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You might have heard that melatonin can help you sleep, but you might not have known that melatonin might also be able to help you with your anxiety. The relationship between melatonin and anxiety is complex, with research showing both promising benefits and potential risks.
Most people know melatonin as a sleep aid, but its relationship with anxiety actually positions melatonin with more potential. Some research shows genuine promise for anxiety relief, while other studies raise red flags about potential risks. Getting this right matters because millions of Americans already use melatonin, and many are hoping it might help with their anxiety too.
Let’s dive deeper into understanding when melatonin helps versus when it might make anxiety worse and how this impacts your mental health and sleep quality.
Melatonin is a hormone naturally produced by your pineal gland that regulates your circadian rhythm. Beyond sleep regulation, melatonin demonstrates anxiolytic action in animal experiments and different clinical conditions through its sympatholytic action, interaction with the renin-angiotensin and glucocorticoid systems, and antioxidant properties.
The hormone works through several pathways that may influence anxiety:
GABA System Enhancement: Melatonin increases GABA levels in certain parts of the brain, which can have a calming effect and reduce symptoms of anxiety. GABA is your brain's primary inhibitory neurotransmitter, responsible for reducing neuronal excitability.
Stress Response Modulation: Melatonin's benefit in anxiety may reside in its sympatholytic action, inhibition of the renin-angiotensin and glucocorticoid system, and modulation of GABA-serotonergic signaling. This means it can help calm your sympathetic nervous system's "fight or flight" response.
Circadian Regulation: Disruptions in sleep and circadian rhythms are associated with anxiety symptoms, and night shift work has been associated with development or worsening of symptoms of anxiety. By stabilizing circadian rhythms, melatonin may indirectly reduce anxiety.
We asked Dr. Michael Grandner, Sleep Expert and Professor of Neuroscience and Physiological Sciences, what his research reveals about melatonin's impact on anxiety. He says:
"Melatonin's anxiolytic properties likely stem from its role in stabilizing circadian rhythms, which are fundamentally disrupted in many anxiety disorders. When we restore proper sleep-wake timing, we often see improvements in daytime anxiety levels."
By fixing your sleep cycle, melatonin may help break the cycle between poor sleep and heightened anxiety.
The strongest research support for melatonin's anti-anxiety effects comes from surgical settings. A 2015 review of 12 studies involving 774 people found strong evidence that melatonin is better than placebo at reducing anxiety before surgery and may be as effective as the anti-anxiety medicine midazolam.
Pre-Surgery Anxiety: In clinical studies, doses of melatonin ranging from 3-14 mg taken one to two hours before surgery effectively reduced pre-operative anxiety and caused fewer side effects than benzodiazepines.
Sleep-Related Anxiety Relief: For people whose anxiety is closely tied to sleep difficulties, melatonin may provide indirect benefits. Treatment with exogenous melatonin has positive effects on sleep quality in adults with respiratory diseases, metabolic disorders, and primary sleep disorders.
Postmenopausal Women: A 2024 systematic review found that melatonin significantly improved anxiety in postmenopausal women, suggesting hormonal interactions may play a role in its anxiolytic effects.
We asked Dr. Suzanne Gorovoy, Sleep Expert, Clinical Psychologist, and Behavioral Sleep Medicine Specialist, about melatonin's role in anxiety management. She says:
"Melatonin can be particularly helpful for anxiety that's exacerbated by sleep disruption. When patients achieve more consistent sleep with melatonin, they often report feeling less overwhelmed by daily stressors."
This highlights how melatonin's primary sleep benefits can create a positive cascade effect on anxiety levels.
Despite its potential benefits, melatonin isn't helpful for everyone with anxiety and may actually worsen symptoms in certain situations:
Mental Health Conditions: Melatonin may cause symptoms of depression and other mood disorders, or make existing symptoms worse in some people. This is particularly concerning for individuals with anxiety disorders that co-occur with depression.
Incorrect Timing and Dosage: Taking melatonin at the wrong time or in inappropriate doses can disrupt your natural circadian rhythm rather than support it. Research suggests optimal timing is 3 hours before desired bedtime with doses of 4 mg, compared to the commonly used 2 mg 30 minutes before bedtime.
Paradoxical Effects: Some people experience what sleep specialists call "paradoxical effects" where melatonin actually increases alertness or anxiety. Side effects can include anxiety, nervousness, confusion, irritability, and mood changes.
