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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Bekka H. on April 9, 2002, at 23:16:00
Hi everyone.
Several years ago, Melatonin became very popular, primarily from all the media hype. As time has passed, it is clear that Melatonin isn't the cure-all it was touted to be in the mid-90s. I understand that it is helpful for re-setting your circadian rhythms by an hour or two if you travel overseas, but what about its use as a sleep aid? Does anyone here use it to help them fall asleep on a regular basis? If so, do you combine it with other meds? How much melatonin do you take (in milligrams or micrograms)? I remember reading that the currently available over-the-counter doses are much too high. Is it safe to combine with other meds? I wonder whether there is a greater danger of serotonin syndrome if Melatonin is combined with a medicine that increases serotonin levels?
Any ideas, thoughts, experiences appreciated.
Bekka
Posted by Ron Hill on April 11, 2002, at 14:49:43
In reply to Melatonin questions, posted by Bekka H. on April 9, 2002, at 23:16:00
Hi Bekka,
> Several years ago, Melatonin became very popular, primarily from all the media hype. As time has passed, it is clear that Melatonin isn't the cure-all it was touted to be in the mid-90s. I understand that it is helpful for re-setting your circadian rhythms by an hour or two if you travel overseas, but what about its use as a sleep aid? Does anyone here use it to help them fall asleep on a regular basis?
About a year or so ago, I used sublingual melatonin regularly as a sleep aid. Oral administration provided little or no sleep aid benefit but the sublingual form worked fairly well, sleep wise. However, at the time, Scott (SLS) warned me that long term use of melatonin can cause depression and, for me, it turned out that Scott was correct. After a few months of using melatonin on an as needed basis, I began to observe a positive correlation between melatonin use and a worsened depressive mood. The next day, following melatonin administration as a sleep aid, I would feel more depressed. The PB archives contain some pretty good information on melatonin.
>If so, do you combine it with other meds?
I'm BP II so I was using it with Lithobid and various AD trials. IMHO, I don't think there were any drug-drug interaction problems.
>How much melatonin do you take (in milligrams or micrograms)?
I typically took a 2.5 mg sublingual tablet to get to sleep. However, for a little while I was taking a 2.5 mg sublingual tablet up to three times a night to put myself to sleep, and back to sleep, and back to sleep again. After I recognized the connection between the melatonin administration and my worsened depression, I started taking one-half of a tablet per night. But even at the lower dose, I still felt it was worsening my depression to a small degree.
The failed AD trials and my bipolarity were causing the insomnia. IMHO, insomnia and hypomania (or mania) are dancing partners and either of the two is capable of leading the dance. Therefore, I was taking melatonin to try to get good sleep and, as a byproduct, stabilize my mood.
>I remember reading that the currently available over-the-counter doses are much too high.
Yes, I’ve read that added benefits do not occur in doses above 1.0 mg.
>Is it safe to combine with other meds?
Based solely on my experience, I think it is safe, just not advisable for chronic administration.
>I wonder whether there is a greater danger of serotonin syndrome if Melatonin is combined with a medicine that increases serotonin levels?
Personally, I don't so, but I'm no doc.
> Any ideas, thoughts, experiences appreciated.
Roughly five months ago I started taking SAM-e and it has been great in a number of ways. On of its beneficial effects is it allows me to sleep GREAT! I take 600 mg/day Lithobid and 200 mg/day SAM-e. I (layman) think that the methylating agent SAM-e improves my sleep via at least two mechanisms. First, it allows my body to synthesize more serotonin, and second, it aids in processing melatonin. One cautionary note, do not take SAM-e later than about 5 pm because it can cause insomnia (at least it does for me). What follows is a paragraph from a Newsweek article on SAM-e that briefly discusses the SAM-e/melatonin connection. Also included is a link to the entire article.
SAMe (known formally as S-adenosylmethionine) is not an herb or a hormone. It's a molecule that all living cells, including our own, produce constantly. To appreciate its importance, you need to understand a process called methylation (chart). It's a simple transaction in which one molecule donates a four-atom appendage—a so-called methyl group—to a neighboring molecule. Both the donor and the recipient change shape in the process, and the transformations can have far-reaching effects. Methylation occurs a billion times a second throughout the body, affecting everything from fetal development to brain function. It regulates the expression of genes. It preserves the fatty membranes that insulate our cells. And it helps regulate the action of various hormones and neurotransmitters, including serotonin, melatonin, dopamine and adrenaline. As biochemist Craig Cooney observes in his new book, "Methyl Magic," "Without methylation there could be no life as we know it."
http://www.biopsychiatry.com/sameart.html
-- Ron
Posted by Bekka H. on April 11, 2002, at 21:30:19
In reply to Re: Melatonin as a sleep aid » Bekka H., posted by Ron Hill on April 11, 2002, at 14:49:43
Hi Ron,
Thank you for your reply. Yes, I was concerned about the possibility of my depression being exacerbated by melatonin because I find that my depressions are MUCH worse on SSRIs. I found a flow chart of the synthesis and metabolism of serotonin, and I see that melatonin is synthesized FROM serotonin in the pineal gland. Since I tend to sleep excessively on SSRIs, I wonder whether too much melatonin is being made???
Thanks again.
Bekka
Posted by Ron Hill on April 11, 2002, at 22:10:24
In reply to Melatonin as a sleep aid - Ron Hill, posted by Bekka H. on April 11, 2002, at 21:30:19
Bekka,
>Yes, I was concerned about the possibility of my depression being exacerbated by melatonin because I find that my depressions are MUCH worse on SSRIs.
Me too, if you mean an increase in anergy and anhedonia. SAM-e saved my life in this regard.
>I found a flow chart of the synthesis and metabolism of serotonin, and I see that melatonin is synthesized FROM serotonin in the pineal gland.
Interesting. Do you have a URL link to share?
>Since I tend to sleep excessively on SSRIs, I wonder whether too much melatonin is being made???
I also slept excessively on SSRI's. Your question is very intriguing. However, I attribute the SSRI induced anergy (including sleepiness) and anhedonia to low dopamine. Whatever the cause, SAM-e fixed it for me.
-- Ron
Posted by Bekka H. on April 11, 2002, at 22:32:48
In reply to Re: Melatonin as a sleep aid » Bekka H., posted by Ron Hill on April 11, 2002, at 22:10:24
> >I found a flow chart of the synthesis and metabolism of serotonin, and I see that melatonin is synthesized FROM serotonin in the pineal gland.
>
> Interesting. Do you have a URL link to share?I don't have a link because I found it in a book, PSYCHOPHARMACOLOGY: FROM THEORY TO PRACTICE, edited by JD Barchas, PA Berger, RD Ciaranello, et al. It's old -- it was published in 1977. There is a diagram of the serotonin pathway that begins with tryptophan, which is transformed to 5-hydroxytryptophan, which is transformed to 5-hydroxytryptamine, which IS serotonin. From there, serotonin can follow several different pathways, and one of those pathways, which occurs in the pineal gland, is for serotonin to be changed into N-acetylserotonin, which is then changed into Melatonin.
> >Since I tend to sleep excessively on SSRIs, I wonder whether too much melatonin is being made???
>
> I also slept excessively on SSRI's. Your question is very intriguing. However, I attribute the SSRI induced anergy (including sleepiness) and anhedonia to low dopamine. Whatever the cause, SAM-e fixed it for me.
> -- RonYes, I think you are right about the low dopamine levels causing anergy and anhedonia. In PROZAC BACKLASH, Joseph Glenmullen, M.D. cites a number of studies in which SSRIs caused lowering of dopamine levels by at least 50%!!
Bekka
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