Jet Lag: Use of Melatonin and Melatonergic Drugs

  • Venkataramanujam SrinivasanEmail author
  • Jarnail Singh
  • Amnon Brzezinski
  • Rahimah Zakaria
  • Samuel D. Shillcutt
  • Gregory M. Brown


Jet lag comprises a constellation of symptoms that occurs as a result of disruptions of entrainment associated with time zone transitions. The jet lag symptoms include daytime fatigue, impaired alertness, insomnia, loss of appetite, poor psychomotor coordination, reduced cognitive skills, and depressed mood. The severity of jet lag symptoms depends on the number of time zones crossed as well as the direction of travel. Eastbound travel tends to cause difficulties in falling asleep, whereas westbound travel interferes with sleep maintenance. Clinical studies also indicate that jet lag can exacerbate existing affective disorders. It has been suggested that dysregulation of melatonin secretion and occurrence of circadian rhythm disturbances may be the common links which underlie jet lag and affective disorders. Melatonin has proven to be highly effective for treating the range of symptoms that accompany transmeridian air travel largely because of its regulatory effects on the circadian system. The therapeutic values of melatonin and its agonists such as ramelteon in reducing the jet lag symptoms and use of the melatonergic antidepressant, agomelatine, for jet lag-associated depressive disorders are discussed in this chapter.


Melatonin Ramelteon Jet lag Time zone transitions Insomnia 


  1. 1.
    Kyriacou CP, Hastings MH. Circadian clocks: genes, sleep, and cognition. Trends Cogn Sci. 2010;16(6):259–67.CrossRefGoogle Scholar
  2. 2.
    Moore RY, Speh JC, Leak RK. Suprachiasmatic nucleus organization. Cell Tissue Res. 2002;309:89–98.PubMedCrossRefGoogle Scholar
  3. 3.
    Morin LP, Allen CN. The circadian visual system, 2005. Brain Res Brain Res Rev. 2006;51:1–60.CrossRefGoogle Scholar
  4. 4.
    Pandi-Perumal SR, Trakht I, Spence DW, Srinivasan V, Dagan Y, Cardinali DP. The roles of melatonin and light in the pathophysiology and treatment of circadian rhythm sleep disorders. Nat Clin Pract Neurol. 2008;4(8):436–47.PubMedCrossRefGoogle Scholar
  5. 5.
    Zee PC, Manthena P. The brain’s master circadian clock: implications and opportunities for therapy of sleep disorders. Sleep Med Rev. 2007;11:59–70.PubMedCrossRefGoogle Scholar
  6. 6.
    Samuels C. Sleep, recovery, and performance: the new frontier in high-performance athletics. Phys Med Rehabil Clin N Am. 2009;20:149–59.PubMedCrossRefGoogle Scholar
  7. 7.
    Sack RL. Clinical practice. Jet lag. N Engl J Med. 2010;362:440–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Waterhouse J, Reilly T. Managing jet lag. Sleep Med Rev. 2009;13:247–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Fahey CD, Zee PC. Circadian rhythm sleep disorders and phototherapy. Psychiatr Clin North Am. 2006;29:989–1007.PubMedCrossRefGoogle Scholar
  10. 10.
    Arendt J. Managing jet lag: some of the problems and possible new solutions. Sleep Med Rev. 2009;13:249–56.PubMedCrossRefGoogle Scholar
  11. 11.
    Auger RR, Morgenthaler TI. Jet lag and other sleep disorders relevant to the traveler. Travel Med Infect Dis. 2009;7:60–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Reilly T, Atkinson G, Waterhouse J. Travel fatigue and jet-lag. J Sports Sci. 1997;15:365–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Nicholson AN. Intercontinental air travel: the cabin atmosphere and circadian realignment. Travel Med Infect Dis. 2009;7:57–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Aschoff J. Response curves in circadian periodicity. In: Aschoff J, editor. Circadian clocks. Amsterdam: North-Holland; 1965. p. 95–111.Google Scholar
  15. 15.
    Arendt J, Marks V. Physiological changes underlying jet lag. Br Med J (Clin Res Ed). 1982;284(6310):144–6.PubMedCentralCrossRefGoogle Scholar
  16. 16.
