Delirium represents a form of acute brain dysfunction predictive of excess death and long-term cognitive impairment in critically ill patients. For many years, we have wondered whether pharmacological doses of melatonin would help prevent the onset or mitigate the duration of this calamity in the life of our sickest patients.

The data are growing to help us realize answers.

Melatonin is a pleiotropic neurohormone produced by the pineal gland during the hours of darkness.

Understanding of the pineal gland and the biological effects of melatonin has evolved from its historical conceptualization as the “tranquilizing organ” and the “seat of the soul” to knowledge of their pivotal role in the regulation of circadian rhythm.

Melatonin is synthesized from tryptophan via a sequence of enzymatic reactions.

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