Role of Melatonin in the Management of Sleep and Circadian Disorders in the Context of Psychiatric Illness

Abstract

Purpose of Review We present a review of research on the role of melatonin in the management of sleep and circadian disorders, stressing current overall view of the knowledge across psychiatric disorders. Recent Findings Dysregulation of sleep and circadian rhythms has been established in several psychiatric and neurocognitive disorders for long. Recent research confirms this finding consistently across disorders. The secretion of melatonin in schizophrenia and neurocognitive disorders is reduced due to a smaller volume and enlarged calcification of the pineal gland. On the other hand, melatonin dysregulation in bipolar disorder may be more dynamic and caused by light-sensitive melatonin suppression and delayed melatonin secretion. In both cases, exogenous melatonin seems indicated to correct the dysfunction. However, a very limited number of well-designed trials with melatonin to correct sleep and circadian rhythms exist in psychiatric disorders, and the evidence for efficacy is robust only in autism, attention deficit hyperactivity disorder (ADHD), and neurocognitive disorders. This topic has mainly not been of interest for recent work and well-designed trials with objective circadian parameters are few. Overall, recent studies in psychiatric disorders reported that melatonin can be effective in improving sleep parameters such as sleep onset latency, sleep efficiency, and sleep quality. Recent meta-analysis suggests that optimal dosage and dosing time might be important to maximize the efficacy of melatonin. The knowledge base is sufficient to propose well-designed, larger trials with circadian parameters as inclusion and outcome criteria. Based on the partly fragmentary information, we propose testing efficacy in disorders with neurocognitive etiopathology with later and higher dosing, and affective and anxiety disorders with lower and earlier dosing of melatonin. Summary Melatonin is promising for the correction of sleep and circadian abnormalities in psychiatric disorders. However, research results on its effect are still few and need to be accumulated. For effective use of melatonin, it is necessary to consider the appropriate dosage and administration time, depending on the individual abnormality of sleep and circadian rhythms.

Exogenous Melatonin Use in University Students: A Cross-Sectional Survey

“…Ironically, the reported prevalence of hypnotic agent and/or sedative use in this study mirrored findings from the first study of this kind, which was conducted 12 years ago among medical students in the Riyadh region, SA [ 33 ]. This continued pattern could be attributed to the availability and tolerability of exogenous melatonin, which replaced demand for other sleep aid agents [ 14 ].…”

“…More recent evidence indicates the safety and effectiveness of exogenous melatonin as a pharmacological supplement in regulating the circadian rhythm of the sleep–wake cycle in adults and children older than 11 years [ 13 , 14 , 15 ]. Moreover, melatonin showed positive impacts on sleep quality for other common forms of sleep disorders, such as insomnia, breathing-related sleep disorders, and sleep-related movement disorders [ 16 , 17 , 18 ].…”

Pineal Abnormalities in Psychosis and Mood Disorders: A Systematic Review

“…Finally, we encourage future studies to examine how currently used antipsychotics for treating psychosis might influence the PG volume and MLT in parallel to changes in sleep parameters, and also consider the use of melatonin as potential treatment avenues for reducing side effects of antipsychotics [86][87][88], ameliorating various cognitive and information processing disturbances typically present in people with schizophrenia [89,90], and treating sleep disturbances in a range of psychiatric disorders, including but not limited to psychosis and mood disorder [91,92].…”

Exploring Links between Pineal Gland Calcification and Central Nervous System Disease

“…Supplementary melatonin has been investigated as a potential adjunctive treatment for schizophrenia, showing promise in improving sleep parameters, and counteracting metabolic adverse reactions and tardive dyskinesia symptoms caused by antipsychotic drugs (Duan, Jenkins, & Castle, 2021). Furthermore, melatonin is advantageous due to its low cost, minimal side effects, lack of drug interactions, and easy availability (Moon, Kim, Partonen, & Linnaranta, 2022). Imaging studies have revealed that patients with schizophrenia exhibit more severe pineal gland calcification and smaller parenchymal volume, suggesting a potential link between pineal gland calcification and the regulation of schizophrenia by melatonin (Takahashi et al, 2021).…”