embarrassment just by having a condition that is so deeply misunderstood by the general public, I think its logical to say that many more people experience mental health issues silently and that the overall figures for psychiatric comorbidity maybe considerably higher than those suggested above.
Narcolepsy and Cataplexy can be very disabling, invasive conditions for some, with symptoms greatly impacting upon many aspects of peoples lives. It's completely understandable that individuals may experience feelings of depression upon the realisation that their illness is life long and will forever force limitations. This is something that is widely accepted within academic and medical circles when considering other chronic illnesses such as MS, narcolepsy and cataplexy are no different. Constant restrictions and exhaustion can sometimes feel like we have become greyer, duller versions of previous selves, whilst the lives of those around us continue in HD, multi-colour. Anxiety is another natural reaction to a narcolepsy/cataplexy diagnosis. Who wouldn't have concerns regarding their ability to work, drive, maintain current commitments or fulfil existing, established roles such as parenting? Factor in symptoms that have the potential to further influence mood, such as frightening hallucinations and night time disturbances, and I think its fairly safe to assume that experiences of anxiety and depression among PWN are much more prevalent.
For me, this aspect of the study has mainly confirmed what people have long suspected/assumed; that there is an association between narcolepsy and increased mental health issues, however the reason for the association requires more research. Despite the study's limitations, we shouldn't disregard or underestimate how useful the above figures can be as benchmarks. Hopefully they will pav the way for future research that is far more detailed.
I have discussed depression and anxiety from a PWN perspective in the post
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