Quality and Dosage Issues: A 2023 study found that 22 out of 25 over-the-counter melatonin products were inaccurately labeled, with melatonin levels ranging from 74 to 347 percent of the labeled quantity. This unpredictability can lead to unexpected effects on anxiety.
We asked Dr. Areti Vassilopoulos, Sleep Expert, Pediatric Health Psychologist, and Assistant Professor of Child Psychology, about when to avoid melatonin for anxiety. She says:
"Melatonin should be avoided in individuals with a history of mood disorders until they've been properly evaluated. The hormone can sometimes trigger or worsen depressive episodes, which often co-occur with anxiety."
This emphasizes the importance of professional guidance, especially for those with complex mental health presentations.
Optimal Dosing for Anxiety: Clinical studies for anxiety have successfully used doses under 10 milligrams, typically ranging from 3-14 mg taken one to two hours before bedtime. However, experts recommend starting with 0.5 to 1 milligram and gradually increasing if needed.
Timing Matters: Meta-analysis research suggests advancing timing to 3 hours before desired bedtime may optimize efficacy compared to the standard 30 minutes. This allows melatonin to work with your natural circadian rhythm rather than against it.
Individual Variability: Melatonin dosages used in studies have ranged from 0.1 mg to 10 mg, typically administered up to 2 hours before bedtime, highlighting the need for individualized approaches.
Generally Safe Short-Term: Melatonin demonstrates remarkably low acute toxicity, with researchers unable to establish an LD50 in animals even at high doses of up to 800 mg/kg.
Important Contraindications:
Drug Interactions: Birth control pills, certain SSRIs, and caffeine might intensify the effects of melatonin supplements.
Recent neuroscience research has revealed fascinating connections between circadian rhythm disruption and anxiety that help explain melatonin's complex effects.
Studies show that genetic disruption of circadian rhythms in the suprachiasmatic nucleus causes helplessness, behavioral despair, and anxiety-like behavior in mice. This suggests that circadian health is fundamental to emotional regulation.
Research demonstrates that disruption of circadian rhythms via jet lag, night-shift work, or exposure to artificial light at night can precipitate or exacerbate affective symptoms in susceptible individuals. This bidirectional relationship means that anxiety can disrupt sleep cycles, which in turn can worsen anxiety.
Key Finding: A 2024 longitudinal study of 233 adolescents found that moderate to severe generalized anxiety was associated with a 3.17-fold increased risk of developing delayed sleep phase disorder. This research demonstrates how anxiety disorders can directly impact circadian timing.
The implications are significant: melatonin's effectiveness for anxiety may depend heavily on whether the individual has underlying circadian rhythm dysfunction. For those with circadian disruption, melatonin may provide substantial anxiety relief. For others with purely psychological anxiety, the benefits may be minimal or even counterproductive.
Consider melatonin if you have these conditions:
Avoid melatonin or use cautiously if you have these conditions:
Note: Healthcare providers should be consulted before taking melatonin, especially for those who are pregnant, breastfeeding, or taking other medications. This is particularly important for anxiety, as mental health conditions can be complex and require professional evaluation.
Melatonin's relationship with anxiety is nuanced. While it shows promise for specific types of anxiety, particularly when tied to sleep disruption or circadian rhythm disorders, it's not a universal anxiety treatment. The hormone's effectiveness depends on proper timing, appropriate dosing, and individual biochemistry.
Since melatonin is freely available, economically undemanding, and has limited side effects, it may be considered an additional or alternative treatment for various conditions associated with anxiety. However, the emphasis should be on "additional" rather than "replacement" for evidence-based anxiety treatments.
For those considering melatonin for anxiety, start low, go slow, and work with a healthcare provider to ensure it's appropriate for your specific situation. Remember that while melatonin may help some people manage anxiety through improved sleep and circadian regulation, it's not a cure-all and may not be suitable for everyone.
Your circadian health and anxiety are more connected than you might think, and addressing one may help improve the other, but only when done thoughtfully and with proper guidance.
Dr. Shiyan Yeo
Dr. Shiyan Yeo is a medical doctor with over a decade of experience treating patients with chronic conditions. She graduated from the University of Manchester with a Bachelor of Medicine and Surgery (MBChB UK) and spent several years working at the National Health Service (NHS) in the United Kingdom, several Singapore government hospitals, and private functional medicine hospitals. Dr. Yeo specializes in root cause analysis, addressing hormonal, gut health, and lifestyle factors to treat chronic conditions. Drawing from her own experiences, she is dedicated to empowering others to optimize their health. She loves traveling, exploring nature, and spending quality time with family and friends.
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