Melatonin for Atypical Antipsychotic-Induced Metabolic Adverse Effects: A Meta-Analysis of Randomized Controlled Trials

Abstract

The objective of our study was to determine the effect of melatonin administration on atypical antipsychotic-induced metabolic adverse effects in patients with psychiatric disorders. A systematic search was performed in PUBMED, Cochrane Library, Scopus, Web of Science, and EBSCOhost electronic databases. Randomized controlled trials studying the effect of melatonin on antipsychotic-induced metabolic adverse effects were identified and subjected to meta-analysis. Four studies were included in the meta-analysis, including 57 patients on melatonin and 61 patients on placebo. Melatonin produced a significant decrease in the diastolic blood pressure compared with placebo (mean difference = −4.44 [95% CI, −7.00 to −1.88]; p = 0.0007; I2 = 13%), but not the systolic blood pressure (mean difference = −4.23 [95% CI, −8.11 to −0.36]; p = 0.03; I2 = 0%). Although a decrease in the body mass index was seen in the melatonin group, the difference was not significant in the random-effects analysis model. To conclude, in patients on atypical antipsychotics, melatonin at a dose of up to 5 mg/day for a treatment duration of up to 12 weeks attenuated the rise in diastolic blood pressure compared with placebo but had no significant effects on other metabolic parameters.

Melatonin and melatonin‐agonists for metabolic syndrome components in patients treated with antipsychotics: A systematic review and meta‐analysis

“…Our findings revealed a definite positive role of melatonin agonists on cardiovascular parameters differently from the previous two meta-analyses on the same topic (Igwe & Brigo, 2018;Kamath & Rather, 2018). The meta-analysis conducted by Igwe and Brigo concluded that no statistically significant difference in any anthropometric or metabolic variable emerged in patients treated with melatonin (Igwe & Brigo, 2018).…”

“…[95% CI, −7.00 to −1.88]; p = 0.0007), but not in the systolic blood pressure (MD = −4.23 [95% CI, −8.11 to −0.36]; Kamath & Rather, 2018). This discrepancy in findings can be explained by several factors.…”

“…A previous systematic review on the effects of melatonin and melatonin-agonists on metabolic status was published in 2016 and suggested the potential benefits of melatonin and its agonists in attenuating one or more components of metabolic syndrome among psychiatric patients exposed to atypical antipsychotics. However, contradictory results emerged from two subsequent meta-analyses, both published in 2018, which did not find any significant effect of melatonin on virtually any metabolic parameter (Igwe & Brigo, 2018;Kamath & Rather, 2018).…”

The association between hormones and antipsychotic use: a focus on postpartum and menopausal women

“…143 Another hormone, melatonin, may be therapeutically useful during the menopause to counteract sleep disturbance and, also, as has been shown recently, to prevent metabolic side effects induced by antipsychotic drugs. 144–149…”

Efficacy and tolerability of pharmacological interventions on metabolic disturbance induced by atypical antipsychotics in adults: A systematic review and network meta-analysis

“…However, previous systematic reviews and meta-analyses on medications for alleviating AAPs-induced metabolic disturbance were limited to a particular pharmacological intervention (e.g. metformin only, GLP-1RAs only, topiramate only, nizatidine only, ranitidine only, or melatonin only) (De Silva et al, 2016;Gu et al, 2018;Hiluy et al, 2019;Kamath and Rather, 2018;Paravattil et al, 2016;Siskind and Hahn, 2018) and could not provide which intervention is superior in efficacy and tolerability. Compared to standard meta-analysis, network meta-analysis (NMA) allows assessment of efficacy and tolerability of two or more interventions (Cipriani et al, 2013).…”