Melatonin - should I?

November 7, 2015 1:48 AM

Melatonin is prescription only in the UK, but having heard many USians talk about how it helps with sleep, I:m tempted to pick some up when I visit the US. However, is it generally OK to take if you are taking drugs for a mood disorder?

Background: bipolar II, am taking sertraline and quetiapine. Despite the quetiapine making me more tired, I have periods where I struggle to sleep through the night - often at weekends I wake very early and end up getting a headache, then returning to work on Monday feeling still exhausted. I have heard people say melatonin helps, and it appeals as it isn't habit forming in the way I worry 'sleeping tablets' are.

Aside from having rubbish weekends, it can be difficult to concentrate on things and lack of sleep has triggered hypomania in the past. Ibam guilty of drinking a lot of tea (because I like it, and to mitigate the quetiapine hunger) but switching to decaf didn't have a noticeable effect. I have mentioned this to my GP (I've been waiting to see a psych for a routine since goddamn March) and they have advised looking at sleep hygeine over yet more medication. It's really frustrating, though.

In the UK it's POM prescribed only to the over-55s for some reason, so I haven't been able to try it out and see how it works. (Obviously I will check it's fine for me to bing home...) Advice welcome!

posted by mippy to Health & Fitness (17 answers total)

You might be interested in talking to your psych (when you get in) about Agomelatine, an antidepressant that acts on brain receptors for melatonin in a way that helps with insomnia.

http://www.nps.org.au/medicines/brain-and-nervous-system/antidepressant-medicines/agomelatine
posted by Year of meteors at 2:11 AM on November 7, 2015

I take SSRIs. It made me depressed. But here more than anywhere else, YMMV.

What about Trazodone?
posted by persona au gratin at 2:29 AM on November 7, 2015

Ask your doctor about "Nortriptyline". It's an older SSRI that didn't do much for depression etc, but works a treat for sleep. I've been using it for several months and it works great with no side effects.
posted by james33 at 2:53 AM on November 7, 2015 [1 favorite]

Setting aside questions of safety and effectiveness, is it practical to try a medication that you might not easily be able to get in your home country? Melatonin can help with sleep problems, but at least in my experience it hasn't been such a miracle drug that it would be worth figuring out how to circumvent POM restrictions to be able to take it on an ongoing basis.
posted by teponaztli at 3:06 AM on November 7, 2015 [1 favorite]

have you tried talking to your doctor about this? obv it depends on your doctor, but in my experience they can be pretty open to you experimenting, if they feel that the risks are low (in my case, for example, i've asked about cannabis use in a country where it's illegal). and if they say no, you can ask why (i'm assuming you've already talked about the problems you have, because it may be that they can address that in other ways).

in your position i would do that, and then perhaps (assuming they don't have any other fix, and they did not give a convincing argument why not) try it. but i wouldn't get your hopes up - my partner thinks it helps a little with jet lag, but i've not noticed it have any effect (we bought a bottle in the usa one trip).
posted by andrewcooke at 3:19 AM on November 7, 2015

I've tried melatonin (MDD/BPD is my dual diagnosis, and have been on and off SSRIs; tried Seroquel once and never again), did exactly nada for me. Trazodone was a godsend.
posted by feckless fecal fear mongering at 7:37 AM on November 7, 2015

As someone who has been on tons of meds, I would urge caution before adding more meds. Melatonin may be ok. Seeing a naturopath may be a good idea. Before anything, I'd do the obvious - try to exercise and eat healthy and limit/eliminate caffeine. Minimizing sugar would be a good idea. Try not to watch tv before bed etc. All the obvious things for getting better sleep.

It seems like everyone advocates taking meds like it is no big deal. In all of my research and personal experience, meds are a huge wild card. I am not saying that people should never take them, but I would always try to resolve the issue without adding more meds. Psychiatrists aren't infallible and most of the ones that I have seen aren't all that knowledgeable. Seems like a broad statement, but it is the truth. My adrenals got so far out of whack and I ended up with cortisol levels that were through the roof.

Again, just food for thought. I wouldn't say that you shouldn't try meds, but just don't be cavalier about it. I would google naturopath sleep aids before anything and go from there
posted by kbbbo at 12:48 PM on November 7, 2015 [1 favorite]

Since you know you have bipolar II, adding more rx meds is a bad idea when you're generally stable - especially tcas like nortriptyline or amitriptyline, which tend to promote manic type episodes in bp I.

