Melatonin shown to reduce some mental health disorders

Morgan Liotta

11/04/2023 3:18:04 PM

But experts are still cautioning against unregulated use of the treatment without a clinical assessment and prescription.

Teenage girl looking sad on bed
International research suggests that melatonin could reduce acts of self-harm in young people, particularly adolescent girls with anxiety or depression.

Sleep disorders have been linked to mental health issues, particularly in young people, who may have increased risk of self-harm and suicidal behaviour.
Based on this association, a recent Swedish study investigated whether a common medication used for sleep disorders – melatonin – can play a role in reducing risk of self-harm. The findings suggest that among young people it does, but that further research is needed to determine the effects for adults.
In Sweden, melatonin is the most common sleep medication recommended for children and adolescents, study co-author and principal researcher Sarah Bergen wrote in a recently published article promoting the research.
Between 2006 and 2013 melatonin was available in Sweden by prescription-only, and the research team identified more than 25,000 children and adolescents aged 6–18 who started using the medication during this period. Around 87% also had a psychiatric diagnosis at the time, with ADHD the most common, followed by anxiety, depression and autism spectrum disorder.
Intentional self-harm and poisoning was shown to increase shortly before melatonin was prescribed but decrease by about half in the months following commencement of treatment. This decrease was especially evident among adolescent girls with depression or anxiety disorders.
‘To check whether the use of other medications might have affected our findings, we repeated the analyses excluding antidepressant users – the same pattern of results emerged,’ Ms Bergen wrote.
‘This suggests that melatonin might be responsible for the reduced self-harm rates, but we cannot exclude the possibility that psychotherapy or the use of psychiatric medications other than antidepressants may have influenced the findings.’
In Australia, melatonin use for children and young people with sleep issues is on the rise, with ‘gummies’ growing in popularity among parents who source them online.
But experts have previously issued warnings regarding the potential risks of overuse without a prescription, citing limited evidence on long-term quality and safety. And unlike Sweden, it has also only been clinically indicated for sleep problems in children and adolescents within specific cohorts.
‘The evidence is very limited on its efficacy and safety and there can be problems associated with it,’ Chair of RACGP Specific Interests Child and Young Person’s Health, Dr James Best, previously told newsGP.
‘It’s appropriate to use in autism, ADHD and in some developmental disabilities, but apart from those specific populations, it isn’t recommended.’
In 2020, the Therapeutic Goods Administration (TGA) approved melatonin (sold as Slenyto) for the treatment of insomnia in children and adolescents aged 2–18 with autism spectrum disorder and/or Smith-Magenis syndrome, where ‘sleep hygiene measures have been insufficient’. For anyone else under the age of 55 experiencing sleep issues, a prescription is required.
The TGA does not recommend melatonin for children who do not have the above conditions due to a lack of research. According to clinical sleep psychologist and Head of Paediatric Sleep Research at CQUniversity Professor Sarah Blunden, this is because ‘most child sleep problems’ can typically be managed with behavioural and psychological sleep techniques instead of medicines.
Professor Blunden is among more experts who have come forward cautioning against unregulated use, saying that melatonin should always be prescribed by a GP or paediatrician who can also monitor progress and side effects.
She says there are ‘very few’ long-term studies on how safe melatonin is in otherwise healthy children, and even less on the quality and safety of melatonin bought online, where the exact quality or quantity of melatonin present in the gummies is uncertain.
In recent years Professor Blunden has seen an ‘exponential rise’ in melatonin use among children, with many sourcing it from the US where it is freely available without a prescription.
‘It is really dangerous that these children are being given drugs that are not indicated for that particular purpose [to aid sleep] … are sometimes not even regulated and [that we don’t] know what is in them,’ she told the ABC.
‘Between 50–70% of the people I see are on melatonin, which is amazing considering five years ago this wasn’t a thing.’
Australian guidelines state that for most children with sleep problems, there is ‘a specific cause which should be identified and treated before melatonin is considered as an option’.
Other experts recognise GPs’ custodianship role in identifying and managing anxiety and other mental health disorders in children, and determining the benefits of appropriate medication and other interventions.
For related sleep issues, while Dr Best recognises it is ‘a common problem’ in children, melatonin is ‘a quick fix’ and should be used with caution.
‘Sleep in children is challenging, but there should be a behavioural approach,’ he said. ‘It’s the GP’s role to have the skills to advise parents to do it or refer to other resources.’
Professor Blunden’s comments echo those of Dr Best – that any medication should be carefully considered before being prescribed to children, and to avoid sourcing melatonin online or from other non-regulated sources.
‘The quick fix is really very tempting but it does not [help in] getting to the crux of the problem,’ she said.
‘We don’t know where it has come from [if bought online] and we don’t know what the long-term effects are, so we have to use it with caution.’
In the Swedish study’s findings, the ‘likely primary reason’ for melatonin having an impact on reducing self-harming behaviours among adolescents is that better decisions are made when people are well rested.
‘Treating the sleep problems that often accompany anxiety and depression may lead people to have fewer thoughts about harming themselves or to choose not to act on these thoughts when they occur,’ the authors wrote.
The authors conclude that while sleep interventions such as melatonin could be considered to reduce sleep problems and associated risk of self-harm among adolescent females with depression and anxiety, a doctor should always be consulted before starting any new medication, even if it’s available without a prescription.
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