Comment by vvpan | Hacker News Reader

Comment by vvpan | Hacker News Reader

Melatonin is very interesting because it is believed that all living things (bacteria, fungi, etc) have it [1]. Calling it a "sleep aid" is somewhat off because in humans and other animals it is compound heavily involved in modulating circadian rhythms. It is not a "drug".

And a little personal anecdote about it: I have gone through a period of bad sleep and depression and was taking melotonin to help with sleep. On some mornings I would wake up completely emotionally destroyed, barely able to function. After observing the patterns for a few months I notice that this happened only on days after melotonin intake. Looking around the internet I've found stories of people describing exactly the same symptoms as I've had mornings after melotonin ingestion. Long story short I am likely not taking melotonin ever again and regret ever doing so. Sometimes I even wonder whether it generally exacerbated or even caused my condition at the time. I think research on this is scant atm.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481276/

I wonder about the dosage you might’ve been taking. Many, many people take much more than needed, and higher doses are more likely to have adverse effects. 250-300 µg is an appropriate dosage for most adults. Note that common over-the-counter dosages are 10 to 25 mg. There is a Cochran collaboration meta-analysis supporting this.

I work in a pharmacy school in the US. One of my colleagues told me a funny anecdote about traveling in Great Britain. He had forgotten his melatonin, so went to a pharmacy to get some. The pharmacist told him that it was only available with a prescription, being a neurohormone. But here’s some promethazine OTC. That’s Rx only in the US.

I think that's super reasonable and I have no record or memory of dosage, sadly. Although nowadays I approach such things from a very different angle: why do I think I need to medicate at all? Why am I, a relatively young and healthy person, not sleeping well? Jet lag in my book is not a strong enough reason to self-medicate, just suck it up and learn to enjoy early mornings =)

I have been reading a book about biological effects of daylight and how little sun a modern person is exposed to on a daily basis. There has been more research on the topic, especially since a recent research on receptors in the eye responsible for detecting gradual changes in daylight (ipRGCs). Spending more time in the daylight might be a better way to self-medicate.

My own two cents on melatonin at low (.5mg) dosages: it helps me go to bed and keep a reasonable circadian rythm 100x better than any sleep hygiene trick. Without it I have racing thoughts for hours and no sleep pressure on a 24 hour cycle. It's a great boon for me, a healthy normal person.

10-25mg seems really high. UK NHS advice is 2mg for sleep, 3mg for jet lag, w/advice it can be increased to up to 10mg if you don't get the desired.effect at lower doses.

For my part, 3mg leaves me totally ruined (exhausted, lethargic, worse than being ill) the following day. 1mg seems to improve my sleep, but I can totally believe less would work too. I will certainly not go higher.

UK is weird with this - I can order all kinds of stuff from abroad that I can't buy OTC here, but there's also another recent "workaround": online pharmacies here can sell you a variety of prescription drugs provided they ask you the appropriate questions and have a prescription issued as part of the sales process. Got my last melatonin that way.

I can tolerate 3 mg very well, 5 mg seems to be the bridge too far, where I wake up exhausted and lethargic.

I experimented with higher doses, such as 15 mg. They worked like sledgehammer to the forehead, with a weird feeling the next day. Not recommended. A good sleep mask and ear plugs are better than increasing dosage of melatonin, at least for me.

Here in CZ, melatonin is OTC.

In addition to the same 3mg, I ask my Google Home (the first "mini tower", not the puck) to "play the sounds of the ocean" + run an older, slightly noisy purifier (mainly for the white noise, have other much better filtering purifiers in the house that are just too quiet!). Putting my phone away, after a few pages of a novel in my Kindle 11 SE (warmest setting ) I'm dead asleep.

My level of tiredness in the morning seems mainly linked to hours of sleep + how heavy I lifted the day/s before.

(I should trial 1mg as well.)

At lower dosages it acts to nudge your body to feel drowsy.

At higher doses it has a soporific effect similar to other more powerful sleep medications.

I and my family use it to help with long jetlag but just for the first few days.

It can be frustrating finding it in reasonable doses. I remember reading somewhere that the original formula was quite a small dose and other manufacturers simply increased the dose to get around the patent. Naturally, people showed a preference for the higher doses because they assumed it must be better, despite a lack of evidence. As a result, manufacturers making pills with a more reasonable dose were less likely to sell their product and a general trend of increasing doses was observed. This is why it’s easy to find 10-25mg dosed pills in stores, but difficult to find anything sub 3mg, let alone sub 1mg.

Melatonin in the US is frequently found in 5 or 10 mg doses, which is a huge amount and can cause adverse reactions in people. A better dose is 0.3mg (300 mcg) or 0.5mg (500 mcg).

General problem with "supplements" I imagine.

It seems to be particularly bad with Melatonin, because a lot of people do really badly with big doses. A 3mg dose makes me more exhausted than I've ever felt before melatonin. I tried A couple of times. Never again. I wrote it off until someone pointed out this isn't unusual with doses that high. 1mg dose is fine. I can't image how I'd have felt with a higher dose.