    Monk TH. Aging human circadian rhythms: conventional wisdom may not always be right. J Biol Rhythms. 2005;20:366–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Ariznavarreta C, Cardinali DP, Villanua M, Granados B, Martín M, Chiesa JJ, et al. Circadian rhythms in airline pilots submitted to long-haul transmeridian flights. Aviat Space Environ Med. 2002;73:445–55.PubMedGoogle Scholar
  18. 18.
    Tresguerres J, Ariznavarreta C, Granados B, Martín M, Villanúa MA, Golombek DA, et al. Circadian urinary 6‐sulphatoxymelatonin, cortisol excretion and locomotor activity in airline pilots during transmeridian flights. J Pineal Res. 2001;31:16–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Shanahan TL, Czeisler CA. Physiological effects of light on the human circadian pacemaker. Semin Perinatol. 2000;24:299–320.PubMedCrossRefGoogle Scholar
  20. 20.
    Takahashi T, Sasaki M, Itoh H, Yamadera W, Ozone M, Obuchi K, et al. Melatonin alleviates jet lag symptoms caused by an 11-hour eastward flight. Psychiatry Clin Neurosci. 2002;56:301–2.PubMedCrossRefGoogle Scholar
  21. 21.
    Nicholson AN. Sleep and intercontinental flights. Travel Med Infect Dis. 2006;4:336–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Lowden A, Akerstedt T, Wibom R. Suppression of sleepiness and melatonin by bright light exposure during breaks in night work. J Sleep Res. 2004;13:37–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Roehrs T, Turner L, Roth T. Effects of sleep loss on waking actigraphy. Sleep. 2000;23:793–7.PubMedGoogle Scholar
  24. 24.
    Wegmann HM, Gundel A, Naumann M, Samel A, Schwartz E, Vejvoda M. Sleep, sleepiness, and circadian rhythmicity in aircrews operating on transatlantic routes. Aviat Space Environ Med. 1986;57:B53–64.PubMedGoogle Scholar
  25. 25.
    Samel A, Wegmann HM, Vejvoda M. Jet lag and sleepiness in aircrew. J Sleep Res. 1995;4:30–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Beaumont M, Batejat D, Pierard C, Van Beers P, Denis JB, Coste O, et al. Caffeine or melatonin effects on sleep and sleepiness after rapid eastward transmeridian travel. J Appl Physiol. 2004;96:50–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Sack RL. The pathophysiology of jet lag. Travel Med Infect Dis. 2009;7:102–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Lemmer B, Kern RI, Nold G, Lohrer H. Jet lag in athletes after eastward and westward time-zone transition. Chronobiol Int. 2002;19:743–64.PubMedCrossRefGoogle Scholar
  29. 29.
    Steenland K, Deddens JA. Effect of travel and rest on performance of professional basketball players. Sleep. 1997;20:366–9.PubMedGoogle Scholar
  30. 30.
    Waterhouse J, Edwards B, Nevill A, Carvalho S, Atkinson G, Buckley P, et al. Identifying some determinants of “jet lag” and its symptoms: a study of athletes and other travellers. Br J Sports Med. 2002;36:54–60.PubMedCrossRefGoogle Scholar
  31. 31.
    Schwartz JR. Pharmacologic management of daytime sleepiness. J Clin Psychiatry. 2004;65 Suppl 16:46–9.PubMedGoogle Scholar
  32. 32.
    Caldwell JA. Fatigue in aviation. Travel Med Infect Dis. 2005;3:85–96.PubMedCrossRefGoogle Scholar
  33. 33.
    Gherardin T. Jet lag. A problem for ‘long haul’ travellers. Aust Fam Physician. 1999;28:833.PubMedGoogle Scholar
  34. 34.
    Arendt J. Jet-lag. Lancet. 1998;351:293–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Kennaway DJ, Wright H. Melatonin and circadian rhythms. Curr Top Med Chem. 2002;2:199–209.PubMedCrossRefGoogle Scholar
  36. 36.
    Paul MA, Miller JC, Gray GW, Love RJ, Lieberman HR, Arendt J. Melatonin treatment for eastward and westward travel preparation. Psychopharmacology (Berl). 2010;208:377–86.CrossRefGoogle Scholar
  37. 37.
