Is Melatonin Good for Psychosis? Understanding Its Role

October 13, 2025 •

5 min read

Approximately 80% of individuals with schizophrenia, a psychotic disorder, report sleep disturbances, often alongside a reduction in the body's natural melatonin production. This has led to an increased interest in whether supplemental melatonin could offer benefits for those experiencing psychosis.

Quick Summary

Melatonin is not a standalone treatment for the core symptoms of psychosis but serves as an adjunctive therapy. Research indicates it can effectively improve sleep quality, mitigate metabolic and motor side effects of antipsychotic medications, and potentially aid negative symptoms. Its use should always be medically supervised due to potential drug interactions and varying effects.

Key Points

Not a Primary Treatment: Melatonin is not a replacement for antipsychotic medication and will not cure psychosis.
Adjunctive Role: It is used as a supplemental therapy to manage co-occurring issues in patients with psychotic disorders, especially sleep problems.
Improves Sleep Quality: Evidence shows melatonin can improve sleep efficiency, decrease night-time awakenings, and help restore a more normal circadian rhythm.
Mitigates Antipsychotic Side Effects: Studies suggest it can help lessen metabolic side effects (like weight gain) and involuntary movements (tardive dyskinesia) associated with antipsychotics.
Requires Medical Supervision: Due to potential drug interactions, side effects, and the complexity of psychiatric disorders, melatonin should only be used under the guidance of a doctor.
Source Reputable Supplements: Over-the-counter melatonin is not strictly regulated, and some products have been found to contain hidden serotonin, posing a risk of serotonin syndrome when combined with certain psychiatric medications.
Addresses Negative Symptoms: Some research indicates that long-term melatonin use may help improve the negative symptoms of schizophrenia, such as lack of motivation, though more data is needed.

The Relationship Between Melatonin, Sleep, and Psychosis

Psychosis, a symptom cluster often associated with conditions like schizophrenia, is characterized by disruptions in thought, perception, and behavior. A consistent challenge for those with psychotic disorders is significant sleep disruption and circadian rhythm misalignment. The pineal gland, which produces the sleep-regulating hormone melatonin, is often compromised in people with schizophrenia, leading to lower levels of the hormone. This biological and behavioral link has prompted extensive research into the therapeutic potential of melatonin as a supplemental treatment.

While melatonin does not replace standard antipsychotic medication, its multifaceted properties—including acting as an antioxidant, regulating circadian rhythms, and possessing anti-inflammatory effects—suggest potential therapeutic applications in managing psychosis-related comorbidities. Understanding these roles is crucial for patients and clinicians alike.

Melatonin as an Adjunctive Treatment for Psychosis

Studies on the adjunctive use of melatonin alongside traditional antipsychotics have explored its effects on several common issues faced by patients with psychotic disorders.

Benefits for Sleep Disturbances

Improved Sleep Quality: Clinical trials have shown that adjunctive melatonin therapy can lead to significant improvements in sleep quality among individuals with chronic schizophrenia and insomnia. Patients report fewer nocturnal awakenings, better subjective sleep quality, and a longer duration of sleep.
Restored Circadian Rhythm: Melatonin helps reset the body's sleep-wake cycle, which is often severely disrupted in psychotic disorders. By mimicking the natural pattern of melatonin release, it can help regulate the sleep-wake function and promote more normal sleep patterns.

Mitigating Antipsychotic Side Effects

Antipsychotic medications, while effective for treating positive symptoms like hallucinations and delusions, can cause significant side effects that reduce quality of life and treatment adherence. Melatonin has shown promise in counteracting some of these issues.

Metabolic Syndrome: Many second-generation antipsychotics are associated with a high risk of metabolic syndrome, including weight gain, increased blood pressure, and changes in cholesterol and blood sugar levels. Some studies have found that adjunctive melatonin can help attenuate these metabolic side effects.
Tardive Dyskinesia: This involuntary movement disorder is a severe, long-term side effect of antipsychotic use. Research, though sometimes conflicting, has explored melatonin's antioxidant effects in reducing the severity of tardive dyskinesia, with one study finding a significant decrease in symptoms at a dose of 10mg/day.

Potential Impact on Negative Symptoms

While primary psychotic symptoms are the focus of antipsychotic medication, negative symptoms like social withdrawal and lack of motivation often persist. Some emerging evidence suggests that melatonin might play a role in addressing these areas.

Improved Mood and Functioning: Some studies have observed improvements in mood and daytime functioning, along with reduced fatigue, in patients taking melatonin. These changes can lead to better engagement in therapeutic activities.
Negative Symptom Reduction: A double-blind, placebo-controlled trial found that long-term use (at least six weeks) of melatonin was associated with a significant reduction in the negative symptoms of schizophrenia. This suggests melatonin may be a valuable complement for a difficult-to-treat aspect of the illness.

