Melatonin for jet lag? [Dec 2000; 82-4]

Melatonin for jet lag?
Study Outcome Results Comment

Many people are now used to intercontinental travel. For some, sometimes, travel either East or West can be accompanied by a horrible set of symptoms that include insomnia, fatigue, dullness of mind and a general feeling of awfulness. We call this jet lag, and attribute it, probably correctly, to rapid movement through many time zones. Our bodies and minds just don't know where they are.

Much time is taken up in pubs and at dinner parties discussing strategies to get over jet lag. Some consider alcohol a splendid remedy. Others recommend different foods, like burgers and fries going West, and salad and fasting going East. In recent years melatonin has been recommended in the press and elsewhere. Bandolier was asked for evidence that it worked. We found one excellent study [1] suggesting that it does not.

Study

The study was randomised, double blind, double-dummy, and conducted on 339 Norwegian physicians who travelled to New York, spent at least five days there, and then returned home. On their return they had either melatonin 5 mg at bedtime on the day of travel, and then daily for five days, or 0.5 mg with the same schedule, or 0.5 mg taken progressively one hour earlier each day, or placebo.

Outcome

A jet lag score was devised and tested. It included nine items, comprising fatigue, daytime sleepiness, impaired concentration, decreased alertness, trouble with memory, physical clumsiness, weakness, lethargy, and light-headedness. Each was scored on a scale from 0 (no bother at all) to 4 (extremely bothered). The scale ranged from 0 to 36 points. Other outcomes were a patient global evaluation and some measures of sleep times.

Results

On the last day in New York before returning to Oslo, the mean scores in the four groups were 4 to 6 out of 36. On the first day back in Oslo the means rose to 11 to 13 out of 36, and then fell on subsequent days to be about 1 out of 36 by the sixth day. Figure 1 shows only placebo, because there was no difference overall between placebo or melatonin for the jet lag score, nor for any of its components, nor for the global score. No sub group analysis showed any efficacy in any particular group among the physicians.

Figure 1: Mean jet-lag scores for placebo treatment

One physician had difficulties in breathing and swallowing with melatonin low dose. These difficulties disappeared, but recurred on repeat challenge.

Comment

On the results themselves, it is interesting how this fine large study contrasts with previous small studies with less adequate design which claimed benefit, even when it was not statistically significant. Unless there is some overwhelming reason to consider Norwegian physicians to be a peculiar bunch, different from the rest of humanity, melatonin won't work for us either.

The design of the study, and particularly the outcome measures, was meticulous, and would provide an exemplar for others wanting to research new or difficult areas. Particularly special was the jet lag score, designed after literature review, focus groups with frequent travellers, and by testing.

References:

RL Spitzer et al. Jet lag: clinical features, validation of a new syndrome-specific scale, and a lack of response to melatonin in a randomized, double-blind trial. American Journal of Psychiatry 1999 156: 1392-1396.

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