title: The Effect of Melatonin on Benzodiazepine Discontinuation and Sleep Quality in Adults Attempting to Discontinue Benzodiazepines: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Abrupt discontinuation of benzodiazepines often results in side effects including anxiety and insomnia, which can be barriers to discontinuation among long-term users. Melatonin improves the onset, duration, and quality of sleep. By preventing insomnia in those attempting to discontinue benzodiazepines, melatonin may facilitate benzodiazepine discontinuation.
  
  
  OBJECTIVE
  The primary objective was to determine the effect of melatonin compared with placebo on benzodiazepine discontinuation in adults attempting to discontinue benzodiazepines. The secondary objective was to determine the effect of melatonin on sleep quality in this population.
  
  
  METHODS
  We searched PubMed, MEDLINE, EMBASE, PsychINFO, and ClinicalTrials.gov from inception to November 2014. We included randomized controlled trials published in English comparing melatonin with placebo that reported benzodiazepine discontinuation or sleep quality. Two reviewers independently screened trials, extracted data, and assessed the risk of bias.
  
  
  RESULTS
  We included six trials randomizing 322 participants. The mean age of participants was approximately 64 years. The trials used varied tapering strategies to discontinue benzodiazepines over 4-10 weeks while using melatonin. Melatonin had no effect on the odds of successfully discontinuing benzodiazepines (odds ratio 0.72, 95% confidence interval 0.21-2.41, p = 0.59). There was important heterogeneity among the trials (I (2) = 76%). The effect of melatonin on sleep quality was inconsistent.
  
  
  CONCLUSIONS
  Melatonin had no effect on benzodiazepine discontinuation while the effect of melatonin on sleep quality was inconsistent. We cannot rule out a role of melatonin in improving benzodiazepine discontinuation or sleep quality owing to imprecise effect estimates. Larger, well-designed, and reported randomized controlled trials may provide more valid and precise estimates of the effect of melatonin on these outcomes.
authors.affiliation: St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada. wrighta@stjosham.on.ca.
authors.forename: Angela
authors.initials: A
authors.lastname: Wright
authors.affiliation: Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Diebold
authors.affiliation: Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Jaskiran
authors.initials: J
authors.lastname: Otal
authors.affiliation: St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.
authors.forename: Carly
authors.initials: C
authors.lastname: Stoneman
authors.affiliation: Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wong
authors.affiliation: St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Wallace
authors.affiliation: Departments of Pediatrics and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Duffett
mesh_terms: D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000209:etiology
chemical_list: D001569:Benzodiazepines; D008550:Melatonin