Potential Risks and Precautions

While generally considered safe, melatonin is not without potential risks, especially in a vulnerable population like those with psychosis. Careful consideration and medical supervision are essential.

Increased Sedation and Dizziness: When taken with antipsychotic medications, melatonin can increase side effects like drowsiness and dizziness. This can impact daily activities and safety.
Mood Changes: Infrequently, some individuals may experience temporary feelings of depression or mood swings. Vivid dreams or nightmares are also possible side effects.
Drug Interactions: Melatonin can interact with a variety of other medications, including certain antidepressants and blood pressure medications. Notably, combining it with certain antidepressants that increase serotonin can increase the risk of serotonin syndrome.
Exacerbation of Psychosis: Though rare, there have been some anecdotal reports or case studies of mood aggravation and psychotic symptoms worsening with melatonin use, highlighting the need for caution and constant monitoring by a healthcare professional.
Unregulated Supplements: Unlike prescription medications, over-the-counter melatonin supplements are not strictly regulated, leading to potential discrepancies in dosage and quality. Some have been found to contain serotonin, which can have dangerous interactions with psychiatric drugs. It is important to source melatonin from reputable manufacturers.

A Comparison of Melatonin vs. Antipsychotics


Feature	Melatonin (as Adjunctive Therapy)	Antipsychotics (Primary Treatment)
Primary Function	Regulates sleep-wake cycle, acts as an antioxidant.	Target dopamine pathways to reduce positive symptoms.
Effectiveness for Psychotic Symptoms	Not effective for positive symptoms (hallucinations, delusions). May improve negative symptoms over time.	Highly effective for managing positive symptoms.
Effectiveness for Sleep	Shown to improve sleep efficiency, latency, and duration in those with insomnia.	Many can cause sedation, but this is a side effect, not a primary therapeutic goal.
Common Side Effects	Drowsiness, dizziness, nausea, vivid dreams.	Weight gain, metabolic syndrome, tardive dyskinesia, cognitive issues.
Impact on Antipsychotic Side Effects	Can help mitigate metabolic and motor side effects.	Can cause significant metabolic and motor side effects.
Regulatory Status	OTC supplement (in many regions) with variable quality.	Prescription-only medication, tightly regulated.

Conclusion

Melatonin is not an antipsychotic and is not a suitable primary treatment for the core symptoms of psychosis. However, its role as an adjunctive therapy is supported by a growing body of evidence. For individuals with psychotic disorders like schizophrenia, particularly those with comorbid insomnia and those experiencing difficult side effects from antipsychotics, melatonin may offer significant benefits. It may improve sleep quality, counteract metabolic issues, and potentially alleviate some negative symptoms.

It is crucial that the decision to use melatonin be made in consultation with a healthcare provider who can weigh the potential benefits against the risks and monitor for drug interactions. With appropriate medical oversight, melatonin can be a valuable tool to improve the overall quality of life for those managing a psychotic illness.

Further research is still needed to fully elucidate the specific effects of melatonin in different stages and types of psychotic disorders and to establish standardized dosing guidelines. The antioxidant and neuroprotective properties of melatonin offer exciting avenues for future investigation into the pathophysiology and treatment of conditions like schizophrenia.

For more information on the efficacy of melatonin as an adjunctive therapy in schizophrenia, review this systematic review and meta-analysis from the National Institutes of Health(https://pmc.ncbi.nlm.nih.gov/articles/PMC8394692/).

Frequently Asked Questions

No, melatonin is not a substitute for antipsychotic medication. It is used as an adjunctive treatment to manage certain symptoms or side effects, but it does not address the core psychotic symptoms like hallucinations and delusions.

Melatonin helps regulate the body's sleep-wake cycle, or circadian rhythm. People with psychosis often have low natural melatonin levels, so supplementation can improve sleep efficiency, reduce awakenings, and help reset their sleep schedule.

You must consult your doctor before combining melatonin with antipsychotics. While generally safe, it can increase side effects like drowsiness and dizziness. Your doctor can assess potential interactions and ensure it is safe for your specific situation.

Some research suggests that adjunctive melatonin may help mitigate certain side effects of antipsychotics, including metabolic issues like weight gain and high blood pressure, and involuntary movements like tardive dyskinesia. The effect can vary based on the specific antipsychotic.

Early research suggests that longer-term melatonin use (over six weeks) may help reduce the severity of negative symptoms, such as lack of motivation or emotional expression, in schizophrenia. This is an area of ongoing study.

Potential side effects include increased sedation, dizziness, headache, nausea, and vivid dreams. In rare instances, there is a risk of worsening mood or psychotic symptoms, which is why medical supervision is critical.

Since supplements are not heavily regulated, it is important to buy from a reputable manufacturer to minimize risks. Some low-quality supplements have been found to contain serotonin, which can lead to serious interactions with psychiatric medications.