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  • Nicholas Walker (a1)
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Abstract
Copyright
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.
Corresponding author
E-mail: Nick.Walker@renver-pct.scot.nhs.uk
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Not only examiners!

  • Nicholas Walker (a1)
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eLetters

Melatonin Dosing

M Jan Wise, Psychiatrist
09 June 2004

Armour & Patton write a helpful review on the use of Melatonin inchildren (Psychiatric Bulletin 28, 222-224, 2004). Several studies they mentioned were with blind subjects. It is important to consider that the blind 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 (Sack et al 2000).

Lewy et al (2002) showed that low levels of melatonin, 0.5mg, reset rhythm but not high doses, 2mg. 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 andSeasonal Affective Disorders, were discarded prematurely due to a perceived lack of efficacy.

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Conflict of interest: The Author uses Melatonin to reduce recovery time from intercontinental jetlag: personal use only] Dr M E J Wise MSc, MRCPsych Consultant Psychiatrist BECMHT, 13-15 Brondesbury Rd London NW6 6HX

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