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Melatonin acts as an antioxidant agent that detoxifies accumulated reactive oxygen or nitrogen species or modulates the balance of pro-oxidant and anti-oxidant enzyme activities by inhibiting pro-oxidative enzymes like xanthine oxidase (XO) and activating antioxidant enzymes such as catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD) [15, 199]

The kynurenine pathway Impaired metabolism of the essential amino acid tryptophan has been proposed to be involved in the pathogenesis of ME/CFS [70,71,72,73, 108]