Questions and answers about the use of melatonin: There are many types, with different effects on children and adults

In order not to give us something that is missing, we must remember that, if they do not want the order of "extended release" melatonin, it is a lie.

In collaboration with the ITA

Questions and answers about the use of melatonin: there are many types, with different effects on children and adults

In order not to give us what is not, we must remember that, if they do not ask for a prescription for "extended release" melatonin, it is a fake.

A study published a few days ago in JAMA Network Open found that while melatonin use is increasing among boys and girls, its effectiveness or long-term effects are unknown.It is important to clarify that there are several types of melatonin, with or without a doctor's prescription, and its effects also differ for children and adults.

What is melatonin and how is it used as a supplement?

Melatonin is a neurohormone synthesized by the brain in response to darkness.It regulates the sleep-wake cycle, induces sleep, and has antioxidant and immune system regulatory functions.Light through the "central biological clock", which is located in the hypothalamus and determines the daily rhythm, regulates the synthesis of melatonin through the pineal gland.

Melatonin is useful for sleep or jet lag, but production declines with age.Melatonin supplements are very well tolerated, although medical supervision is recommended for chronic treatment.

Are we talking about the same melatonin product?

No. It is important to remember that there are two types of melatonin:

- Immediate release melatonin: works for about four hours, is useful for promoting sleep and is not subject to a doctor's prescription, so it does not need a prescription, so it has less control than AEMPS.Its regulation is the same as, for example, omega 3 supplements.

- Sustained release melatonin: there are only two brands on the market, it works all night long, especially one of the products, which also induces sleep, and is effective in improving sleep fragmentation.They require a prescription, so they are highly regulated.

Which products have a long-lasting effect?

As you know, when we talk about the true “long action”, remember that there are only two products on the market and the price exceeds 25 euros (it can exceed 30 euros).It may happen that the gradual release is a supplement such as Passiflora, Valerian, etc., or we are told that melatonin, the part that is released gradually, guarantees continuous release over time, without explaining the type of mechanism.Therefore, so that they do not give it to us or not, we must bear in mind that if they are the same, it does not require a prescription for “extended release” melatonin, it is false.

In terms of concentration, do the products contain 1 mg of melatonin?

It should be questioned: the advertised concentration may not correspond to the actual concentration of melatonin.In one study, 31 melatonin-containing products were analyzed and a “significant difference” was observed between reality and advertising (Erland et al., JCSM).

Is it safe for children?

To date, there have been more than 1,100 studies on melatonin in children under 6 years of age, including 41 reviews and 71 systematic reviews, including infants (one of which aimed to provide melatonin to accelerate their growth (Carloni et al., Molecule 2017).

As the author of the article published a few days ago in JAMA Network Open admits, the results of observational studies included in the review may not be generalized internationally, due to differences in access to melatonin products in different national health systems.

Additionally, many studies did not include statistical power calculations and consideration of confounding factors, which could influence the results.Safety has been tested for up to two years and side effects are generally very well tolerated.It is true that short-term, double-blind, randomized, placebo-controlled trials have not shown serious side effects, but we do not have data on their long-term use.However, the widespread use of melatonin products without reports of serious side effects can be seen as confirmation, although this does not justify complacency.

Is it effective for minors?

Thousands of children under age 6 take immediate-release melatonin, which is usually recommended by the primary care pediatrician, although a prescription is not necessary.About 80% receive it inappropriately, based on what we have observed in our Pediatric Sleep Disorders Unit, at La Paz University Hospital (Madrid), in patients with maintenance insomnia (frequent awakenings).In these cases, immediate-release melatonin (over the counter), with or without other supplements, is not effective, mainly because it does not reach the third third of the night.

Where to buy immediate release melatonin without a prescription?

It's like a condom: it's sold in pharmacies, pharmacies, supermarkets, etc. We'll end up getting melatonin from vending machines!From the scientific society related to sleep medicine (SES, SEN, FESMES, AEP, SEPAP, etc.) we claimed that melatonin for immediate release should be considered as a medicine and not as a dietary supplement and always by prescription.

Milagros Merino Andreu Clinical Neurophysiology Specialist and Coordinator of the Neurological Sleep Disorders Unit at the University Hospital of La Paz

This article is provided by the Media Center of Science Spain

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