Melatonin May Be Natural, But It Also Has Dangers

Natural Does Not Always Equal Safe

by Don Drake, Connelly Law Offices, Ltd.

"Welcome to June, everyone! It's the transition month from spring to summer, and typically, a time when sleep disorders tend to pop up with the time change, the hot and humid weather, longer hours of daylight, summer fun, add whatever cliche you like," said certified elder law Attorney RJ Connelly III. "Given these changes, we thought it would be a suitable time to discuss sleep disruptions and the use of melatonin to treat them and why, like all supplements, we need to heed some warnings."

We have written in the past about the use of nighttime prescription medications for sleep (such as Ambien, Edluar, Intermezzo, Zolpimist, and Sonata) and over-the-counter sleep aids (such as Unisom, Zzzquil, Sominex, Tylenol PM, diphenhydramine, etc.) and the dangers they pose, but what about those who decide on the all-natural route by taking melatonin products? After all, how bad can something natural be? But as Attorney Connelly said, natural products like melatonin can present with dangers, too.

The Importance of Sleep

Doctors call sleep an essential function of the human body. It is needed to restore the organs and provide the mind with a recharge. Research shows that those who have a healthy sleep pattern also have less illnesses and can fight off viruses better than those who do not. If the brain is deprived of sleep, an individual has difficulty concentrating, thinking, making appropriate judgments, and processing memories.

For most adults, seven to nine hours of sleep are needed, and children and teens need more, especially if they are under five years of age. As most of you know, good luck getting in seven to nine hours as family issues, work stressors, and even medical conditions can interfere with this. A lack of an adequate amount of sleep can be the beginning of a sleep disorder, caused by a disruption in our circadian rhythms, and for many who struggle with this, they seek help in the form of melatonin.

Circadian Rhythms

Circadian rhythms are 24-hour cycles that are part of our body’s internal clock, constantly running in the background carrying out the processes of the body, much like our phones have programs and apps running in the background. Different systems of the body follow different rhythms and these rhythms are synchronized with a master clock in our brains. This clock is activated by the length of the day and other environmental cues which is why these rhythms are tied in with the day and night.

When everything in the body is running appropriately, the circadian rhythm is good, leading to a restful and restorative sleep. But if these rhythms are thrown off, sleep problems begin and can lead to insomnia. These rhythms also influence physical and mental health.

What is Melatonin

Melatonin is a hormone that occurs naturally in the body and is used to regulate our circadian rhythms. Our bodies begin to make this hormone about two hours before bedtime which leads to that drowsy feeling and continues throughout the night to keep us asleep. This production is not necessarily caused by the time, but by the darkness outside.

The pineal gland, located deep in the brain, is the producer of this hormone. When the sun goes down and dusk begins, the pineal gland goes to work and increases melatonin levels, telling your body it's time to rest. As the sun rises, the gland begins to slow down the production of this hormone and the body starts to wake up.

So, given that our own body produces this hormone, most people assume it is safe since it is natural. Because of this, melatonin has become the fourth most popular over the counter supplement in the United States and between the years of 2007 and 2012, its use doubled with more than three million adults using it as a sleep aid. And with the pandemic and stress, reports are that the use of this product has skyrocketed. In general, the use of melatonin is harmless, but it is intended to be used for an abbreviated period as long-term use can result in problems which we will discuss and can result in serious interactions with medications being used for pre-existing conditions.

Where Do Melatonin Supplements Come From?

Supplements, in general, come in two forms - natural and synthetic. If you are taking "natural" melatonin supplements, these come from animals. Using "natural" products are preferred by health-conscious people, but because over the counter products are not regulated by the Food and Drug Administration (FDA), they may be impure and subject humans to viruses from the animal from which it is sourced.

Melatonin comes in several forms

"Synthetic" melatonin is man-made, using chemicals that simulate the molecular make-up of natural melatonin. When adults have sleep problems, using melatonin products raises the levels of the hormone in the body triggering the body to have a better and more restorative sleep. But as mentioned earlier, they are best used in the short term, for those experiencing insomnia, jet lag, sleep phase disorder or shift work sleep disorders.

Melatonin is also helpful for those experiencing certain physical and mental health issues including:

  • Depression

  • Bipolar disorders

  • Schizophrenia

  • Alzheimer's disease and other dementias (but with caution)

  • Pre-surgical or post-surgical anxiety

These supplements are available in liquid, pill, chewable and gummy form.

Melatonin Addiction?

This is not a concern as the body cannot build up a tolerance to it or cause withdrawal symptoms since it is produced naturally, unlike other sleep aids. However, some can experience side effects when using this supplement including:

  • Dizziness

  • Headaches

  • Drowsiness

  • Nausea

  • Daytime sleepiness

  • Anxiety

Some can, but rarely, experience serious side effects such as:

  • Excessive bleeding in those with clotting disorders

  • Depression

  • Stomach cramps

Those with autoimmune diseases should not use this product. More concerning however, are the interactions with other drugs that melatonin use may have.

