title: Melatonin for perceived sleep disturbances associated with benzodiazepine withdrawal among patients in methadone maintenance treatment: a double-blind randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of melatonin in attenuating sleep difficulties during benzodiazepine (BDZ) withdrawal.
  
  
  METHODS
  Double-blind cross-over control study.
  
  
  METHODS
  Methadone maintenance treatment clinic.
  
  
  METHODS
  Eighty patients enrolled at a community methadone maintenance clinic recruited to a BDZ withdrawal programme.
  
  
  METHODS
  Melatonin (5 mg/day) or placebo: 6 weeks one arm, 1 week washout, 6 weeks other arm.
  
  
  METHODS
  Urine BDZ; self-reported Pittsburgh Sleep Quality Index (PSQI) and the Center for Epidemiologic Studies Depression (CES-D) questionnaires administered at baseline, and at 6, 7 and 13 weeks.
  
  
  RESULTS
  Sixty-one patients (77.5% in the 'melatonin first' condition and 75% in the 'placebo first' condition) completed 6 weeks of treatment, showing a similar BDZ discontinuation rate of 11/31 and 11/30, respectively. PSQI scores were significantly lower (indicating better sleep quality) in the 22 patients who discontinued BDZ (8.9 +/- 0.9) than in 39 with urine BDZ (11.2 +/- 0.7, P = 0.04). Sleep quality in patients who continued abusing BDZ improved more in the 'melatonin first' group than in the 'placebo first' group, with no differences in sleep quality improvement in patients who stopped BDZ. CONCLUSION Most improvement in sleep quality was attributed to BDZ discontinuation. Although melatonin did not enhance BDZ discontinuation, it improved sleep quality, especially in patients who did not stop BDZ.
authors.affiliation: Dr Miriam and Sheldon G Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. einatp@tasmc.health.gov.il
authors.forename: Einat
authors.initials: E
authors.lastname: Peles
authors.forename: Tal
authors.initials: T
authors.lastname: Hetzroni
authors.forename: Rachel
authors.initials: R
authors.lastname: Bar-Hamburger
authors.forename: Miriam
authors.initials: M
authors.lastname: Adelson
authors.forename: Shaul
authors.initials: S
authors.lastname: Schreiber
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D002492:Central Nervous System Depressants / Q000627:therapeutic use*; D002940:Circadian Rhythm; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000627:therapeutic use; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D012890:Sleep / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000139:chemically induced*; D013375:Substance Withdrawal Syndrome / Q000150:complications / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation*
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D002492:Central Nervous System Depressants; D001569:Benzodiazepines; D008550:Melatonin; D008691:Methadone