Melatonin, in the minds of most people, is a cross between a sleeping pill, a dietary supplement, and something coloring. The latter is explained by the consonance in name with the pigment melanin, which is responsible for the color of the skin and hair in humans. Meanwhile, melatonin is a hormone, which means that it is involved in many processes in the human body, many of which have little to do with sleep.
What is melatonin
Melatonin is the main hormone of the pineal gland, the pineal gland of the brain. It is also produced by lymphocytes and enterochromaffin cells located in the gastrointestinal tract (GIT) — in particular, in the pancreas and hepatobiliary system (organs that form bile). Moreover, the level of melatonin in the intestine is 10–100 times higher than in the blood, and 400 times higher than in the pineal gland.
Accordingly, they say:
epiphyseal (central) melatonin and
paracrine (regional, peripheral) melatonin.
If you completely block the body’s ability to receive central melatonin from the pineal gland, then the peripheral one will not go anywhere and will continue to work. Therefore, scientists believe that one of the functions of melatonin is the coordination of cellular functions at the level of individual organs.
In addition, melatonin is the oldest antioxidant (and it is stronger than vitamins C and E), which is found in almost all living organisms on Earth. So along the way, it can perform protective functions, protecting individual organs and tissues from oxidative stress.
Melatonin levels decrease during a person’s life for the following reasons:
Increased body mass index.
Considering the issue of using melatonin to influence the body from the outside, we should talk about:
endogenous melatonin, which is produced in the body and
exogenous melatonin, which a person enters in the form of drugs.
Melatonin and biological rhythms
Melatonin is a key element of the “molecular clock” of all animals on Earth. The maximum production of melatonin in the pineal gland falls on the dark time of the day (200 pg/ml and more), and the minimum — on the light day (no more than 10 pg/ml). The pineal gland is associated with the suprachiasmatic nuclei of the hypothalamus, which are the circadian pacemaker, that is, they are responsible for fluctuations in various body functions during the day.
The main task of melatonin is the synchronization of biological rhythms and the observance of daily periodicity. Moreover, melatonin allows you to build in a single rhythm not only the “sleep-wakefulness” system, but also the systems responsible for memory, thinking, logic and human emotions — maintaining them in working condition is part of a healthy lifestyle.
Scientists believe that it is this ability that makes it possible to use the exogenous melatonin preparation to combat the manifestations of desynchronosis (disturbance of daily human biorhythms) during flights between different time zones, to treat sleep disorders and some mental disorders.
Other abilities of melatonin
Melatonin receptors are found not only in the gastrointestinal tract, but also in the myocardium (heart muscle), in vascular and blood cells. This diversity indicates a high level of melatonin versatility. For example, hormone receptors have been found on the surface of certain immune system cells. Therefore, it is an immunostimulant, and is also involved in the regulation of seasonal and lunar cycles in humans.
In general, it is a mistake to consider melatonin a hormone that can only be used to treat sleep disorders. The effectiveness of melatonin has been demonstrated in traumatic brain injury, epilepsy, Alzheimer’s and Parkinson’s diseases, hypertension, angina pectoris, certain types of arrhythmia, certain types of depression, eczema, glaucoma and cataracts, and also as part of complex therapy for certain types of cancer.
Scientists are also paying special attention to the ability of melatonin to reduce the side effects of various pharmacotherapies. Melatonin is successfully used for various kinds of intoxication: from drug overdose to poisoning with industrial poisons or salts of heavy metals.
It should be remembered that melatonin is a hormone. So, epiphyseal melatonin can affect the work of some endocrine glands, for example, the production of hormones by the adrenal cortex. That is, we can say that, in addition to its direct effect on many body systems, melatonin also has an indirect effect, starting the production of other hormones.
Melatonin and sleep
Practice has shown that taking melatonin preparations really helps a person fall asleep. And the lower the level of his own, endogenous melatonin, the stronger the effect of the external, exogenous drug. But at the same time, the duration of sleep does not change. But the combination of melatonin with other drugs (benzodiazepines) improves sleep quality, duration, reduces the time to fall asleep and the number of night awakenings.
In addition, the effect of melatonin is highly dependent on what time of day it was taken. So, if the patient received melatonin in the first half of the night or right before bedtime, then the phase change of his circadian rhythms occurs faster. If the drug was taken in the second half of the night or in the first half of the day, then the phase change of circadian rhythms, on the contrary, occurs later. Therefore, the best time to take the medicine is the time of 22–23 hours.
Benefits of melatonin preparations
Melatonin is not a foreign substance for our body, we ourselves know how to produce it. Therefore, it is quite safe as a drug — even high doses (100–150 mg daily) do not lead to an overdose.
