Evaluating the Effects of Melatonin in Improving Sleep Quality in Patients with Generalized Anxiety Disorder or Major Depressive Disorders
Abstract
Background: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are among the most common mental disorders contributing to sleep disturbance. Given the decline in sleep quality of these patients, improving sleep may be addressed alongside other treatment strategies. This study evaluated the effect of melatonin on improving sleep quality in patients who were diagnosed with MDD or GAD.
Methods: Seventy-eight patients diagnosed with MDD or GAD were randomly assigned to two groups, including the intervention group, which received oral melatonin 3 mg daily for four weeks and the control group, which received only placebo. Assessments were made by the Groningen Sleep Quality Scale (GSQS) and Pittsburgh Sleep Quality Index (PSQI) questionnaire at the beginning and after four weeks using SPSS software.
Results: The mean age of patients was 38.78±14.12 years. There was no significant difference between the two groups in terms of demographic data. According to the analysis, although the change in GSQS scores between the placebo and melatonin groups was not significantly different from baseline scores, the difference in PSQI scores before and after the use of melatonin was significant (P=0.01). There was also a significant difference regarding the GSQS score between the two groups before and after the intervention (P=0.04).
Conclusion: The present study illustrated that melatonin use for one month could improve the quality of sleep among MDD and patients with GAD to some degree; however, according to the PSQI and GSQS scoring, there is no credible evidence that shows a significant improvement in the sleep quality of our study population.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed., text rev.). APA website 2022; Available from: URL: https://doi.org/10.1176/appi.books.9780890425787.
Nutt DJ, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008;10(3):329-36.
Gureje O, Kola L, Afolabi E. Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of Ageing: a community-based survey. Lancet. 2007;370(9591):957-64.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
Meijman TF, Thunnissen MJ, De Vries-Griever AGH. The after-effects of a prolonged period of day-sleep on subjective sleep quality. Work Stress. 1990;4(1):65-70.
Morin CM, Inoue Y, Kushida C, Poyares D, Winkelman J. Endorsement of European guideline for the diagnosis and treatment of insomnia by the World Sleep Society. Sleep Med. 2021;81:124-6.
Delgado PL, Price LH, Miller HL, Salomon RM, Aghajanian GK, Heninger GR, et al. Serotonin and the neurobiology of depression. Effects of tryptophan depletion in drug-free depressed patients. Arch Gen Psychiatry. 1994;51(11):865-74.
Wilson S, Argyropoulos S. Antidepressants and sleep: A qualitative review of the literature. Drugs. 2005;65(7):927-47.
Diaz-Martinez A, Benassinni O, Ontiveros A, Gonzalez S, Salin R, Basquedano G, et al. A randomized, open-label comparison of venlafaxine and fluoxetine in depressed outpatients. Clin Ther. 1998;20(3):467-76.
Hicks JA, Argyropoulos SV, Rich AS, Nash JR, Bell CJ, Edwards C, et al. Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression. Br J Psychiatry. 2002;180:528-35.
Nelson JC, Portera L, Leon AC. Residual symptoms in depressed patients after treatment with fluoxetine or reboxetine. J Clin Psychiatry. 2005;66(11):1409-14.
Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008;31(4):489-95.
Brenes GA, Miller ME, Stanley MA, Williamson JD, Knudson M, McCall WV. Insomnia in older adults with generalized anxiety disorder. Am J Geriatr Psychiatry. 2009;17(6):465-72.
Bélanger L, Morin CM, Langlois F, Ladouceur R. Insomnia and generalized anxiety disorder: effects of cognitive behavior therapy for gad on insomnia symptoms. J Anxiety Disord. 2004;18(4):561-71.
Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39(6):411-8.
Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res. 2006;40(8):700-8.
Ohayon MM, Roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003;37(1):9-15.
Ford DE. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. 1989;262(11):1479-84.
Choi S Il, Dadakhujaev S, Ryu H, Im Kim T, Kim EK. Melatonin protects against oxidative stress in granular corneal dystrophy type 2 corneal fibroblasts by mechanisms that involve membrane melatonin receptors. J Pineal Res. 2011;51(1):94-103.
Arendt J. Melatonin and human rhythms. Chronobiol Int. 2006;23(1-2):21-37.
Madsen MT, Isbrand A, Andersen UO, Andersen LJ, Taskiran M, Simonsen E, et al. The effect of MElatonin on Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome (MEDACIS): study protocol for a randomized controlled trial. Trials. 2017;18(1):81.
Tonon AC, Pilz LK, Markus RP, Hidalgo MP, Elisabetsky E. Melatonin and depression: a translational perspective from animal models to clinical studies. Front Psychiatry. 2021;12:1-13.