Drug Interactions and Melatonin

The Mayo Clinic has published a list of drugs that may interact with melatonin and this list should be heeded. They include:

  • Anticoagulants and anti-platelet drugs, herbs, and supplements. These types of drugs, herbs and supplements reduce blood clotting. Combining use of melatonin with them might increase the risk of bleeding.

  • Anticonvulsants. Melatonin might inhibit the effects of anticonvulsants and increase the frequency of seizures particularly in children with neurological disabilities.

  • Blood pressure drugs. Melatonin might worsen blood pressure in people taking blood pressure medications.

  • Central nervous system (CNS) depressants. Melatonin use with these medications might cause an additive sedative effect.

  • Diabetes medications. Melatonin might affect sugar levels. If you take diabetes medications, talk to your doctor before using melatonin.

  • Contraceptive drugs. Use of contraceptive drugs with melatonin might cause an additive sedative effect and increase possible side effects of melatonin.

  • Cytochrome P450 1A2 (CYP1A2) and cytochrome P450 2C19 (CPY2C19) substrates. Use melatonin cautiously if you take drugs such as diazepam (Valium, Valtoco, others) and others that are affected by these enzymes.

  • Fluvoxamine (Luvox). This medication used to treat obsessive-compulsive disorder can increase melatonin levels, causing unwanted excessive drowsiness.

  • Immunosuppressants. Melatonin can stimulate immune function and interfere with immunosuppressive therapy.

  • Seizure threshold lowering drugs. Taking melatonin with these drugs might increase the risk of seizures.

In a 2017 study published in the Journal of Clinical Sleep Medicine, thirty-one supplements were analyzed, and the hormone serotonin was also detected in 26% of the samples analyzed. According to the study, "this could be potentially harmful for some people, particularly those who are taking selective serotonin reuptake inhibitors (SSRIs), antidepressants that increase serotonin levels in the brain. Combining medication or supplements that jointly boost serotonin can cause it to accumulate and reach abnormally elevated levels in the body - a serious condition called serotonin syndrome, which can result in shivering, diarrhea, muscle rigidity, fever or seizures."

"...the hormone serotonin was detected in 26% of [over the counter melatonin supplements] ...when combined with medications that boost serotonin levels in the brain, it can result in a serious condition called serotonin syndrome." ---Journal of Clinical Sleep Medicine

When Not to Use It

The Mayo Clinic cautions that people need to be wary about cavalier attitude towards melatonin, especially if it triggers a negative reaction. This includes those with:

  • Chronic insomnia. Having trouble falling asleep or staying asleep that lasts a month or more shouldn't be managed with melatonin, according to the American Academy of Sleep Medicine and the American College of Physicians. These groups recommend other more proven remedies (a combination of lifestyle changes, cognitive-behavioral therapy and/or medication), noting that there is not enough evidence that melatonin is safe and effective for long-term use.

  • Restless Legs Syndrome (RLS). The tingling or "creepy-crawly" feeling in the legs that often keeps people awake could be worsened by melatonin. The supplement can intensify RLS symptoms because it lowers the amount of dopamine in the brain, according to the Restless Legs Syndrome Foundation. If you've been diagnosed with RLS or suspect that you have the condition, talk to your HCP about lifestyle changes or medications that could help.

  • Dementia. This progressive cognitive deterioration is often associated with insomnia, which can tax both patients and their caregivers. But melatonin may do more harm than good among those with dementia since the condition causes people to metabolize the supplement more slowly, resulting in daytime drowsiness. In people with moderate or severe dementia, melatonin supplementation may increase the risk of falls, according to guidelines from the American Academy of Sleep Medicine.

  • Alcohol and Marijuana use. If you have been drinking alcohol, it's not safe to use this supplement as it can magnify the possible side-effects leading to increased drowsiness and a fall danger. Although little research is available on using melatonin with marijuana, we do know that both melatonin and weed can make you sleepy, so combining the two could potentially lead to more drowsiness and sedation than you expected. Also, there are some suggestions that marijuana use may increase the body's production of melatonin. Again, the research is just beginning.

  • Breast feeding. Melatonin is also not for you if you're pregnant or breastfeeding. Researchers simply don't have enough data to know if it's safe for fetuses or breastfed babies.

It's Not a Permanent Solution

As we stated earlier, melatonin is best for short-term use and should not be used as a solution for a possible sleep disorder. Relying on any drug or supplement could mask a more severe problem. As an example, the inability to sleep could be caused by a more general hormonal imbalance, a mental health issue like depression or anxiety, or sleep apnea, which can lead to a number of health problems including hypertension, stroke, arrhythmias, cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes, obesity, and heart attacks.

"What we do know is that some supplements can be very beneficial for us," stated Attorney Connelly. "But remember, just because it is advertised as a natural product, it does not mean it is totally safe. Supplements contain active ingredients that can cause unwanted side-effects such as elevated blood pressure, racing or irregular heartbeat, headache, dizziness, and even digestive symptoms. This can be especially concerning for seniors who may have a pre-existing condition. Seniors should always discuss taking over-the-counter products with their medical providers so everyone is on the same page."

80 views0 comments