January 2023
Moon E, Kim K, Partonen T, Linnaranta O. Role of Melatonin in the Management of Sleep and Circadian Disorders in the Context of Psychiatric Illness. Curr Psychiatry Rep. 2022;24(11):623-634. doi:10.1007/s11920-022-01369-6
Overview
Abnormalities in sleep are well documented as a common concern for various psychiatric and neurological disorders. This review examines the research available on melatonin’s role in psychiatric illness for the management of sleep and circadian disorders. The authors report on the principle abnormalities of sleep and circadian rhythms, possible dose(s) of melatonin and the outcomes in sleep for autism, ADHD, neurocognitive disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety and anxiety disorders, and eating disorders.
Our comments/takeaway from the article
This review provides an overview of the use of melatonin for sleep disorders in psychiatric illnesses and it may provide guidance to clinicians on possible doses of melatonin for select conditions. It is well documented that sleep abnormalities are common in psychiatric disorders and the impairments in sleep and/or circadian rhythm can negatively impact the symptoms and outcomes of the disorder, stressing the importance of regulating sleep as part of the management of these conditions. The evidence is most robust for autism, ADHD, and neurocognitive disorders, though melatonin is reported to improve sleep parameters (sleep onset latency, sleep efficiency, and sleep quality) in multiple psychiatric disorders. Overall, the data presented in this review highlighted some limitations in the studies, including factors such as a wide range of doses, lack of current evidence, or poorly designed studies that were completed, not allowing for enough evidence to provide a solid recommendation clinically.
However, we appreciate the details on the possible abnormalities in sleep and circadian rhythms and believe this can help to further guide research in the future. Further, we agree with the author’s notation that a dose of 0.3 mg melatonin is well evidenced and has “the largest impact on sleep efficiency.” Therefore, given this current evidence, along with other well-established evidence, we would consider 0.3 mg of melatonin a safe and effective dose to aid in sleep disturbances and restoring circadian rhythm dysfunction.
Article summary
This table was modified from: Moon E, Kim K, Partonen T, Linnaranta O. Role of Melatonin in the Management of Sleep and Circadian Disorders in the Context of Psychiatric Illness. Curr Psychiatry Rep. 2022;24(11):623-634. doi:10.1007/s11920-022-01369-6. This work is licensed under CC BY 4.0.
Abbreviations: ADHD- attention deficit hyperactivity disorder; AD- Alzheimer’s disease; DLMO-dim-light melatonin onsetThis table was modified from: Moon E, Kim K, Partonen T, Linnaranta O. Role of Melatonin in the Management of Sleep and Circadian Disorders in the Context of Psychiatric Illness. Curr Psychiatry Rep. 2022;24(11):623-634. doi:10.1007/s11920-022-01369-6. This work is licensed under CC BY 4.0.
Commonly used pharmaceuticals to aid in the management of these conditions can negatively impact one’s circadian rhythm, causing an increased need to find a therapy to support healthy sleep patterns in these populations. At present, the number of well-designed studies is lacking to conclude if melatonin can be a therapeutic option for the management of sleep dysregulation specifically in psychiatric illnesses, though the authors state, “We consider melatonin and melatonergic compounds to be the most promising existing complimentary therapeutic compounds to correct abnormalities of sleep and circadian rhythms.” Further, the authors recognize the importance of optimizing the right dose of melatonin and the proper timing of administration according to the circadian rhythm dysfunction.
Limitations stated by the authors include:
This was not conducted as a systematic review
Studies on melatonergic agonists were not included
Other limitations noted in our review:
The duration of melatonin use was not stated
Varying doses of melatonin were used in the studies reviewed
Article review completed by Kim Ross, DCN
Content reviewed by Deanna Minich, PhD
December 29, 2022