    Cardinali DP, Bortman GP, Liotta G, Pérez Lloret S, Albornoz LE, Cutrera RA, et al. A multifactorial approach employing melatonin to accelerate resynchronization of sleep-wake cycle after a 12 time-zone westerly transmeridian flight in elite soccer athletes. J Pineal Res. 2002;32:41–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Arendt J, Aldhous M, Marks V. Alleviation of jet lag by melatonin: preliminary results of controlled double blind trial. Br Med J (Clin Res Ed). 1986;292:1170.CrossRefGoogle Scholar
  39. 39.
    Petrie K, Dawson AG, Thompson L, Brook R. A double-blind trial of melatonin as a treatment for jet lag in international cabin crew. Biol Psychiatry. 1993;33:526–30.PubMedCrossRefGoogle Scholar
  40. 40.
    Claustrat B, Brun J, David M, Sassolas G, Chazot G. Melatonin and jet lag: confirmatory result using a simplified protocol. Biol Psychiatry. 1992;32:705–11.PubMedCrossRefGoogle Scholar
  41. 41.
    Lino A, Silvy S, Condorelli L, Rusconi AC. Melatonin and jet lag: treatment schedule. Biol Psychiatry. 1993;34:587.PubMedCrossRefGoogle Scholar
  42. 42.
    Spitzer RL, Terman M, Williams JB, Terman JS, Malt UF, Singer F, et al. Jet lag: clinical features, validation of a new syndrome-specific scale, and lack of response to melatonin in a randomized, double-blind trial. Am J Psychiatry. 1999;156:1392–6.PubMedGoogle Scholar
  43. 43.
    Samel A. Melatonin and jet-lag. Eur J Med Res. 1999;4:385–8.PubMedGoogle Scholar
  44. 44.
    Edwards BJ, Atkinson G, Waterhouse J, Reilly T, Godfrey R, Budgett R. Use of melatonin in recovery from jet-lag following an eastward flight across 10 time-zones. Ergonomics. 2000;43:1501–13.PubMedCrossRefGoogle Scholar
  45. 45.
    Revell VL, Burgess HJ, Gazda CJ, Smith MR, Fogg LF, Eastman CI. Advancing human circadian rhythms with afternoon melatonin and morning intermittent bright light. J Clin Endocrinol Metab. 2006;91:54–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Arendt J, Skene DJ, Middleton B, Lockley SW, Deacon S. Efficacy of melatonin treatment in jet lag, shift work, and blindness. J Biol Rhythms. 1997;12:604–17.PubMedCrossRefGoogle Scholar
  47. 47.
    Herxheimer A, Petrie KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database Syst Rev. 2002;(2):CD001520.Google Scholar
  48. 48.
    Cardinali DP, Furio AM, Reyes MP, Brusco LI. The use of chronobiotics in the resynchronization of the sleep/wake cycle. Cancer Causes Control. 2006;17(4):601–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Brown GM, Pandi-Perumal SR, Trakht I, Cardinali DP. Melatonin and its relevance to jet lag. Travel Med Infect Dis. 2009;7:69–81.PubMedCrossRefGoogle Scholar
  50. 50.
    Bellon A. Searching for new options for treating insomnia: are melatonin and ramelteon beneficial? J Psychiatr Pract. 2006;12:229–43.PubMedCrossRefGoogle Scholar
  51. 51.
    Dobkin RD, Menza M, Bienfait KL, Allen LA, Marin H, Gara MA. Ramelteon for the treatment of insomnia in menopausal women. Menopause Int. 2009;15:13–8.PubMedCentralPubMedGoogle Scholar
  52. 52.
    Gross PK, Nourse R, Wasser TE. Ramelteon for insomnia symptoms in a community sample of adults with generalized anxiety disorder: an open label study. J Clin Sleep Med. 2009;5:28–33.PubMedGoogle Scholar
  53. 53.
    Hirai K, Kita M, Ohta H, Nishikawa H, Fujiwara Y, Ohkawa S, Miyamoto M. Ramelteon (TAK-375) accelerates reentrainment of circadian rhythm after a phase advance of the light–dark cycle in rats. J Biol Rhythms. 2005;20:27–37.PubMedCrossRefGoogle Scholar
  54. 54.
