Melatonin and Ramelteon for the treatment of delirium: A systematic review and meta-analysis

Beaucage-Charron et al., 2023 | J Psychosom Res | Meta Analysis

Citation

Beaucage-Charron Johannie, Rinfret Justine, ... Williamson David. Melatonin and Ramelteon for the treatment of delirium: A systematic review and meta-analysis. J Psychosom Res. 2023-Jul;170:111345. doi:10.1016/j.jpsychores.2023.111345

Abstract

OBJECTIVE: To assess the efficacy of melatonin and melatonergic agonist for the treatment of delirium in hospitalized patients. METHODS: Embase, MEDLINE, PsycINFO, PubMed, CENTRAL, Cochrane Database of Systematic Reviews, TRIP Medical Database, ClinicalTrials.gov and Google were searched from inception to October 2022. Randomized controlled trials (RCT) and observational studies with any type of comparator evaluating melatonin or melatonergic agonist (ramelteon) enrolling any populations (ICU, surgery, geriatric) were included. Two reviewers independently selected and extracted data using the Cochrane risk of bias tools (RoB2 and ROBINSI). RESULTS: Out of the 650 screened publications, three RCTs and six observational studies were included (n = 1211). All three RCTs compared melatonin to placebo, as the majority of observational studies compared melatonin or ramelteon to antipsychotics. Two RCTs reported the duration of delirium and a meta-analysis provided a statistical difference between melatonin and placebo (-1.72 days, 95% CI -2.66 to -0.77, p = 0.0004). Five observational studies reported the duration of delirium but only one reported a statistical reduction in the duration of delirium. CONCLUSION: Although melatonin and ramelteon may be effective treatments for delirium, particularly to shorten the duration of delirium and to limit the use of rescue medication, current data is limited in number and in its quality. Clinicians should wait until higher quality data from ongoing RCTs are available before prescribing melatonin to delirious patients.

Key Findings

Out of the 650 screened publications, three RCTs and six observational studies were included (n = 1211). All three RCTs compared melatonin to placebo, as the majority of observational studies compared melatonin or ramelteon to antipsychotics. Two RCTs reported the duration of delirium and a meta-analysis provided a statistical difference between melatonin and placebo (-1.72 days, 95% CI -2.66 to -0.77, p = 0.0004). Five observational studies reported the duration of delirium but only one reporte

Outcomes Measured

• Requires manual extraction

Population

MeSH Terms

• Humans
• Aged
• Melatonin
• Delirium
• Indenes
• Antipsychotic Agents

Evidence Classification

• Level: Meta Analysis
• Publication Types: Meta-Analysis, Systematic Review, Journal Article, Research Support, Non-U.S. Gov't
• Vertical: melatonin

Provenance

• PMID: 37150157
• DOI: 10.1016/j.jpsychores.2023.111345
• PMCID: Not in PMC
• Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09