Melatonin
CAM (hormone involved in sleep and circadian rhythm, rises when lights out)
- Hypnotic safe for elderly1
- Hypnotic safe in sleep apnea1
- Antipsychotic weight gain1
- Migraines3
- Improves cognition in Alzheimers and mild mood/anxiety symptoms in postmenopausal women
Features
Dosing
Insomnia: 0.5-4 mg qhs, maximium response at 4 mg, give 3 hours before bed to optimize response.
Take with magnesium (200-300 mg) and zinc (10-25 mg) to improve hypnotic response (these enhance melatonin release).
Weight: 2-5 mg qhs.
Cognition in dementia: 2 mg qhs.
Take with low-dose buspirone (15 mg) for depression.
Management
Main risk is am fatigue. Best studied in children, elderly, and those with autism or neurodevelopmental disorders.
Works almost as well as standard hypnotics when a good formulation is used. In many other countries it is by prescription only. Some patients do better with instant release, others with sustained release, and Dr. Wurtman’s has a mix of both.
Reduces weight gain on antipsychotics. However, wearing blue-light filtering glasses 2 hours before bed is probably more effective as that raises endogenous melatonin. Can improve jetlag when used with jetlagrooster.com to time it right.
TOLERABILITY: Morning fatigue, headache, dizziness, nausea.
RISKS: Bone fracture risk with long-term use, but does not weaken melatonin secretion with long-term use. Avoid in pregnancy.
MEDICAL BENEFITS: Irritable bowel symdrome, migraines, tinnitus, menopausal symptoms, atopic dermatitis fatty liver.
EMR Text
Insomnia
Melatonin use based on randomized controlled trials for insomnia (Cruz-Sanabria F et al, J Pineal Res. 2024;76(5):e12985).
Melatonin side effects reviewed with patient. Guided patient toward lab-tested melatonin products.
Insomnia in Sleep Apnea
Melatonin use based on randomized controlled trials for insomnia (Cruz-Sanabria F et al, J Pineal Res. 2024;76(5):e12985), including studies supporting its safety in sleep apnea (and improvement in CPAP adherence) (Motlaq TM et al, J Pharm Health Care Sci 2024;10(1):25).
Melatonin side effects reviewed with patient. Guided patient toward lab-tested melatonin products.
Weight
Melatonin use based on randomized controlled trials for antipsychotic-induced weight gain (Agahi M et al, Diabetes Metab Syndr. 2018;12(1):9-15).
Melatonin side effects reviewed with patient. Guided patient toward lab-tested melatonin products.
Postmenopausal psychological symptoms
Melatonin use based on randomized controlled trials where it improved sleep, anxiety, and mood in postmenopausal women (Demirhan Kayacik A et al, Arch Womens Ment Health. 2024;27(2):265-273).
Melatonin side effects reviewed with patient. Guided patient toward lab-tested melatonin products.
Dementia
Melatonin use based on randomized controlled trials where it improved sleep and cognition in dementia (Terao I et al, J Alzheimers Dis. 2024;98(3):825-835).
Melatonin side effects reviewed with patient. Guided patient toward lab-tested melatonin products.