    Kato K, Hirai K, Nishiyama K, Uchikawa O, Fukatsu K, Ohkawa S, et al. Neurochemical properties of ramelteon (TAK-375), a selective MT1/MT2 receptor agonist. Neuropharmacology. 2005;48:301–10.PubMedCrossRefGoogle Scholar
  55. 55.
    Erman M, Seiden D, Zammit G, Sainati S, Zhang J. An efficacy, safety, and dose–response study of Ramelteon in patients with chronic primary insomnia. Sleep Med. 2006;7(1):17–24.PubMedCrossRefGoogle Scholar
  56. 56.
    Roth T, Seiden D, Wang-Weigand S, Zhang J. A 2-night, 3-period, crossover study of ramelteon’s efficacy and safety in older adults with chronic insomnia. Curr Med Res Opin. 2007;23:1005–14.PubMedCrossRefGoogle Scholar
  57. 57.
    Zammit G, Erman M, Wang-Weigand S, Sainati S, Zhang J, Roth T. Evaluation of the efficacy and safety of ramelteon in subjects with chronic insomnia. J Clin Sleep Med. 2007;3:495–504.PubMedGoogle Scholar
  58. 58.
    Mini L, Wang-Weigand S, Zhang J. Ramelteon 8 mg/d versus placebo in patients with chronic insomnia: post hoc analysis of a 5-week trial using 50% or greater reduction in latency to persistent sleep as a measure of treatment effect. Clin Ther. 2008;30:1316–23.PubMedCrossRefGoogle Scholar
  59. 59.
    Richardson GS, Zee PC, Wang-Weigand S, Rodriguez L, Peng X. Circadian phase-shifting effects of repeated ramelteon administration in healthy adults. J Clin Sleep Med. 2008;4:456–61.PubMedGoogle Scholar
  60. 60.
    Zee PC, Wang-Weigand S, Wright Jr KP, Peng X, Roth T. Effects of ramelteon on insomnia symptoms induced by rapid, eastward travel. Sleep Med. 2010;11:525–33.PubMedCrossRefGoogle Scholar
  61. 61.
    Rajaratnam SM, Polymeropoulos MH, Fisher DM, Roth T, Scott C, Birznieks G, Klerman EB. Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials. Lancet. 2009;373:482–91.PubMedCrossRefGoogle Scholar
  62. 62.
    Jauhar P, Weller MP. Psychiatric morbidity and time zone changes: a study of patients from Heathrow airport. Br J Psychiatry. 1982;140:231–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Young DM. Psychiatric morbidity in travelers to Honolulu, Hawaii. Compr Psychiatry. 1995;36:224–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Katz G, Knobler HY, Laibel Z, Strauss Z, Durst R. Time zone change and major psychiatric morbidity: the results of a 6-year study in Jerusalem. Compr Psychiatry. 2002;43:37–40.PubMedCrossRefGoogle Scholar
  65. 65.
    Srinivasan V, Spence DW, Pandi-Perumal SR, Trakht I, Cardinali DP. Jet lag: therapeutic use of melatonin and possible application of melatonin analogues. Travel Med Infect Dis. 2008;6(1):17–28.PubMedCrossRefGoogle Scholar
  66. 66.
    Halberg F, Vestergaard P, Sakai M. Rhythmometry on urinary 17-ketosteroid excretion by healthy men and women and patients with chronic schizophrenia; possible chronopathology in depressive illness. Arch Anat Histol Embryol. 1968;51:299–311.PubMedGoogle Scholar
  67. 67.
    Wehr TA, Wirz-Justice A. Circadian rhythm mechanisms in affective illness and in antidepressant drug action. Pharmacopsychiatria. 1982;15:31–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Healy D, Waterhouse JM. The circadian system and the therapeutics of the affective disorders. Pharmacol Ther. 1995;65:241–63.PubMedCrossRefGoogle Scholar
  69. 69.
    Lustberg L, Reynolds CF. Depression and insomnia: questions of cause and effect. Sleep Med Rev. 2000;4:253–62.PubMedCrossRefGoogle Scholar
  70. 70.