Melatonin works pretty well in 50% of people for sleep initiation or abnormal sleep cycles. Maintaining sleep is very often a problem of ongoing anxiety or environmental factors - noises or bring too warm. You note your sleep seems more off on the weekend - if I'm reading this right - which says to me that this might be a sleep hygiene thing - keeping different hours and habits on Friday and Saturday nights.

Take your sertraline in the morning if you aren't, remove the tv/media from the bedroom, find a non-caffeinated herbal tea that is bedtime-only (make it part of your sleep ritual).

The other thing to do medically is to consider with your prescribes if your sertraline dose is right. It's got a pretty wide dose range compared to other SSRIs.
posted by cobaltnine at 1:56 PM on November 7, 2015

I would ask your doctor whether 5-HTP or melatonin is preferred in your case. I like plain old L-tryptophan (500mg) or 200mg of 5-HTP, which your body will eventually convert into serotonin and then melatonin. In many cases it's better to ingest precursors and then let your body produce the appropriate regulated amount of potent neurotransmitter. There is some concern about doses of melatonin above 1mg, so definitely do some homework and find out whether it's ideal to skip the serotonin / tryptophan conversion process and use melatonin.

Also check out theanine for relaxation and pre-sleep. It's a super mild GABA-effecting supplement from tea that is often helpful in bipolar or anxious patients. I also take "ZMA" every night, which specifically is zinc and magnesium but also has D-aspartic acid which in men supposedly helps create testosterone (I'm pretty certain that when my body converts too much testosterone into estrogen, I become angry-depressed), whereas the magnesium helps me relax to sleep (and may soften your stool, especially at first) and keeps me from having charlie horses in my anxiously tense super-calves, and the zinc also helps with male virility and recovery from intense exercise.
posted by aydeejones at 4:27 PM on November 7, 2015

Also ZMA is often used by women, who have a little testosterone too and benefit from the right balance. But mainly it's about replenishing your mineral levels after stress or exercise, and the woman dose is typically 2/3 the men's dose. I only bring it up because it's also supposed to help with other restless symptoms experienced either by the anxious, RLS, fibromyalgia, etc.
posted by aydeejones at 4:30 PM on November 7, 2015

Also do some research on which teas (brands, formulations etc) have the most theanine. It's an indicator of quality and hard to find in large amounts without supplementation, but if you like tea anyway, doesn't hurt to get something that helps you relax along with the caffeine. In fact, caffeine and theanine synergize so well that they are referred to in combination as "the people's nootropic" in smart-drug circles.
posted by aydeejones at 4:32 PM on November 7, 2015 [1 favorite]

I share your diagnosis, here's some anecdata.

My cocktail includes SNRI, tricyclics, lamatrogine, benzodiazepam. My psych said to go slow when trying melatonin. I used the self-assessment tools provided by the Center for Environmental Therapeutics to plan when to take the melatonin, which is crucial to maximizing its affects. I use a liquid preparation which makes it easier to titrate up to a useful dose (currently 1.0mg, started with 0.25mg).

Melatonin made it much easier for me to fall asleep, especially combined with bedtime meditation. But now I must turn off my screen if I want to fall asleep in 90 minutes.
posted by Jesse the K at 6:36 PM on November 7, 2015

Without being on any other drugs, I tried melatonin at a time when I felt I needed better sleep than I was getting.

The result was a horrific and seemingly infinite night of vivid lucid dreaming that ended with me as wretched and exhausted as I have ever been. It felt like I had run several marathons in my sleep.

The stuff reacts differently for different people, so be careful.
posted by instead of three wishes at 9:15 PM on November 7, 2015 [1 favorite]

I'd skip it. Melatonin's not that helpful for sleep maintenance in my experience, and I remember being advised at one point that there's some theoretical risk of serotonin syndrome taking it on top of an SSRI.
posted by en forme de poire at 11:12 PM on November 7, 2015

Be careful with 5htp. There is the risk for Serotonin Syndrome when mixed with other stuff.

You may want to look into MTHFR and your genetics snps. Methylfolate and b12 and 5htp help me sleep
posted by kbbbo at 7:55 AM on November 8, 2015

Yeah seconding the 5HTP warning, that one is a lot less ambiguous of a risk factor than melatonin even.
posted by en forme de poire at 2:13 PM on November 8, 2015

No. Nope. Not until you've consulted with a psychiatrist.
posted by listen, lady at 4:08 PM on November 28, 2015