Also, a supplement being labled "500 micrograms" has no requirement to be correct. The FDA has handwaved away the entire industry, and broadly there is zero quality control for actual active ingredients. Many supplements will claim that they've been tested, but there's no legal requirement to do so, the labs are usually owned by supplement makers, and there's no penalty for lying about any testing as fraudulent marketing claims largely go unpunished because the US judicial branch chooses to interpret the law stupidly conservatively

It' a general problem with the US.

That explains a lot. I have a bottle of 5mg pills and I found out I could still feel the effects when I would take a tiny “nibble” of the pill. So over the course of a bad sleep week I would slowly consume a single pill. This bottle is a lifetime supply, assuming it doesn’t degrade.

Isn’t a drug just anything that affects how your body functions? It doesn’t have to be something that your body wouldn’t have in it anyway

I’m no doctor but I think the difference between a drug and a hormone is that a drug is a foreign substance you take to affect the way your body functions while a hormone is something produced endogenously to regulate various processes in the body.

People need to understand that melatonin is a hormone and that comes with different risks and issues than a drug.

Drugs and hormones aren't separate groups either. Melatonin is a hormone which is also sold as a drug. Additionally, some hormones are wholly artificial; many of the estrogens and progestins which are used for birth control fit that description.

Nah, there are drugs that already exist in the body (such as the extremely strong psychedelic DMT, which naturally occurs in tiny amounts within human brains and within many other animals and plants).

There isn't a hard scientific boundary of what substances count as a "drug", and if a hormone is being taken as a pill to affect a human then it is being used as a drug.

There is no concrete definition of "Drug". Most working definitions are "Something that affects you, but isn't food".

Nor is there a concrete definition of hormone.

Drug: Chemical that affect you (by ingesting), but isn't food.

Hormone: Chemical that affects you.

They are not mutually exclusive. A drug may be a hormone and hormones may be endogenous or exogenous. For example, oral contraceptives are drugs which are exogenous hormones.

One may think of the neuroendocrine system as the body's event system. Hormones are the event signals. Where they're emitted from doesn't particularly matter, the key is they're flowing and circulating to places and producing observable effects on any tissue with the appropriate interfaces which range from cell membrane receptors to nuclear receptors.

You are probably correct, I honestly do not know. What I meant is that there is an association between melatonin and sleep and there is _some_ research on it as an effective medicine but the quantity of it (to my untrained eye) is limited. So when people take it they generally take it as an over-the-counter supplement with some hope for uncertain effects because "it's the thing in the body that regulates sleep". Thus the quotes around "drug".

Sugar affects how your body functions too.

So homeopathy pills are drugs!

The dosage of melatonin you can buy over-the-counter in the US always surprises me. In the UK I believe it’s only 2mg with a prescription, but I was seeing 5mg+ just in a grocery store.

Behold the new target market: children at 1mg [1]. The US markets melatonin as a vitamin.

I really have no clue on the long term adverse effects, but having used 5mg as a sleeping aid for a bit, one thing is for sure: melatonin is really not for OTC child use.

I'm shocked that this is legal!

[1] https://www.target.com/s/kids+melatonin+gummies

My friend, a children’s psychiatric nurse, said they offer something like 0.2mg doses for kids in their care. 1mg is huge!

Yes, let’s make everything illegal, so you have to pay somebody to give a prescription to you any time you need anything. Somebody else always knows better what is good for you! Especially it will help poor people, which already shop at veterinary stores instead of pharmacies.

Part of the problem historically (into the 2010s) was that MIT had a patent on doses of melatonin under 1mg[1]. So manufacturers could only avoid the patent by selling larger doses. That patent is expired but to some extent customers probably still think more is better.

Personally, I use a fairly large dose of melatonin daily without ill effect; and it works better for me than smaller doses.

[1]: https://patents.google.com/patent/US5641801A/en

I've seen few better examples of what's wrong with the patent system than this.

Up to 2mg for sleep, 3mg for jet lag in the UK. 3mg affects me badly - I take at most 1mg.

I had much better results with tryptophan than melatonin in sleep quality.

Taking melatonin for me resulted in top many random grogginess or waking early in the middle of nights.

How were you taking it? My psychiatrist recommended that I take it 12 hours before I want to wake up and really only recommends 1 mg or so.

Honestly, I do not remember. A few years have elapsed. I did not do so in any thoughtful way - there was a supplement in pill form and I took it in the evening. Pretty much the only time in my life I self-medicated with something. I would say just observe how it makes you feel, keep a diary? At least out of curiosity rather than caution. If you find it makes you feel better then that's great. (Of course subjectivity is a problem in this case).

Just taking melatonin vs not taking it isn't the only decision space. There's a lot that goes into taking it to make it work. I've never done so but I understand this to be the case from reading this [0].

[0] https://slatestarcodex.com/2018/07/10/melatonin-much-more-th...

I believe it. I guess my takeaways are:

* Be cautious, effects of taking a hormone are complex and it can be more potent than might be evident at first.

* If you have sleep issues they might have a root cause. In my case I think it was circumstantial anxiety.

* Jetlag is not that big of a deal.

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