    Reynolds 3rd CF, Monk TH, Hoch CC, Jennings JR, Buysse DJ, Houck PR, et al. Electroencephalographic sleep in the healthy “old old”: a comparison with the “young old” in visually scored and automated measures. J Gerontol. 1991;46:M39–46.PubMedCrossRefGoogle Scholar
  71. 71.
    Bunney JN, Potkin SG. Circadian abnormalities, molecular clock genes and chronobiological treatments in depression. Br Med Bull. 2008;86:23–32.PubMedCrossRefGoogle Scholar
  72. 72.
    Quera-Salva MA, Lemoine P, Guilleminault C. Impact of the novel antidepressant agomelatine on disturbed sleep-wake cycles in depressed patients. Hum Psychopharmacol. 2010;25:222–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Riemann D, Berger M, Voderholzer U. Sleep and depression – results from psychobiological studies: an overview. Biol Psychol. 2001;57:67–103.PubMedCrossRefGoogle Scholar
  74. 74.
    Lam RW. Sleep disturbances and depression: a challenge for antidepressants. Int Clin Psychopharmacol. 2006;21 Suppl 1:S25–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Moltzen EK, Bang-Andersen B. Serotonin reuptake inhibitors: the corner stone in treatment of depression for half a century – a medicinal chemistry survey. Curr Top Med Chem. 2006;6:1801–23.PubMedCrossRefGoogle Scholar
  76. 76.
    Yous S, Andrieux J, Howell HE, Morgan PJ, Renard P, Pfeiffer B, et al. Novel naphthalenic ligands with high affinity for the melatonin receptor. J Med Chem. 1992;35:1484–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Millan MJ, Gobert A, Lejeune F, Dekeyne A, Newman-Tancredi A, Pasteau V, et al. The novel melatonin agonist agomelatine (S20098) is an antagonist at 5-hydroxytryptamine2C receptors, blockade of which enhances the activity of frontocortical dopaminergic and adrenergic pathways. J Pharmacol Exp Ther. 2003;306:954–64.PubMedCrossRefGoogle Scholar
  78. 78.
    Loo H, Hale A, D’haenen H. Determination of the dose of agomelatine, a melatoninergic agonist and selective 5-HT(2C) antagonist, in the treatment of major depressive disorder: a placebo-controlled dose range study. Int Clin Psychopharmacol. 2002;17:239–47.PubMedCrossRefGoogle Scholar
  79. 79.
    Kennedy SH, Emsley R. Placebo-controlled trial of agomelatine in the treatment of major depressive disorder. Eur Neuropsychopharmacol. 2006;16:93–100.PubMedCrossRefGoogle Scholar
  80. 80.
    Montgomery SA. Major depressive disorders: clinical efficacy and tolerability of agomelatine, a new melatonergic agonist. Eur Neuropsychopharmacol. 2006;16 Suppl 5:S633–8.CrossRefGoogle Scholar
  81. 81.
    Kupfer DJ. Depression and associated sleep disturbances: patient benefits with agomelatine. Eur Neuropsychopharmacol. 2006;16 Suppl 5:S639–43.CrossRefGoogle Scholar
  82. 82.
    Srinivasan V, Smits M, Spence W, Lowe AD, Kayumov L, Pandi-Perumal SR, et al. Melatonin in mood disorders. World J Biol Psychiatry. 2006;7(3):138–51.PubMedCrossRefGoogle Scholar
  83. 83.
    Branchey L, Weinberg U, Branchey M, Linkowski P, Mendlewicz J. Simultaneous study of 24-hour patterns of melatonin and cortisol secretion in depressed patients. Neuropsychobiology. 1982;8:225–32.PubMedCrossRefGoogle Scholar
  84. 84.
    Claustrat B, Chazot G, Brun J, Jordan D, Sassolas G. A chronobiological study of melatonin and cortisol secretion in depressed subjects: plasma melatonin, a biochemical marker in major depression. Biol Psychiatry. 1984;19:1215–28.PubMedGoogle Scholar
  85. 85.
    Nair NP, Hariharasubramanian N, Pilapil C. Circadian rhythm of plasma melatonin in endogenous depression. Prog Neuropsychopharmacol Biol Psychiatry. 1984;8:715–8.PubMedCrossRefGoogle Scholar
  86. 86.
