Melatonin for the prevention and treatment of jet lag

Abstract

BackgroundJet lag commonly affects air travellers who cross several time zones. It results from the body's internal rhythms being out of step with the day-night cycle at the destination. Melatonin is a pineal hormone that plays a central part in regulating bodily rhythms and has been used as a drug to re-align them with the outside world. ObjectivesTo assess the effectiveness of oral melatonin taken in different dosage regimens for alleviating jet lag after air travel across several time zones. Search methodsWe searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, PsychLit and Science Citation Index electronically, and the journals 'Aviation, Space and Environmental Medicine' and 'Sleep' by hand. We searched citation lists of relevant studies for other relevant trials. We asked principal authors of relevant studies to tell us about unpublished trials. Reports of adverse events linked to melatonin use outside randomised trials were searched for systematically in 'Side Effects of Drugs' (SED) and SED Annuals, 'Reactions Weekly', MEDLINE, and the adverse drug reactions databases of the WHO Uppsala Monitoring Centre (UMC) and the US Food & Drug Administration. An updating search was carried out on 12/2/2008 but no new studies were identified. Selection criteriaRandomised trials in airline passengers, airline staff or military personnel given oral melatonin, compared with placebo or other medication. Outcome measures should consist of subjective rating of jet lag or related components, such as subjective well being, daytime tiredness, onset and quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms. Data collection and analysisTen trials met the inclusion criteria. All compared melatonin with placebo; one in addition compared it with a hypnotic, zolpidem. Nine of the trials were of adequate quality to contribute to the assessment, one had a design fault and could not be used in the assessment.Reports of adverse events outside trials were found through MEDLINE, 'Reactions Weekly', and in the WHO UMC database. 1 Melatonin for the prevention and treatment of jet lag (Review)

What Keeps Us Awake?—the Role of Clocks and Hourglasses, Light, and Melatonin

“…There have been many placebo controlled and placebo-uncontrolled studies that have been summarized in a Cochrane (Herxheimer and Petrie, 2002). This stringent analysis concludes that 9 of 10 trials of melatonin, taken close to the target bedtime at destination, decreased jet-lag symptoms arising after flights crossing five or more time zones.…”

Melatonin

“…1 Of 10 trials, 8 showed significant reductions in the jet lag score (a visual analog scale from 0 to 100); a score of 60 or higher was present in 67% of controls but in only 17% of melatonin recipients (number needed to treat = 2). The benefit was greater when flying eastward and when crossing more time zones.…”

“…Melatonin should be used with caution in patients with epilepsy, and in those taking warfarin given reports of possible interactions. 1 …”

Travel Risks for Those With Serious Mental Illness

“…No evidence of benefit has been found when melatonin is taken prior to travel, however. 76 Melatonin reduces the latency of sleep onset, increases sleep efficiency, and increases sleep duration. 77 It may also have antidepressant effects, 78 useful in vulnerable populations.…”