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Melatonin and the “Diseases of the Soul”: The Stone of Madness Returns

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Ma Vie en Noir

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Abstract

Circadian rhythm abnormalities, as shown by sleep/wake cycle disturbances, are among the most prevalent signs of mood disorders, advances or delays in the circadian phase and decrease of amplitude being documented in patients with major depressive disorder, bipolar disorder, or seasonal affective disorder. Changes in the sleep/wake cycle structure of mood disorders often precede changes in a patient’s ongoing clinical state. Clinical studies involving chronobiological manipulations, such as exposure to bright light in the morning and melatonin administration in the evening, have been found useful for reducing phase abnormalities and depressive symptomatology, and psychiatric treatment programs are increasingly incorporating recommendations that chronotherapies be adopted as adjunctive strategies for treating mood disorders. Among the melatonin analogs on the market, agomelatine has been licensed by the European Medicines Agency for the treatment of major depressive disorder. Agomelatine has a unique pharmacological profile as it is both an MT1/MT2 melatonin receptor agonist and, although with less affinity, an antagonist of 5-HT2C receptors. As the first melatonergic antidepressant on the market, agomelatine is a treatment for sleep disturbances as well as for depressive symptoms. Lastly, drug-induced liver injury has been noted in patients treated with agomelatine, and this has become a subject of great concern. The use of the native molecule melatonin in mood disorders is hampered by the low doses approved for clinical use (2 mg in Europe, 3 mg in Argentina). These doses are clearly inadequate when compared with the melatonin analogs approved on the market, which, in addition to being generally more potent than the native molecule, are used in considerably higher amounts.

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  1. Facultad de Ciencias Médicas, Pontificia Univ Católica Argentina, Buenos Aires, Argentina

    Daniel Pedro Cardinali

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Cardinali, D.P. (2016). Melatonin and the “Diseases of the Soul”: The Stone of Madness Returns. In: Ma Vie en Noir. Springer Biographies. Springer, Cham. https://doi.org/10.1007/978-3-319-41679-3_10

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  • DOI: https://doi.org/10.1007/978-3-319-41679-3_10

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