Last week we considered fourth grader Josh who was given Concerta for his ADD. This resulted in improved academics and overall well being. However, the parents were very disturbed with his sleep deprivation. The medication Melatonin was being considered by his physician.
Another area where Melatonin has shown promise is in the patient with ADD. Numerous articles have looked at this. One paper looked at 105 ADD patients whose ages ranged from 6-to-12 years. These ADD patients were NOT on stimulant medications. They were given Melatonin for four weeks at a dose of 3 mg if they weighted 40 kg or less. 6 mg was given if they were over 40 kg. The Melatonin was given at 7:00 p.m. Overall there was a reduction in falling asleep by an average of 24 minutes. The parents reported an increase in sleep time by 33 minutes.
Similar results are shown for ADD patients who ARE on stimulant medications. One study looked at 23 children, ages 6-to-14 years, who were on stimulant medication. They were given 5 mg of Melatonin at bedtime. The results showed an average reduction of 16 minutes to fall asleep, and an average of 15 minutes on increased sleep time.
In the United States and Canada Melatonin use is considered safe in the pediatric patient when used short-term, less than four weeks, and is safe at relatively high doses. Long-term use, over four weeks, has not been sufficiently studied and its safety has not been established. Few serious side effects have been linked to Melatonin use. One study of 122 patients looked at the incidence of headaches, dizziness, nausea and drowsiness. There was no difference in the group treated with Melatonin and the control/placebo group.
A paper appearing in the journal LANCET looked at six patients with severe neurological deficits, which included seizures. They were given Melatonin to help with sleep. Although all of them reported marked improvement in sleep, four of the six reported increased number of seizures. Another paper, however, looked at a similar group of six severely impaired neurological children who also had seizure disorders. They were given Melatonin along with their seizure medication for a period of three months. In this study all reported marked improvement in sleep. 5 of the 6 reported less seizures during the three month study.
Both in the United States and Canada Melatonin use in children is considered safe, yet is NOT recommended without the consultation and guidance of their physician. In Canada, the Natural Health Products Directorate of Health says the Melatonin is not to be used in patients who have hormonal disorders, diabetes, kidney or liver disease, cerebral palsy, seizures, migraines, depression and hypertension.
In Josh’s case we tried three mg of Melatonin an hour before he went to bed. This didn’t make an real difference. We then tried five mg, and it worked beautifully. He continued the Concerta, excelling in his schoolwork. Sleep was no longer a problem as he would get in bed with a book and be asleep within 10 minutes. In fact, 20 minutes after he would go to bed mom would go into his room, remove the book from his bed, and turn out the light. He would sleep soundly until she got him up for school. After three weeks we reduced the Melatonin to every other night for a week. Then it was stopped altogether. He has been off the medication for almost two months now without any relapse of sleep problems.