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

4. Efficacy Used by those who travel across time zones
Studies support melatonin’s efficacy
Doses 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, pp

5. 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:

6. 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

7. 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

8. 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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