Melatonin is the principle hormone produced in the pineal gland and it is a derivative of the amino acid tryptophan. Researchers since the late ‘70s have concurred that melatonin plays a vital role in regulating sleep cycles and hormonal changes that initiate sexual maturity during adolescence. Children under 7 years old release higher amounts of melatonin than older children and adolescents, and melatonin levels continue to drop throughout the adult years. It is believed that the levels of melatonin dictate the start of puberty and this is supported by evidence that children born with dysfunctional pineal glands or pineal tumors usually begin puberty at very young ages. How it is believed to relate to sleep cycles is via circadian rhythms and light and darkness triggers. Regardless of the amount of melatonin due to age, higher levels are released into the blood prior to bedtime and dim lighting or a dark room also causes the release of melatonin.

There is current research into the helpful effects of melatonin on fibromyalgia and Alzheimer’s disease, but it is too soon for definitive results in these areas. The premise that melatonin affects sleep patterns, daily circadian rhythms and seasonal adjustments has led to the popularity of taking melatonin supplements as a safe and natural way to address sleeping issues. Initially, melatonin supplements were touted as jet lag remedies but have long since been taken by many in an effort to combat insomnia. However, it is not very clear as to whether melatonin supplements are an effective treatment for insomnia. Yet there are clearly known precautions, side effects and interactions with conditions and other drugs that are often under presented.

One thing to keep in mind is that most melatonin supplements are synthetic, which could cause more harm than good. Since they are considered a dietary supplement, few studies have been done regarding the safety of its long term use and it is not tested or regulated by the FDA. Labeling of potential side effects is not required. In general, melatonin supplements are regarded as safe for short term use.

PRECAUTIONS

As with any new medication or supplement, it is advisable to speak first with your doctor before taking anything. Unless it is a 100 percent organic melatonin supplement, keep in mind that there will be many inactive ingredients that may not be listed on the packaging. These inactive ingredients could cause allergic reactions or other problems. Extra caution should be considered by people with the following conditions: diabetes, high blood pressure, immune system disorders, liver disease, mental or mood disorders like depression, and seizure disorders like epilepsy. Since it is intended to encourage restful sleep, do not drive, operate machinery or embark on any task that requires alertness after taking melatonin supplements. Alcohol use should be limited or curtailed. Liquid forms may contain sugar, alcohol or aspartame. Caution is advised in giving melatonin supplements to children because of the possible risk in changes in sexual development. It is not recommended for use in women who are pregnant or planning pregnancy as it may have an effect on ovulation. It is not presently known if melatonin supplements are passed into breast milk so consult your doctor before breast feeding if using this product.

SIDE EFFECTS

Changes in sleep For many people, melatonin supplements cause one or several undesired changes in their sleep patterns, such as nightmares, vivid dreams and sleepwalking. Such sleep-related symptoms usually cease as soon as taking melatonin supplements stops. Incorrect use, especially taking too high of a dose, can disrupt the circadian rhythm, which creates irregular sleep-wake cycles. Because natural melatonin will be automatically released upon bedtime and with darkness, it is very easy to incorrectly use melatonin supplements and effectively give your body too much melatonin.

Hormonal Changes Melatonin causes changes to the levels of luteinizing hormones and progesterone levels and other hormones controlled by the pituitary gland. Thus, pregnant women, women trying to conceive and nursing women should not take melatonin supplements. Excessive melatonin use during pregnancy may lead to developmental disorders in the baby. High levels of melatonin can act as a contraceptive and in men it can decrease sperm count, decrease sperm mobility and increase male breast size. Both men and women may experience a decrease in sex drive.

Mood Changes Mood changes ranging from sadness to giddiness is reported by some users and melatonin supplements has also been known to worsen existing symptoms of depression. Irritability, a heavy headed feeling and sluggishness are the most widely reported mood changes in the general population of regular melatonin supplement users. In severe cases, delusion, paranoia and hallucinations have been reported. Such mood changes are generally found in those overdosing the supplement. Anyone with a history of psychotic disorders or depression should not take melatonin supplements.

Cholesterol and Blood Pressure and Sugar Levels Melatonin supplements can increase cholesterol and decrease blood pressure. Elevated blood sugar levels have been found in patients with type 1 diabetes. Even low doses of melatonin can reduce glucose tolerance and insulin sensitivity. Arrhythmia is often associated with regular use of melatonin supplements.

Generalized Side Effects Although its use is intended as a sleep aid, for many it leads to drowsiness and feeling less alert during the day time or typical wakeful hours. Headaches, dizziness, shaking, nausea, abdominal cramps and vomiting are all common side effects for the many people who take melatonin supplements regularly; however, they can occur in some with one use.

Disorientation and Seizures Taking overdoses of melatonin supplements can cause disorientation and increase the risk of seizures.

Increased Risk of Autoimmune Disorders Melatonin supplements have been linked to an increased risk of autoimmune disorders like hepatitis. It has also been shown to trigger Crohn’s disease symptoms.

DRUG INTERACTIONS

Caffeine from coffee, tea or soda, should also be considered when taking melatonin supplements because caffeine raises the melatonin levels (http://www.ncbi.nlm.nih.gov/pubmed/12906366). It may also interact with tobacco and alcohol. Melatonin supplements can interfere with or cause other interactions with several over the counter and prescription medications. Some important ones to be aware of are:

• Antihistamines (diphenhydramine) and any medication that causes drowsiness
• Anti-inflammatories (aspirin, ibuprofen)
• Steroidal medications (prednisone)
• Birth control pills
• Blood thinners (warfarin, heparin)
• Blood pressure medications (especially nifedipine)
• Immune system drugs (azathioprine, cyclosporine, prednisone)
• Sleep and anxiety medications (alprazolam, diazepam, zoldpidem)
• Muscle relaxants Narcotic pain relievers (codeine)
• SSRIs - Selective serotonin reuptake inhibitors and anti-depressant medications (fluvoxamine)
• Psychiatric and anti-psychotic medications (chlorpromazine, risperidone, amitriptyline, trazodone)
• Anti-seizure medications (carbamazepine)
• Benzodiazepines (Valium, Librium, Dalmane)

*The drugs cited in parenthesis are not definitive lists, merely popular examples of such medications