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Melatonin: Effective for Mild Insomnia, Benzodiazepine Withdrawal, and Jet Lag


Many patients with anxiety disorders suffer from insomnia. Some patients want to stop using benzodiazepines, but experience withdrawal symptoms when they stop. Melatonin may be helpful to these patients. In addition, melatonin can be used for jet lag. This article details what you should know about melatonin if you choose to use it.

Background

Melatonin is a dietary supplement. Dietary supplements are regulated differently than prescription drugs or over the counter drugs. The Food and Drug Administration (FDA) monitors drugs for safety, efficacy, and purity. The FDA does not monitor dietary supplements for safety, efficacy, or purity.

Why is this important?

Not all dietary supplements are safe, effective, and pure. Melatonin is not safe, it is not effective for all conditions it is claimed to be effective for, and some unscrupulous companies are selling impure or adulterated products.

If I choose to use dietary supplements, how can be sure the products I use don't hurt me?

  • Do stay informed on the good AND bad aspects of each supplement you decide to take.
  • Do purchase USP or GMP certified supplements. These certifications indicate that the manufacturer has made an effort to ensure consistency, purity, and quality in those certified products. If the product is USP or GMP certified, this will be displayed on the product's label.
  • Do educate yourself with quality information, and be skeptical of information given to you from those attempting to sell you something.
  • Don't believe everything you hear about a supplement.
  • Don't continually purchase different brands of a supplement. Find one brand that suits your needs, and only buy that brand.
  • Don't purchase products that you no longer need.
  • Don't purchase products that no longer work for you.

How does melatonin work?

Your pineal gland in your brain secretes melatonin when the retinas in your eyes sense darkness. This melatonin travels to special receptors in your brain that causes you to become sleepy. Taking melatonin as a supplement will activate this pathway, which causes you to become sleepy.

Melatonin is chemically similar to serotonin and tryptophan, both of which have a role in sleep induction. A reduction in serotonin sometimes results in depression, which can lead to insomnia. Tryptophan is found in protein rich foods, and is blamed for why people fall asleep after the turkey dinner that accompanies the Thanksgiving Day holiday in the United States. Tryptophan is converted to melatonin, and this is probably why you are sleepy after eating foods rich in tryptophan.

What is melatonin used for?

Melatonin is effective for treating mild to moderate insomnia. It helps patients fall asleep, but may not help patients stay asleep. If you have trouble falling asleep, melatonin may work for you. If you have trouble staying asleep, melatonin may not work for you.

Melatonin is effective for jet lag. Jet lag occurs when your internal clock does not match the clock of the location you are in. To help symptoms of jet lag, take melatonin 30-60 minutes before you want to fall asleep when you are in the new location.

Melatonin is effective for helping patients wean themselves off of benzodiazepines. Benzodiazepines are drugs used to stop anxiety. Examples of benzodiazepines include: alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). Melatonin does not act like a benzodiazepine, but it helps the body cope with the absence of the benzodiazepine. In one study, patients cut the time they needed to wean off their benzodiazepines in half. Ask your physician if he/she would be comfortable with you trying melatonin while weaning off of your benzodiazepine.

What else should I know about melatonin?

The usual dose for melatonin is 1-10 mg. Melatonin can make you drowsy, so avoid alcohol after taking it. Also, don't drive or operate heavy machinery after taking melatonin, as melatonin can impair your ability to command these machines. The drowsiness produced by melatonin is additive with the drowsiness produced by other drugs, including alcohol. Do not use melatonin if you are pregnant or lactating. Do not give to children under 18 years old. Do not use for more than 9 months, as studies have not been performed to evaluate its safety beyond this point.

Summary

Melatonin is effective for treating one form of insomnia, jet lag, and benzodiazepine withdrawal. It causes drowsiness, so don't operate heavy machinery for 8 hours after taking it. Melatonin's sedating property is additive with other sedating drugs. The usual dose range is 1-10 mg. Do not use for more than 9 months. Do not take melatonin if you are pregnant or lactating. Do not give melatonin to children under 18 years old.

Joey Sweeney DPH-4
Doctor of Pharmacy Candidate 2009
Anxiety Support Network Author
http://www.anxietysupportnetwork.com

References

1. Morin C, Bootzin R, Buysse D, et al. Psychological and behavioral treatment of insomnia: update of the recent evidence. Sleep. 2006; 29:1398-14.

2. Bellon A. Searching for new options for treating insomnia: are melatonin and ramelteon beneficial? J Psychiatr Pract. 2006; 12:229-243. 3. Kayumov L, Brown G, Jindal R, et al. A randomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome. Psychosom Med. 2001; 63:40-48.

4. Buscemi N, Vandermeer B, Hooton N, et al. The efficacy and safety of exogenous melatonin for primary sleep disorders. J Gen Intern Med. 2005; 20:1151-58.

5. Vissers F, Knipschild P, Brebolder H. Is melatonin helpful in stopping the long-term use of hypnotics? Pharm World Sci. 2007; 29:641-46.

6. Garfunkel D, Zisapel N, Wainstein J, et al. Facilitation of benzodiazepine discontinuation by melatonin. Arch Intern Med. 1999; 159: 2456-60.

7. Lee C. Complementary and alternative medicines in patients are talking about: melatonin. Clin J Oncol Nurs. 2006; 10: 105-107.

8. Herxheimer A & Petrie KJ: Melatonin for the prevention and treatment of jet lag (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford: Update Software, 2002.

9. Smucny J. Can melatonin prevent or treat jet lag? AFP. 2002; 66:2087-88.

10. Jan J, Freeman R. Melatonin therapy for circadian rhythm sleep disorders in children with multiple disabilities: what have we learned in the last decade? Dev Med Child Neurol. 2004; 46:776-782.

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