Melatonin Director, Depression Clinical and Research Program

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Presentation transcript:

Melatonin Director, Depression Clinical and Research Program David Mischoulon, MD, PhD Director, Depression Clinical and Research Program Massachusetts General Hospital Professor of Psychiatry Harvard Medical School

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Melatonin: Introduction and Mechanism A sleep-inducing hormone Mechanism Resetting the circadian rhythm Direct sedative effects Pineal gland

Efficacy Used by those who travel across time zones Studies support melatonin’s efficacy Doses 0.25 - 0.30 mg / day. Some preparations up to 5 or 10 mg Recommended: begin at low dose and increase it gradually Auld F, et al. (2017) : Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Med Rev; 34:10-22   Zhdanova V, et al. (2008): Therapeutic Potential of Melatonin in Sleep and Circadian disorders. In: Mischoulon D, Rosenbaum J, editors. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp140-159

Evidence of efficacy and safety Children Studied in Good alternative to benzodiazepines Elderly Blackmer AB, et al. (2016). Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review. Pharmacotherapy 2016; 36:84-98 Luthringer R, et al. (2009) The effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomnia. Int Clin Psychopharmacol;24:239-249

Safety Safe Very rare serious adverse effects Few side effects Inhibition of fertility High doses: Sedation Decreased sex drive Confusion Lowering body temperature Begin low and increase the dose gradually One case: retinal damage Zhdanova V, et al. (2008) Therapeutic Potential of Melatonin in Sleep and Circadian disorders. In: Mischoulon D, Rosenbaum J, editors. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp. 140-159

Special Groups Immunosuppressive activity Caution in: HIV patients Immunosuppressed individuals Risk to fetus ? Unknown Caution is advised Zhdanova V, et al. (2008) Therapeutic Potential of Melatonin in Sleep and Circadian disorders. In: Mischoulon D, Rosenbaum J, editors. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp. 140-159

Key Points Melatonin appears to be an effective hypnotic that may be good for sleep disturbances associated with circadian disruptions e.g. shift work and traveling across time zones. Melatonin may be especially useful for children and elderly individuals in whom benzodiazepines may prove too sedating. Melatonin appears to be safe and while some serious side effects have been reported, they appear to be very rare.

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