1.Jet Lag and Psychotic Disorders
Gregory Katz. Curr Psychiatry Rep (2011) 13:187–192
Newly developed melatonin agonist tasimelteon (VEC-162) has been evaluated recently in phase 2 and phase 3 randomized, double-blind, placebo-controlled, parallelgroup studies for treatment of transient insomnia after sleep–time shift. Results were encouraging, and although they were not yet specifically applied to jet lag symptoms, they showed that after an abrupt advance in sleep time, tasimelteon improved sleep initiation and maintenance concurrently with a shift in endogenous circadian rhythms.
2.Circadian-Based Therapies for Circadian Rhythm Sleep-Wake Disorders
Helen J. Burgess & Jonathan S. Emens. Curr Sleep Medicine Rep
There were two new publications concerning blind individuals with N24SWD. Most important was Lockley et al.’s study of the drug tasimelteon in this population which became the first medication approved by the FDA for the treatment of any CRSWD. The study was a randomized, placebo controlled study in 84 individuals with N24SWD comparing 20 mg of tasimelteon and placebo administered 1 h before a target bedtime. Tasimelteon was found to safely and effectively treat individuals with N24SWD: entrainment (synchronization to the 24-h day) occurred in 20 % (8 of 40) of patients receiving the drug compared with 3 % (1 of 38) receiving placebo. As noted in the AASM CRSWD practice guideline, the entrainment rate was lower than the 67 % entrainment rate (12 of 18 patients) found in the metaanalysis of melatonin treatment in N24SWD. However, as noted by the authors themselves, this may have been because entrainment was assessed after just 1 month of treatment. Such a theory is borne out by the higher rates of entrainment found during the longer, open label treatment with tasimelteon. The tasimelteon study also demonstrated improvements (increases and decreases, respectively) in nighttime and daytime sleep (as measured by the worst quartiles of treatment days compared to baseline). Of note, the tasimelteon study could also be considered to include a component of prescribed sleep/wake scheduling as subjects were instructed to maintain selfselected 9-h sleep opportunities with bedtimes within a 4-h range (21:00 to 01:00). The second new publication in N24SWD was a small placebo controlled study by St. Hilaire and Lockley looking at the effects of caffeine on entrainment in three blind individuals with the disorder. Caffeine (150 mg at 10 am) failed to entrain the subjects although it did improve daytime alertness in the setting of circadian misalignment.