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November 2001

Should Sisyphus Have Taken Melatonin?

Arch Gen Psychiatry. 2001;58(11):1054-1055. doi:10.1001/archpsyc.58.11.1054

IS MELATONIN a new inroad into the treatment and understanding of the pathophysiologic characteristics of tardive dyskinesia (TD), or is it just another boulder in the Sisyphean history of treatments for iatrogenic conditions? In this issue of the ARCHIVES, Shamir et al1 report the effectiveness of a 6-week trial of melatonin, 10 mg/d, relative to placebo in 22 patients. The authors postulate, among many possible mechanisms,2 that melatonin asserts a modulatory effect on dopamine release or a neuroprotective, antioxidative action on brain dopaminergic functioning. What is the relevance of this finding to research strategies and treatment approaches in patients? Certainly TD has been a driving force behind the effort to develop better antipsychotic agents. The estimated 68% risk of TD after 20 to 25 years of exposure to the older "typical" antipsychotic drugs is a public health problem.3 Unquestionably, we need ways to treat and prevent this iatrogenic condition.

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