International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Laura Palagini¹, Raffaele Manni², Eugenio Aguglia³, Mario Amore^{4

5}, Roberto Brugnoli⁶, Stéphanie Bioulac⁷, Patrice Bourgin^{8

9}, Jean-Arthur Micoulaud Franchi⁷, Paolo Girardi⁶, Luigi Grassi¹⁰, Régis Lopez^{11

12}, Claudio Mencacci¹³, Giuseppe Plazzi^{14

15}, Julia Maruani¹⁶, Antonino Minervino¹⁷, Pierre Philip⁷, Sylvie Royant Parola¹⁸, Isabelle Poirot¹⁹, Lino Nobili^{20

21}, Giovanni Biggio²², Carmen M Schroder^{8

23}, Pierre A Geoffroy^{16

24

25

26}

Affiliations

¹ Psychiatry Division, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
² Unit of Sleep Medicine and Epilepsy, Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy.
³ Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy.
⁴ Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
⁵ Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy.
⁶ Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy.
⁷ University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France.
⁸ Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France.
⁹ Centre des troubles du sommeil - CIRCSom, Strasbourg University Hospitals, Strasbourg, France.
¹⁰ Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
¹¹ Service de Neurologie, Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France.
¹² PSNREC, Univ Montpellier, INSERM, Montpellier, France.
¹³ Department of Neuroscience, Aziende Socio Sanitarie Territoriali Fatebenefratelli Sacco, Milan, Italy.
¹⁴ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
¹⁵ Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Neurological Sciences of Bologna, Bologna, Italy.
¹⁶ Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France.
¹⁷ Department of Psychiatry, Italian Society of Psychosomatic Medicine (SIMP), Parma, Italy.
¹⁸ Reseau Morphee Paris, Paris, France.
¹⁹ Service de psychiatrie adulte, Hôpital Fontan, CHU de Lille, Lille, France.
²⁰ Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.
²¹ Istituto di Ricovero e Cura a Carattere Scientifico, Child Neuropsychiatry Unit, Giannina Gaslini Institute, Genoa, Italy.
²² Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, Cagliari, Italy.
²³ Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France.
²⁴ GHU Paris - Psychiatry & Neurosciences, Paris, France.
²⁵ CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France.
²⁶ Université de Paris, NeuroDiderot, Inserm, Paris, France.

PMID: 34177671
PMCID: PMC8222620
DOI: 10.3389/fpsyt.2021.688890

International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Laura Palagini et al. Front Psychiatry. 2021.

. 2021 Jun 10:12:688890.

doi: 10.3389/fpsyt.2021.688890. eCollection 2021.

Authors

Affiliations

¹ Psychiatry Division, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
² Unit of Sleep Medicine and Epilepsy, Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy.
³ Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy.
⁴ Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
⁵ Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy.
⁶ Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy.
⁷ University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France.
⁸ Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France.
⁹ Centre des troubles du sommeil - CIRCSom, Strasbourg University Hospitals, Strasbourg, France.
¹⁰ Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
¹¹ Service de Neurologie, Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France.
¹² PSNREC, Univ Montpellier, INSERM, Montpellier, France.
¹³ Department of Neuroscience, Aziende Socio Sanitarie Territoriali Fatebenefratelli Sacco, Milan, Italy.
¹⁴ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
¹⁵ Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Neurological Sciences of Bologna, Bologna, Italy.
¹⁶ Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France.
¹⁷ Department of Psychiatry, Italian Society of Psychosomatic Medicine (SIMP), Parma, Italy.
¹⁸ Reseau Morphee Paris, Paris, France.
¹⁹ Service de psychiatrie adulte, Hôpital Fontan, CHU de Lille, Lille, France.
²⁰ Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.
²¹ Istituto di Ricovero e Cura a Carattere Scientifico, Child Neuropsychiatry Unit, Giannina Gaslini Institute, Genoa, Italy.
²² Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, Cagliari, Italy.
²³ Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France.
²⁴ GHU Paris - Psychiatry & Neurosciences, Paris, France.
²⁵ CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France.
²⁶ Université de Paris, NeuroDiderot, Inserm, Paris, France.

PMID: 34177671
PMCID: PMC8222620
DOI: 10.3389/fpsyt.2021.688890

Abstract

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders. Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method. Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders. Conclusion: The administration of prolonged release melatonin at 2-10 mg, 1-2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders.

Keywords: circadian sleep disorders; delirium; dementia; expert opinion; insomnia; melatonin; psychiatric disorders.

Copyright © 2021 Palagini, Manni, Aguglia, Amore, Brugnoli, Bioulac, Bourgin, Micoulaud Franchi, Girardi, Grassi, Lopez, Mencacci, Plazzi, Maruani, Minervino, Philip, Royant Parola, Poirot, Nobili, Biggio, Schroder and Geoffroy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

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References

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International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Affiliations

International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources