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Megha KB, Arathi A, Shikha S, Alka R, Ramya P, Mohanan PV. Significance of Melatonin in the Regulation of Circadian Rhythms and Disease Management. Mol Neurobiol 2024; 61:5541-5571. [PMID: 38206471 DOI: 10.1007/s12035-024-03915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
Melatonin, the 'hormone of darkness' is a neuronal hormone secreted by the pineal gland and other extra pineal sites. Responsible for the circadian rhythm and seasonal behaviour of vertebrates and mammals, melatonin is responsible for regulating various physiological conditions and the maintenance of sleep, body weight and the neuronal activities of the ocular sites. With its unique amphiphilic structure, melatonin can cross the cellular barriers and elucidate its activities in the subcellular components, including mitochondria. Melatonin is a potential scavenger of oxygen and nitrogen-reactive species and can directly obliterate the ROS and RNS by a receptor-independent mechanism. It can also regulate the pro- and anti-inflammatory cytokines in various pathological conditions and exhibit therapeutic activities against neurodegenerative, psychiatric disorders and cancer. Melatonin is also found to show its effects on major organs, particularly the brain, liver and heart, and also imparts a role in the modulation of the immune system. Thus, melatonin is a multifaceted candidate with immense therapeutic potential and is still considered an effective supplement on various therapies. This is primarily due to rectification of aberrant circadian rhythm by improvement of sleep quality associated with risk development of neurodegenerative, cognitive, cardiovascular and other metabolic disorders, thereby enhancing the quality of life.
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Affiliation(s)
- K B Megha
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum, 695 012, Kerala, India
| | - A Arathi
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum, 695 012, Kerala, India
| | - Saini Shikha
- CSIR-Institute of Microbial Technology, Sector 39-A, Chandigarh, 160036, India
| | - Rao Alka
- CSIR-Institute of Microbial Technology, Sector 39-A, Chandigarh, 160036, India
- Academy of Scientific and Innovation Research (AcSIR), Ghaziabad, 201002, India
| | - Prabhu Ramya
- P.G. Department of Biotechnology, Government Arts College, Trivandrum, 695 014, India
| | - P V Mohanan
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum, 695 012, Kerala, India.
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Cruz-Sanabria F, Faraguna U, Violi M, Bruno S, Gravina D, Bonelli C, Bazzani A, Massoni L, Musetti L, Simoncini M, Frumento P, Dell'Osso L, Carmassi C. Effects of exogenous melatonin on sleep and circadian rhythm parameters in bipolar disorder with comorbid delayed sleep-wake phase disorder: An actigraphic study. J Psychiatr Res 2023; 165:96-104. [PMID: 37487294 DOI: 10.1016/j.jpsychires.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
The present study evaluates the effect of exogenous melatonin (exo-MEL) on sleep and circadian parameters in patients with bipolar disorder (BD) and delayed sleep-wake phase disorder (DSWPD). BD euthymic patients (n = 83, mean age = 45.13 ± 13.68, males 56%) were evaluated for chronotype (reduced Morningness-Eveningness Questionnaire [rMEQ]), sleep quality (Pittsburgh Sleep Quality Index), sleep and circadian parameters (actigraphic monitoring). Patients that fulfilled criteria for DSWPD (n = 25) were treated for three months with exo-MEL 2 mg administered approximately 4 h before the sleep onset time (SOT) actigraphically-determined at baseline. Sleep and circadian parameters at baseline (T0) and after the exo-MEL treatment (T1) were compared using paired Wilcoxon test. In patients that completed the treatment (n = 19), the rMEQ score increased between T0 (median = 8.0 [IQR = 7.0, 11.0]) and T1 (median = 13.5 [IQR = 9.3, 15.0], p-value = 0.006), the SOT was advanced between T0 (median = 00:55 [IQR = 00:25, 01:39] and T1 (median = 00:09 [IQR = 23:41, 01:04], p-value = 0.039), the sleep efficiency and total sleep time increased (T0: median = 84.4 [IQR = 81.3, 89.4]; T1 (median = 90.3 [IQR = 85.5, 92.9] %, p-value = 0.01, and T0: median = 7.20 [IQR = 6.15, 8.15]; T1: median = 7.7 [IQR = 7.0, 9.3] hours, p-value = 0.04, respectively). These results indicate that in BD with comorbid DSWPD, the self-reported chronotype, the sleep onset time, and sleep efficiency and duration were modified after a personalized treatment with exo-MEL, suggesting its potential efficacy in improving sleep patterns in BD. The absence of proper control groups and of treatment randomization constitute limitations of our study and further randomized controlled trials are required to confirm our results.
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Affiliation(s)
- Francy Cruz-Sanabria
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, via Savi 10, 56126, Pisa, Italy.
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, via Savi 10, 56126, Pisa, Italy; Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Viale del Tirreno, 341/A/B/C, 56128, Calambrone, Pisa, Italy
| | - Miriam Violi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Simone Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, via Savi 10, 56126, Pisa, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Andrea Bazzani
- Institute of Management, Scuola Superiore Sant'Anna, piazza Martiri della libertà 33, 56127, Pisa, Italy
| | - Leonardo Massoni
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Laura Musetti
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Marly Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, via Serafini 3, 56126, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
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Sauvaget A, Guitteny M, Bukowski N, Duffieux V, Mezouari A, Brisson A, Raveneau C, Gohier B, Bulteau S. [Treatments for depression in consultation-liaison psychiatry: From theory to practice]. Rev Med Interne 2021; 42:694-706. [PMID: 34256970 DOI: 10.1016/j.revmed.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
Treatments for depression include an adapted lifestyle, physical activity, psychotherapies, antidepressant and mood stabilizing drugs, neuromodulation, chronotherapy, spa treatments. Drug treatments used for major depressive episode are antidepressants and mood stabilizers. For a mild episode, psychotherapy is indicated. It should be combined with an antidepressant (serotonin reuptake inhibitor) for moderate and severe episodes. Suicide risk assessment is essential throughout the depressive episode. It is recommended to monitor at the start of antidepressant treatment for suicidal behavior, a change in mood suggesting an underlying bipolar disorder. The effectiveness of the treatment is evaluated after 4 to 8 weeks. The total duration of antidepressant treatment for an EDC is between 6 months and 1 year after remission, in order to prevent relapses. The use of liaison psychiatry, a real healthcare system within the general hospital, is strongly recommended for better screening and treatment of depression, thus reducing the length of hospital stays, improving the prognosis of depression. The aim of this article is to provide clinicians with a summary of validated data on the efficacy/tolerance of treatment for depression, and to suggest practical action to be taken on the main daily clinical situations: treating comorbid conditions, taking into account interactions drugs, manage the serotonin syndrome, lead to withdrawal from antidepressants, manage treatment in the elderly.
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Affiliation(s)
- A Sauvaget
- Nantes Université, CHU Nantes, Movement, Interactions, Performance (MIP), EA 4334,University of Nantes, Nantes, France.
| | - M Guitteny
- CHU Nantes, Department of Addictology and Liaison Psychiatry, Nantes, France
| | - N Bukowski
- CHU Nantes, Department of Addictology and Liaison Psychiatry, Nantes, France
| | - V Duffieux
- CHU Nantes, Department of Addictology and Liaison Psychiatry, Nantes, France; Centre Hospitalier Loire Vendée Océan (CHLVO), Psychiatrie de liaison, boulevard Guérin, 85300 Challans, France
| | - A Mezouari
- Centre Hospitalier Loire Vendée Océan (CHLVO), Psychiatrie de liaison, boulevard Guérin, 85300 Challans, France
| | - A Brisson
- CHU Nantes, Department of Addictology and Liaison Psychiatry, Nantes, France
| | - C Raveneau
- UPRES, EA 4638, département de psychiatrie et d'addictologie, université d'Angers, CHU d'Angers, Angers, France
| | - B Gohier
- UPRES, EA 4638, département de psychiatrie et d'addictologie, université d'Angers, CHU d'Angers, Angers, France
| | - S Bulteau
- CHU Nantes, Department of Addictology and Liaison Psychiatry, Nantes, France; Inserm-U1246 SPHERE University of Nantes and University of Tours, Nantes, France
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Palagini L, Manni R, Aguglia E, Amore M, Brugnoli R, Bioulac S, Bourgin P, Micoulaud Franchi JA, Girardi P, Grassi L, Lopez R, Mencacci C, Plazzi G, Maruani J, Minervino A, Philip P, Royant Parola S, Poirot I, Nobili L, Biggio G, Schroder CM, Geoffroy PA. International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders. Front Psychiatry 2021; 12:688890. [PMID: 34177671 PMCID: PMC8222620 DOI: 10.3389/fpsyt.2021.688890] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
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.
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Affiliation(s)
- Laura Palagini
- Psychiatry Division, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Eugenio Aguglia
- Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital “Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Stéphanie Bioulac
- 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
| | - Patrice Bourgin
- Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France
- Centre des troubles du sommeil - CIRCSom, Strasbourg University Hospitals, Strasbourg, France
| | - Jean-Arthur Micoulaud Franchi
- 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
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Régis Lopez
- Service de Neurologie, Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - Claudio Mencacci
- Department of Neuroscience, Aziende Socio Sanitarie Territoriali Fatebenefratelli Sacco, Milan, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Julia Maruani
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
| | - Antonino Minervino
- Department of Psychiatry, Italian Society of Psychosomatic Medicine (SIMP), Parma, Italy
| | - Pierre Philip
- 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
| | | | - Isabelle Poirot
- Service de psychiatrie adulte, Hôpital Fontan, CHU de Lille, Lille, France
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Child Neuropsychiatry Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, Cagliari, Italy
| | - Carmen M. Schroder
- Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
| | - Pierre A. Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
- GHU Paris - Psychiatry & Neurosciences, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
- Université de Paris, NeuroDiderot, Inserm, Paris, France
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Geoffroy PA, Palagini L. Biological rhythms and chronotherapeutics in depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110158. [PMID: 33152388 DOI: 10.1016/j.pnpbp.2020.110158] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Depressive syndromes are frequent and heterogeneous brain conditions with more than 90% of patients suffering from sleep complaints. Better characterizing this "sleep" domain may allow to both better treat acute episodes with existing chronotherapeutics, but also to prevent the manifestation or recurrences of mood disorders. This work aims to i) review theoretical and fundamental data of chronotherapeutics, and ii) provide practical recommendations. Light therapy (LT) can be used as a first-line monotherapy of moderate to severe depression of all subtypes. LT can be also used as a combination with antidepressant to maximize patients' response rates, which has a clear superiority to antidepressant alone. Sleep deprivation (SD) is a rapid and powerful chronotherapeutic with antidepressant responses within hours in 45-60% of patients with unipolar or bipolar depression. Different strategies should be combined to stabilize the SD antidepressant effect, including concomitant medications, repeated SD, combination with sleep phase advance and/or LT (triple chronotherapy). Melatonin treatment is of interest in remitted patients with mood disorder to prevent relapses or recurrences, if a complaint of insomnia, poor sleep quality or phase delay syndrome is associated. During the acute phase, melatonin could be used as an adjuvant treatment for symptoms of insomnia associated with depression. The cognitive behavioral therapy for insomnia (CBT-I) can be recommend to treat insomnia during euthymic phases. The Interpersonal and social rhythm therapy (IPSRT) is indicated for the acute treatment of bipolar depression and for the prevention of mood episodes. Chronotherapeutics should always be associated with behavioral measures for healthy sleep.
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Affiliation(s)
- Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France.
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy
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Kirlioglu SS, Balcioglu YH. Chronobiology Revisited in Psychiatric Disorders: From a Translational Perspective. Psychiatry Investig 2020; 17:725-743. [PMID: 32750762 PMCID: PMC7449842 DOI: 10.30773/pi.2020.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/15/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Several lines of evidence support a relationship between circadian rhythms disruption in the onset, course, and maintenance of mental disorders. Despite the study of circadian phenotypes promising a decent understanding of the pathophysiologic or etiologic mechanisms of psychiatric entities, several questions still need to be addressed. In this review, we aimed to synthesize the literature investigating chronobiologic theories and their associations with psychiatric entities. METHODS The Medline, Embase, PsycInfo, and Scopus databases were comprehensively and systematically searched and articles published between January 1990 and October 2019 were reviewed. Different combinations of the relevant keywords were polled. We first introduced molecular elements and mechanisms of the circadian system to promote a better understanding of the chronobiologic implications of mental disorders. Then, we comprehensively and systematically reviewed circadian system studies in mood disorders, schizophrenia, and anxiety disorders. RESULTS Although subject characteristics and study designs vary across studies, current research has demonstrated that circadian pathologies, including genetic and neurohumoral alterations, represent the neural substrates of the pathophysiology of many psychiatric disorders. Impaired HPA-axis function-related glucocorticoid rhythm and disrupted melatonin homeostasis have been prominently demonstrated in schizophrenia and other psychotic disorders, while alterations of molecular expressions of circadian rhythm genes including CLOCK, PER, and CRY have been reported to be involved in the pathogenesis of mood disorders. CONCLUSION Further translational work is needed to identify the causal relationship between circadian physiology abnormalities and mental disorders and related psychopathology, and to develop sound pharmacologic interventions.
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Affiliation(s)
- Simge Seren Kirlioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Yasin Hasan Balcioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Gottlieb JF, Benedetti F, Geoffroy PA, Henriksen TEG, Lam RW, Murray G, Phelps J, Sit D, Swartz HA, Crowe M, Etain B, Frank E, Goel N, Haarman BCM, Inder M, Kallestad H, Jae Kim S, Martiny K, Meesters Y, Porter R, Riemersma-van der Lek RF, Ritter PS, Schulte PFJ, Scott J, Wu JC, Yu X, Chen S. The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology. Bipolar Disord 2019; 21:741-773. [PMID: 31609530 DOI: 10.1111/bdi.12847] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence. METHODS PRISMA-based systematic review of the literature. RESULTS The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated. CONCLUSIONS The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.
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Affiliation(s)
- John F Gottlieb
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Chicago Psychiatry Associates, Chicago, IL, USA
| | | | - Pierre A Geoffroy
- Department of Psychiatry and Addictive Medicine, University Hospital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Paris Diderot University - Paris VII, Paris, France
| | - Tone E G Henriksen
- Faculty of Medicine, Section for Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Faculty of Psychology, Bergen Stress and Sleep Group, University of Bergen, Bergen, Norway.,Valen Hospital, Fonna Health Authority, Division of Mental Health Care, Valen, Norway
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Greg Murray
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Dorothy Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Holly A Swartz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Bruno Etain
- Department of Psychological Medicine, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Namni Goel
- Department of Psychiatry Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bartholomeus C M Haarman
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maree Inder
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Håvard Kallestad
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Psychiatry, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Seong Jae Kim
- Department of Psychiatry, Doeun Hospital, Jincheon, Korea
| | - Klaus Martiny
- Department of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark
| | - Ybe Meesters
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Rixt F Riemersma-van der Lek
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Philipp S Ritter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Joseph C Wu
- Department of Psychiatry & Human Behavior, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Xin Yu
- Department of Public Mental Health, Peking University Institute of Mental Health, Beijing, China
| | - Shenghao Chen
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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8
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Geoffroy PA, Micoulaud Franchi JA, Lopez R, Schroder CM. The use of melatonin in adult psychiatric disorders: Expert recommendations by the French institute of medical research on sleep (SFRMS). L'ENCEPHALE 2019; 45:413-423. [PMID: 31248601 DOI: 10.1016/j.encep.2019.04.068] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
Melatonin is a hormone secreted by the pineal gland at night. This hormone has many physiological functions, the main one being to synchronise individuals' biological rhythms. Exogenous melatonin has the same chronobiotic action, even at small doses (0.125mg). In addition, a sleep-inducing (soporific) action appears to occur in a dose-effect relationship, i.e. as the dose increases. In psychiatric disorders, these two effects could have interesting applications in clinical practice. The French institute of medical research on sleep (SFRMS) appointed a group of experts to conduct a consensus conference to study the indications of melatonin and the conditions of its prescription. An account of the conclusions on adult psychiatric disorders (presented orally at the Congress on Sleep in Marseille, 23 November 2017) is given here. Exogenous melatonin proves to be useful among patients with a stabilized psychiatric disorder or in remission, to prevent relapse in case of associated complaints of insomnia, poor quality sleep or delayed sleep phase syndrome. During acute phases, melatonin could be used as an adjuvant treatment when there are insomnia symptoms, in mood disorders (bipolar disorder, major depressive disorder, seasonal affective disorder), in attention deficit hyperactivity disorder (ADHD), in peri-surgical anxiety and in schizophrenia. In somatoform disorders, melatonin is a possible treatment for painful symptoms in fibromyalgia, irritable bowel syndrome, functional dyspeptic syndrome and temporomandibular joint dysfunction.
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Affiliation(s)
- P A Geoffroy
- Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), University Hospital, 1, place de l'hôpital, 67000 Strasbourg, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France; Paris Diderot University - Paris VII, 5, rue Thomas-Mann, 75013 Paris, France.
| | - J-A Micoulaud Franchi
- Services d'explorations fonctionnelles du système nerveux, clinique du sommeil, CHU de Bordeaux, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, université de Bordeaux, CHU de Pellegrin, 33076 Bordeaux, France
| | - R Lopez
- Unité des troubles du sommeil, département de neurologie, centre national de référence narcolepsie, hypersomnies rares, hôpital Gui de Chauliac, 34000 Montpellier, France; Inserm U1061, 34000 Montpellier, France
| | - C M Schroder
- Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), University Hospital, 1, place de l'hôpital, 67000 Strasbourg, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France; Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 1, place de l'hôpital, 67091 Strasbourg cedex, France
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9
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Onaolapo OJ, Onaolapo AY. Melatonin, adolescence, and the brain: An insight into the period-specific influences of a multifunctional signaling molecule. Birth Defects Res 2018; 109:1659-1671. [PMID: 29251845 DOI: 10.1002/bdr2.1171] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
Abstract
Melatonin is a neurohormone that is involved in the modulation of a wide range of physiological processes, including maintenance of the circadian rhythm, mediation of photoperiodic information, regulation of the sleep-wake cycle, synchronization of cell physiology, antioxidant defense, and immune-modulation. Although there are reports of increasing use of melatonin in the management of a number of health conditions, evidence exists that is suggestive of deleterious effects of melatonin administration on brain and reproductive development in the prepubertal and pubertal periods that are within the teenage years. In this review, we examine the influences of endogenous and exogenous melatonin on the adolescent brain, with specific reference to its involvement in the evolution of brain functions, brain structure, sleep regulation, and modulation of behaviors in health or disease.
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Affiliation(s)
- O J Onaolapo
- Behavioral Neuroscience/Neuropharmacology Unit, Department of Pharmacology, Ladoke Akintola University of Technology, Osogbo, Osun State, Nigeria
| | - A Y Onaolapo
- Behavioral Neuroscience/Neurobiology Unit, Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Actigraphic features of bipolar disorder: A systematic review and meta-analysis. Sleep Med Rev 2017; 33:58-69. [DOI: 10.1016/j.smrv.2016.05.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 12/21/2022]
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Geoffroy P, Fovet T, Micoulaud-Franchi JA, Boudebesse C, Thomas P, Etain B, Amad A. Luminothérapie et épisodes dépressifs saisonniers du trouble bipolaire. L'ENCEPHALE 2015; 41:527-33. [DOI: 10.1016/j.encep.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/13/2015] [Indexed: 10/22/2022]
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Geoffroy PA, Bellivier F, Scott J, Etain B. Seasonality and bipolar disorder: a systematic review, from admission rates to seasonality of symptoms. J Affect Disord 2014; 168:210-23. [PMID: 25063960 DOI: 10.1016/j.jad.2014.07.002] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is a severe mental disorder affecting 1-4% of the population worldwide. It is characterized by periods of (hypo)manic and depressive episodes. Seasonal patterns (SP) may be observed in admission rates, mood relapses and symptom fluctuations. METHODS We conducted a systematic review of seasonality in BD, classifying studies based on seasonal admission rates to seasonality of symptoms assessments. RESULTS Fifty-one papers were identified of which 32 addressed hospitalization rates by season, 6 addressed categorical diagnoses, and 13 explored symptom dimensions. Seasonal peaks for different BD mood episodes are observed worldwide and widely replicated. Manic episodes peak during spring/summer and, to a lesser extent, in autumn, depressive episodes peak in early winter and, to a lesser extent, summer, and mixed episodes peak in early spring or mid/late summer. There was a high frequency of SP for manic episodes (15%) and depressive episodes (25%), the latter being associated with a more complex clinical profile (BD II subtype, comorbid eating disorders, more relapses and rapid cycling). Finally, there was evidence for greater seasonal fluctuations in mood and behavior in individuals with BD than in those with unipolar depression or 'healthy' controls. LIMITATIONS Sample size, gender distribution, methodological quality and sophistication of the analytical approaches employed varied considerably. CONCLUSIONS There is evidence of seasonality in BD, with emerging evidence that climatic conditions may trigger BD symptoms or episodes. A better understanding of the underlying mechanisms would facilitate the development of personalized chronobiological therapeutic and preventive strategies.
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Affiliation(s)
- Pierre Alexis Geoffroy
- Inserm, U1144, Paris F-75006, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, 75475 Paris Cedex 10, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, UMR-S 1144, Paris, F-75013, France; Fondation FondaMental, Créteil, 94000, France.
| | - Frank Bellivier
- Inserm, U1144, Paris F-75006, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, 75475 Paris Cedex 10, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, UMR-S 1144, Paris, F-75013, France; Fondation FondaMental, Créteil, 94000, France
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | - Bruno Etain
- Fondation FondaMental, Créteil, 94000, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, 94000, France; Inserm, U955, Psychiatrie génétique, Créteil, 94000, France
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Geoffroy PA, Boudebesse C, Bellivier F, Lajnef M, Henry C, Leboyer M, Scott J, Etain B. Sleep in remitted bipolar disorder: a naturalistic case-control study using actigraphy. J Affect Disord 2014; 158:1-7. [PMID: 24655758 DOI: 10.1016/j.jad.2014.01.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Findings from actigraphic studies suggesting that sleep and circadian rhythms are disrupted in bipolar disorder (BD) patients have been undermined by methodological heterogeneity and the failure to adequately address potential confounders. METHOD Twenty-six euthymic BD cases and 29 healthy controls (HC), recruited from University Paris-Est and matched for age and gender, were compared on subjective (Pittsburgh Sleep Questionnaire Inventory; PQSI) and objective (mean scores and variability in actigraphy) measures of sleep as recorded by over 21 consecutive days. RESULTS Multivariate generalized linear modelling (GLM) revealed significant differences between BD cases and HC for five PSQI items (total score and four subscales), four actigraphy variables (mean scores) and five actigraphy variability measures. Backward stepwise linear regression (BSLR) indicated that a combination of four variables (mean sleep duration, mean sleep latency, variability of the fragmentation index over 21 days, and mean score on PSQI daytime dysfunction sub-scale) correctly classified 89% of study participants as cases or controls (Chi-square=39.81; df=6; p=0.001). LIMITATIONS The sample size (although larger than most actigraphy studies) and incomplete matching of cases and controls may have influenced our findings. It was not possible to control for potential effects of psychotropic medication or differences in employment status between groups. CONCLUSIONS When potential confounders of sleep and circadian profiles are adequately taken into account (particularly age, gender, daytime sleepiness, mood symptoms, body mass index, and risk of sleep apnoea), a selected subset of quantitative (mean scores) and qualitative (variability) features differentiated euthymic BD cases from HC.
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Affiliation(s)
- Pierre Alexis Geoffroy
- INSERM, U955, Psychiatrie génétique, Créteil 94000, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil 94000, France; Pôle de psychiatrie, Université Lille Nord de France, CHRU de Lille, F-59000 Lille, France; Fondation FondaMental, Créteil 94000, France.
| | - Carole Boudebesse
- INSERM, U955, Psychiatrie génétique, Créteil 94000, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil 94000, France; Fondation FondaMental, Créteil 94000, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil 94000, France; AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris-7 Paris-Diderot, UFR de Médecine, Paris, France
| | - Mohamed Lajnef
- INSERM, U955, Psychiatrie génétique, Créteil 94000, France
| | - Chantal Henry
- INSERM, U955, Psychiatrie génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil 94000, France; Fondation FondaMental, Créteil 94000, France
| | - Marion Leboyer
- INSERM, U955, Psychiatrie génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil 94000, France; Fondation FondaMental, Créteil 94000, France
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | - Bruno Etain
- INSERM, U955, Psychiatrie génétique, Créteil 94000, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil 94000, France; Fondation FondaMental, Créteil 94000, France
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Geoffroy PA, Boudebesse C, Henrion A, Jamain S, Henry C, Leboyer M, Bellivier F, Etain B. An ASMT variant associated with bipolar disorder influences sleep and circadian rhythms: a pilot study. GENES BRAIN AND BEHAVIOR 2013; 13:299-304. [DOI: 10.1111/gbb.12103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/21/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022]
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Geoffroy PA, Bellivier F, Scott J, Boudebesse C, Lajnef M, Gard S, Kahn JP, Azorin JM, Henry C, Leboyer M, Etain B. Bipolar disorder with seasonal pattern: clinical characteristics and gender influences. Chronobiol Int 2013; 30:1101-7. [PMID: 23931033 DOI: 10.3109/07420528.2013.800091] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bipolar disorder (BD) has a multifactorial etiology with heterogeneous clinical presentations. Around 25% of BD patients may present with a depressive seasonal pattern (SP). However, there are limited scientific data on the prevalence of SP, its clinical manifestations, and any gender influence. Four hundred and fifty-two BD I and II cases (62% female), recruited from three French university-affiliated psychiatric departments, were assessed for SP. Clinical, treatment, and sociodemographic variables were obtained from structured interviews. One hundred and two (23%) cases met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for SP, with similar frequency according to gender. Multivariate analysis showed a significant association between SP and BD II (odds ratio [OR] = 1.99, p = 0.01), lifetime history of rapid cycling (OR = 2.05, p = 0.02), eating disorders (OR = 2.94, p = 0.003), and total number of depressive episodes (OR = 1.13, p = 0.002). Seventy-one percent of cases were correctly classified by this analysis. However, when stratifying the analyses by gender, SP was associated with BD II subtype (OR = 2.89, p = 0.017) and total number of depressive episodes (OR = 1.21, p = 0.0018) in males but with rapid cycling (OR = 3.02, p = 0.0027) and eating disorders (OR = 2.60, p = 0.016) in females. This is the first study to identify different associations between SP and clinical characteristics of BD according to gender. The authors suggest that SP represents a potentially important specifier of BD. These findings indicate that seasonality may reflect increased severity or complexity of disorder.
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Teixeira AL, Barbosa IG, Machado-Vieira R, Rizzo LB, Wieck A, Bauer ME. Novel biomarkers for bipolar disorder. ACTA ACUST UNITED AC 2012; 7:147-59. [DOI: 10.1517/17530059.2013.734807] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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