Melatonin is a hormone. Even in small doses (3–5 mg) it gives a real clinical effect, for example, in the fight against insomnia.
Disadvantages of melatonin preparations
Lack of evidence for safety and efficacy.
Too few observations have been made when taking the drug, so that it can be considered with 100% certainty that it is absolutely safe and, moreover, effective.
Atypical dependence of the effect on the dose of the drug taken.
For most drugs, dependence is observed: a larger dose — a stronger effect, up to an overdose. Not everything is so simple with melatonin: starting from a certain dose, the effect not only decreases, but can even take on negative values. During the experiments, it was found that at certain dosages, melatonin, which had just protected against oxidative stress, on the contrary, began to increase stress manifestations. According to other studies, the hypnogenic effect of melatonin will be higher if you take a dose 10 times smaller than what is recommended by doctors today.
The need to analyze the initial hormonal background.
Since melatonin is produced by the person himself, before prescribing its introduction from the outside, it is necessary to determine not only the content of the hormone in various human biological fluids, but also to calculate the curve of the daily production of epiphyseal melatonin.
duration of treatment.
To achieve a real effect, long courses of treatment (3–4 months) are required.
Weak directional effect.
Melatonin works best in combination with other drugs, more traditional for the treatment of the same insomnia.
Lack of control.
Melatonin is involved in a huge number of biochemical processes in the body. It is impossible to control them completely. But you need to understand exactly that when taking a hormonal drug, we trigger dozens, if not hundreds, of reactions, most of which we actually do not need at the moment.
Melatonin in the body is designed mainly to adapt to changing environmental conditions. In ordinary life, it should be used to treat desynchronosis and to adapt to night shift work.
It is best to use melatonin as an additional drug as part of complex therapy.
You can not prescribe yourself melatonin on your own, without examination and tests, without the recommendations of a neurologist.
You should not only carefully calculate the dose, taking into account the mass of influencing factors, but also take the drug at a strictly defined time of day, so as not to get the opposite effect.
Mashilov Stanislav Kirillovich, neurologist of the network of medical centers I CURE
Melatonin preparations have been widely used in clinical practice since their appearance. The main indications for its appointment are the so-called “desynchronoses” (“jet lag”) — sleep disorders with a rapid change in time zones as a result of flights, as well as due to work on night shifts.
In sleep disorders not related to the above reasons, the effectiveness of this drug seems to be very modest. However, melatonin is considered as a treatment for sleep disorders in the elderly associated with age-related changes in the metabolism of this hormone in the body (again, if insomnia is not associated with other pathological conditions). When taking melatonin on a course, it is important to remember that the optimal time for taking it is 22–23 hours, which corresponds to the daily rhythm of its production in the body. In general, the drug has not established itself as a “panacea”, and its appointment requires a clear definition of indications.
Summing up, I would like to say that sleep disorders, especially long-term ones, are characterized by a large variety of causes, therefore their treatment is a complex task, requiring a careful and versatile assessment by the doctor of the patient’s condition.
Sergey Alexandrovich Beshkarev, neurologist, CDC Medsi
I will answer the main question right away — of course, “for”, “against” — only if there is no effect from the drug. The drug Melaxen (active ingredient melatonin) works great, especially in young and not “neglected” patients. And then, the meaning of the word “against” is not that the drug will harm the patient or have some side effects, but that in the absence of the effect of melatonin in this particular person, it is necessary to solve his problem with disturbed sleep more widely. and complex than just taking a drug that promotes falling asleep.
Has anyone wondered what the main physiological cause of sleep disturbance is? My practical experience shows that for the first time a sleep disorder occurs in people in the range of about 40–50 years. True, now the lower limit of age against the background of the realities of our life tends to decrease.
The fact is that by the age of 35–40, many people experience significant changes in the cervical spine of a degenerative nature, while the blood flow through the vertebral arteries, which supply blood to the autonomic centers of the brain, is pronouncedly affected. And sleep is a manifestation of a normally functioning autonomic nervous system. Under conditions of chronic hypoxia of the vegetative centers and, above all, the hypothalamus, due to deficient blood supply to the brain through the system of vertebral arteries, disturbed sleep becomes one of the first manifestations of serious malfunctions in the autonomic nervous system. These are the cases when melatonin does not help.
Therefore, in a 40-year-old person, taking into account the age and individual degree of “wear and tear” of the cervical spine under conditions of permanent stress, overwork, with a rather long winter and a long absence of sun in our geographic latitudes, the problem of improving sleep should be approached somewhat differently. In any case, it has been noticed that those who regularly work out in the gym “for health” have practically no problems with sleep disturbance.