Sonntag VKH. Bypass in Carotid Siphon Disease. Stroke. 1978;9(1):76-7.
Posadzki PP, Bajpai R, Kyaw BM, Roberts NJ, Brzezinski A, Christopoulos GI, et al. Melatonin and health: an umbrella review of health outcomes and biological mechanisms of action. BMC Med. 2018;16(1):1-18.
Pollack M, Kinrys G, Krystal A, McCall WV, Roth T, Schaefer K, et al. Eszopiclone coadministered with escitalopram in patients with insomnia and comorbid generalized anxiety disorder. Arch Gen Psychiatry. 2008;65(5):551-62.
Savino R, Polito AN, Marsala G, Ventriglio A, Di Salvatore M, De Stefano MI, et al. Agomelatine: a potential multitarget compound for neurodevelopmental disorders. Brain Sci. 2023;13(5):734.
Dolberg OT, Hirschmann S, Grunhaus L. Melatonin for the treatment of sleep disturbances in major depressive disorder. Am J Psychiatry. 1998;155(8):1119-21.
Kudrnáčová M, Kudrnáč A. Better sleep, better life? testing the role of sleep on quality of life. PLoS One. 2023;18(3): e0282085.
Lee S, Kin JH, Chung JH. The association between sleep quality and quality of life: a population-based study. Sleep Med. 2021;84:121-6.
Palagini L, Manni R, Aguglia E, Amore M, Brugnoli R, Bioulac S, et al. 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.
Zhang C, Zhang H, Zhao M, Li Z, Cook CE, Buysse DJ, et al. Reliability, validity, and factor structure of Pittsburgh sleep quality index in community-based centenarians. Front Psychiatry. 2020;11:573530.
Vahia VN. Diagnostic and statistical manual of mental disorders 5: a quick glance. Indian J Psychiatry. 2013;55(3):220-3.
Won E, Na KS, Kim YK. Associations between melatonin, neuroinflammation, and brain alterations in depression. Int J Mol Sci. 2021;23(1):305.
Wang YQ, Jiang YJ, Zou MS, Liu J, Zhao HQ, Wang YH. Antidepressant actions of melatonin and melatonin receptor agonist: focus on pathophysiology and treatment. Behav Brain Res. 2022;420:113724.
Laudon M, Frydman-Marom A. Therapeutic effects of melatonin receptor agonists on sleep and comorbid disorders. Int J Mol Sci. 2014;15(9):15924-50.
Srinivasan V, Smits M, Spence W, Lowe AD, Kayumov L, Pandi-Perumal SR, Parry B, Cardinali DP. Melatonin in mood disorders. World J Biol Psychiatry. 2006;7(3):138-51.
Brasure M, Fuchs E, MacDonald R, Nelson VA, Koffel E, Olson CM, et al. Psychological and behavioral interventions for managing insomnia disorder: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med. 2016;165(2):113-24.
Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307-49.
De Crescenzo F, Lennox A, Gibson JC, Cordey JH, Stockton S, Cowen PJ, et al. Melatonin as a treatment for mood disorders: a systematic review. Acta Psychiatr Scand. 2017;136(6):549-58.
Serfaty MA, Osborne D, Buszewicz MJ, Blizard R, Raven PW. A randomized double-blind placebo-controlled trial of treatment as usual plus exogenous slow-release melatonin (6 mg) or placebo for sleep disturbance and depressed mood. Int Clin Psychopharmacol. 2010;25(3):132-42.
Fava M, Targum SD, Nierenberg AA, Bleicher LS, Carter TA, Wedel PC, et al. An exploratory study of combination buspirone and melatonin SR in Major Depressive Disorder (MDD): a possible role for neurogenesis in drug discovery. J Psychiatr Res. 2012;46(12):1553-63.
Ghaeli P, Solduzian M, Vejdani S, Talasaz AH. Comparison of the effects of melatonin and oxazepam on anxiety levels and sleep quality in patients with ST-segment-elevation myocardial infarction following primary percutaneous coronary intervention: a randomized clinical trial. Ann Pharmacother. 2018;52(10):949-55.
Mirsepassi Z, Saedi S, Behpournia H, Shadloo B, Artounian V, Yahyavi ST, Tabatabaei M, Soleimani M, Khajehpour S, Ghaeli P. Comparing effects of melatonin versus trazodone on sleep quality in major depressed patients receiving sertraline. J Pharm Care. 2018;4(3-4):52-57.
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Issue | Vol 13, No 2 (Spring 2025) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/jpc.v13i2.19306 | |
Keywords | ||
Generalized Anxiety Disorders (GAD) Major Depressive Disorders (MDD) Groningen Sleep Quality Score (GSQS) Pittsburgh Sleep Quality Index (PSQI) |
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