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Melatonin use in children

Published online by Cambridge University Press:  02 January 2018

M. E. J. Wise*
Affiliation:
BECMHT, 13–15 Brondesbury Road, London NW6 6HX. E-mail: ian.wise@nhs.net
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Abstract

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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 2004. The Royal College of Psychiatrists

Armour & Patton write a helpful review on the use of Melatonin in children (Psychiatric Bulletin, June 2004, 28, 222-224). Several studies they mentioned were with blind subjects. It is important to consider that blind people have free-running circadian rhythms that are not amenable to the most powerful of resetting cues - light. The use of melatonin to trigger the new 24-hour period is very powerful in this population (Reference Sack, Brandes and KendallSack et al, 2000).

Lewy et al (Reference Lewy, Emens and Sack2002) showed that low levels of melatonin, 0.5 mg, reset rhythm but not high doses, 2 mg. The prolonged half-life of melatonin and the sensitivity of the circadian rhythm to its presence mean that in trying to achieve phase advancement (bringing sleep forward to combat ‘sundowning’ in the elderly) or delay (delaying sleep onset to combat ‘jetlag’) melatonin has a window effect. Too low a dose and no effect, too high and the chronobiologic effects are lost and the direct somnolent action is experienced. It would be a shame if a potentially useful treatment for circadian rhythm disorders, including sleep disturbances and seasonal affective disorders, were discarded prematurely due to a perceived lack of efficacy.

Footnotes

Declaration of interest

The author uses melatonin to reduce recovery time from intercontinental jetlag: personal use only.

References

Lewy, A. J., Emens, J. S., Sack, R. L., et al (2002) Low, but not high, doses of melatonin entrained a free-running blind person with long circadian period. Chronobiology International, 19, 649658.Google Scholar
Sack, R. L., Brandes, R.W., Kendall, A. R., et al (2000) Entrainment of free-running circadian rhythms by melatonin in blind people. New England Journal of Medicine, 343, 10701077.CrossRefGoogle ScholarPubMed
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