Can I Take Melatonin While on Antidepressants?

To avoid side effects with melatonin, avoid medications such as fluoxetine (Prozac, Sarafem), desipramine (Norpramin), or medications or supplements that work to increase serotonin levels.

Melatonin is a hormone produced in a pea-sized gland located in the brain called the pineal gland. Melatonin helps send signals to distant organs and plays a role in sleep and circadian rhythms.

The body naturally produces more melatonin at night which helps people fall asleep. Levels are lower in the morning when people awaken and are exposed to light. Melatonin levels decline as people age. 

Antidepressant drugs are used to treat depression, depression with anxiety, and depression associated with bipolar disorder or cyclothymic disorder. They may also be prescribed for pain relief and sleep problems. 

The use of melatonin with antidepressant drugs may increase the risk of some side effects, including sedation. 

• Fluoxetine (Prozac, Sarafem), a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) can cause low levels of melatonin in people
• In an animal study, melatonin supplements reduced the antidepressant effects of fluoxetine (Prozac, Sarafem) and desipramine (Norpramin), a type of antidepressant called a tricyclic
  • It is unknown if these same effects would occur in humans
• Combining medications or supplements that both work to increase serotonin levels can cause serotonin to accumulate and reach abnormally high levels in the body, resulting in a serious condition called serotonin syndrome, which can cause shivering, fever, diarrhea, muscle rigidity, or seizures

If you take any kind of antidepressant, talk to your doctor before using melatonin supplements.

Melatonin is available as an over-the-counter (OTC) supplement used for:

• Insomnia
• Jet lag
  • Low doses (0.1 to 0.5 mg) are recommended for insomnia or jet lag because high doses can alter normal day/night melatonin rhythms.
• Shift work disorder
• Circadian rhythm sleep disorders in the blind
• Sleep-wake cycle disturbances
• Delayed sleep phase (delayed sleep-wake phase sleep disorder)
• Anxiety before and after surgery

Melatonin is being investigated as a possible treatment for conditions such as:

• Cancer
• Alzheimer's disease
• Amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease)
• High nighttime blood pressure
• Sleep problems in children with autism spectrum disorders (ASD)
• More study is needed to confirm whether melatonin is effective for these conditions. 

• Selective serotonin reuptake inhibitors (SSRIs) 
  • The most prescribed type of antidepressant
  • They work by blocking some reuptake of serotonin, helping elevate mood
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) 
  • Similar to SSRIs 
  • They work by blocking reuptake of both serotonin and norepinephrine to help elevate mood
• Tricyclic antidepressants (TCAs) 
  • An older class of antidepressant
  • They are stronger but have more side effects and are usually only prescribed when other, newer types of antidepressants don’t work
• Monoamine oxidase inhibitors (MAOIs) 
  • One of the first class of antidepressants on the market 
  • Usually only prescribed when all other categories of antidepressants have failed to work because they have serious side effects and interactions with foods and other medicines
• Other types of antidepressants
  • A norepinephrine and dopamine reuptake inhibitor (NDRI) is another type of antidepressant that works differently than SSRIs or SNRI 
  • Sedating antidepressants may also be used to help treat insomnia

Side effects of over-the-counter melatonin supplements include:

• Headache
• Confusion
• Fragmented sleep

Side effects of ramelteon (Rozerem), a prescription melatonin agonist include:

• Dizziness
• Sleepiness
• Nausea
• Headache
• Daytime drowsiness
• Worsening sleep problems

While melatonin is generally safe for use at lower doses, always consult your doctor before taking any supplement. Possible risks of melatonin use include:

• Drug interactions
  • Seizure medications
  • Blood thinners
• Allergic reaction
• Unknown if it is safe for use during pregnancy or while breastfeeding 
• American Academy of Sleep Medicine recommends against melatonin use by people with dementia
• May cause daytime drowsiness, especially in older people 
• Because it’s classified as a dietary supplement in the U.S. and not a drug, it is less strictly regulated by the Food and Drug Administration (FDA) 
• Melatonin products may not contain what’s listed on the label
  • One study found most supplements did not contain the amount of melatonin that was listed on the package 
  • About one-quarter of the supplements contained serotonin, a hormone that can have harmful effects even at low levels