    Beck-Friis J, Kjellman BF, Aperia B, Undén F, von Rosen D, Ljunggren JG, et al. Serum melatonin in relation to clinical variables in patients with major depressive disorder and a hypothesis of a low melatonin syndrome. Acta Psychiatr Scand. 1985;71:319–30.PubMedCrossRefGoogle Scholar
  87. 87.
    Wehr TA, Sack DA, Rosenthal NE. Antidepressant effects of sleep deprivation and phototherapy. Acta Psychiatr Belg. 1985;85:593–602.PubMedGoogle Scholar
  88. 88.
    Rubin RT, Heist EK, McGeoy SS, Hanada K, Lesser IM. Neuroendocrine aspects of primary endogenous depression. XI. Serum melatonin measures in patients and matched control subjects. Arch Gen Psychiatry. 1992;49:558–67.PubMedCrossRefGoogle Scholar
  89. 89.
    Sekula LK, Lucke JF, Heist EK, Czambel RK, Rubin RT. Neuroendocrine aspects of primary endogenous depression. XV: mathematical modeling of nocturnal melatonin secretion in major depressives and normal controls. Psychiatry Res. 1997;69:143–53.PubMedCrossRefGoogle Scholar
  90. 90.
    Crasson M, Kjiri S, Colin A, Kjiri K, L’Hermite-Baleriaux M, Ansseau M, et al. Serum melatonin and urinary 6-sulfatoxymelatonin in major depression. Psychoneuroendocrinology. 2004;29:1–12.PubMedCrossRefGoogle Scholar
  91. 91.
    Tuunainen A, Kripke DF, Elliott JA, Assmus JD, Rex KM, Klauber MR, et al. Depression and endogenous melatonin in postmenopausal women. J Affect Disord. 2002;69:149–58.PubMedCrossRefGoogle Scholar
  92. 92.
    Leproult R, Van Onderbergen A, L’hermite-Baleriaux M, Van Cauter E, Copinschi G. Phase-shifts of 24-h rhythms of hormonal release and body temperature following early evening administration of the melatonin agonist agomelatine in healthy older men. Clin Endocrinol (Oxf). 2005;63:298–304.CrossRefGoogle Scholar
  93. 93.
    Koorengevel KM, Beersma DG, den Boer JA, van den Hoofdakker RH. A forced desynchrony study of circadian pacemaker characteristics in seasonal affective disorder. J Biol Rhythms. 2002;17:463–75.PubMedCrossRefGoogle Scholar
  94. 94.
    Pjrek E, Winkler D, Konstantinidis A, Willeit M, Praschak-Rieder N, Kasper S. Agomelatine in the treatment of seasonal affective disorder. Psychopharmacology (Berl). 2007;190:575–9.CrossRefGoogle Scholar

Copyright information

© Springer India 2014

Authors and Affiliations

  • Venkataramanujam Srinivasan
    • 1
    • 2
    • 3
    Email author
  • Jarnail Singh
    • 4
  • Amnon Brzezinski
    • 5
  • Rahimah Zakaria
    • 6
  • Samuel D. Shillcutt
    • 7
  • Gregory M. Brown
    • 8
  1. 1.Sri Sathya Sai Medical Educational and Research Foundation, An International Medical Sciences Research Study CenterCoimbatoreIndia
  2. 2.National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and TreatmentHospital “G. Mazzini” ASL 4TeramoItaly
  3. 3.Department of Neuroscience and ImagingUniversity “G.D’ Annunzio”ChietiItaly
  4. 4.Department of Civil Aviation Medical BoardCivil Aviation Authority of SingaporeSingaporeSingapore
  5. 5.Department of Obstetrics and GynecologyHadassah Hebrew-University Medical CenterJerusalemIsrael
  6. 6.Department of PhysiologySchool of Medical Sciences, Universiti Sains MalaysiaKubang KerianMalaysia
  7. 7.Department of Psychiatry and Behavioral ScienceMercer University School of MedicineMaconUSA
  8. 8.Department of Psychiatry, Faculty of MedicineUniversity of Toronto, Centre for Addiction and Mental HealthTorontoCanada

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