The Importance of Serotonin

Ryan the authorRyan Fiorenzi, Certified Sleep Coach
Updated: September 4, 2020

What is Serotonin?

Serotonin is known as the "happy hormone" as it contributes to a feeling of happiness and well-being, though it acts as a hormone and a neurotransmitter. 95% is found in the gut, though it's also in the brain, blood platelets, and central nervous system. Serotonin can't cross the blood-brain barrier, so any serotonin needed by the brain must be produced by the brain. If the brain has too little serotonin, it may cause depression. If it has too much, it can lead to excessive nerve cell activity.

Its scientific name is 5-hydroxytryptamine (5-HT), and has several important functions:

  • controls sleep and wake cycles
  • regulates mood; low serotonin levels are associated with depression
  • plays a role in memory and cognition
  • regulates anxiety
  • controls bowel function
  • critical to bone health
  • heals wounds
  • may have a role in obesity, migraines, and Parkinson's disease
  • low levels are associated with eating disorders, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder
  • gets rid of foods that don't agree with you through nausea and diarrhea
  • low levels are associated with increased libido
  • associated with breast milk production, liver regeneration, and cell reproduction

Serotonin and Depression

Depression is a complex topic and narrowing the causes of depression to one factor isn't realistic. However, research has shown that some people who deal with depression have reduced serotonin transmission, and low levels of a serotonin byproduct have been linked to a higher rate of suicide.

Serotonin doesn't necessarily cause depression, but increasing the amount of serotonin available in the body through selective serotonin reuptake inhibitors (SSRIs) is one of the most common and effective treatments for depression. According to research from Germany, 40 to 60% of people with moderate to severe depression show improvement after 6 to 8 weeks of SSRI treatment. The SSRIs are believed to increase positive emotional processing, which improves mood. SSRIs are anti-inflammatory, and inflammation has been associated with depression.

Serotonin and Sleep

The first observations of the biochemical events of sleep were made over 40 years ago. It's now clear that several neurotransmitters, neuropeptides, and neurohormones are involved in the sleep/wake cycle. According to Progress in Neurobiology, serotonin has been known to play an important role in sleep, but how and where is controversial.

What we know is that vitamin D3 promotes the production of serotonin. At night, serotonin is synthesized by the pineal gland to make melatonin, the sleep hormone. Without getting enough serotonin during the day, you may have trouble sleeping at night. This is why experts recommend getting 10 to 30 minutes of sunlight on your skin per day to promote your production of serotonin. 

Serotonin levels are lower in sleep than when awake, and are lowest during rapid-eye-movement sleep (REM), or when dreaming occurs. This is why SSRIs reduce REM or dreaming sleep.

Signs of Serotonin Deficiency

There are several signs of serotonin deficiency. Some physical signs are:

  • poor memory
  • cravings for sweets and starchy foods
  • insomnia
  • aggression
  • low self-esteem
  • fatigue
  • weight gain
  • nausea
  • constipation or other more serious bowel problems such as irritable bowel syndrome

There are other psychological issues that are associated with low serotonin levels:

  • eating disorders
  • obsessive-compulsive disorder
  • panic disorder
  • post-traumatic stress disorder
  • social anxiety disorder

Normal Ranges for Serotonin Levels

According to the University of California San Francisco Children's Hospital, serotonin levels in your blood should be between 101 to 283 nanograms per milliliter (ng/ml). Normal ranges may vary slightly between laboratories; your doctor will interpret your blood test results.

Higher serotonin levels may indicate carcinoid syndrome. Carcinoid tumors are rare and develop from hormone-producing cells called enterochromafin cells that occur throughout the body, with 65% starting the gut and 25% in the lungs.

SSRIs

SSRIs are selective serotonin reuptake inhibitors, and are the most commonly prescribed antidepressants, though they are also used for anxiety disorders. They ease the symptoms of moderate to severe depression and are generally considered safe, causing fewer side effects than other antidepressants.

They work by increasing serotonin levels in the brain. SSRIs prevent the reabsorption (reuptake) of serotonin into neurons, making more available in the brain, improving the transmission of messages between neurons (hence why it's a neurotransmitter).

The Food and Drug Administration (FDA) has approved the following SSRIs to treat depression:

  • Zoloft (Sertaline)
  • Prozac (Fluoxetine)
  • Lexapro (Escitalopram)
  • Paxil (Paroxetine)
  • Celexa (Citalopram)

Some people experience no side effects with SSRIs, and for some, the side effects go away after a few weeks. Possible side effects include:

  • headache
  • dry mouth
  • nausea, vomiting, and/or diarrhea
  • insomnia
  • nervousness
  • drowsiness
  • sexual issues
  • dizziness
  • increased or decreased appetite

Excessive levels of serotonin can cause serotonin syndrome. This is usually caused by taking more than one medication, such as an antidepressant with a migraine medication. It can also be caused by an overdose of antidepressant medications. Drugs that can cause serotonin syndrome include:

  • SSRIS
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Bupropion
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors (MAOIs)
  • Migraine medications
  • Pain medication
  • Lithium
  • Some herbs, such as St. John's Wort
  • Some over-the-counter cough and cold medications
  • Cocaine, LSD, Ecstasy, and amphetamines

Recreational Drugs and Serotonin

Cocaine, LSD, ecstasy, and amphetamines can raise your serotonin levels by blocking the transport of serotonin, dopamine, and norepinephrine. According to the National Institute on Drug Abuse (NIDA), sharp spikes in dopamine (the "happy hormone" that's part of your brain's reward system) in the nucleus accumbens (NAc) create the addictive effect, along with extracellular serotonin in the ventral pallidum (VP) and orbitofrontal cortex (OFC). Researchers found that cocaine-induced increases in serotonin in the VP can weaken one's ability to curb impulsive behaviors.

A study published in Neurology examined the brain of a 26-year old man who started using Ecstasy (whose chemical name is methylenedioxymethamphetamine, or MDMA) once a month at age 17. MDMA causes neurons to release serotonin and causes an increased awareness of emotions and a heightened sense of intimacy. He continued using and in the last 3 years of his life, he used it 4 to 5 nights per week at "rave" clubs, often with a 3-day weekend binge when he took 6 to 8 tablets. His friends reported that after these binges he appeared depressed and had slow speech.

In the last months of his life the man began using heroin and cocaine. His brain was compared to the autopsies of 11 normal individuals. The levels of serotonin and other chemicals associated with serotonin were 50 to 80% lower the brain of the MDMA user. Researchers believe that the behavioral effects of the drug as well as the depression after are probably due to the massive release and depletion of serotonin. The lead researcher said that research should be done to determine whether increasing levels of serotonin in people who are going off of the drug would help eliminate some of the behavioral problems that happen during withdrawal.

How to Increase Your Serotonin Naturally

There are several ways to naturally increase your serotonin levels, avoiding the side effects that you can experience with pharmaceuticals (although with herbal products you will want to talk to your doctor). 

Sunlight

Research has shown that people's serotonin levels tend to be lower after winter and higher in summer and fall. Exposure to sunlight stimulates the body's production of vitamin D3, which produces serotonin. If you're in an area with little natural sunlight, one option is a light therapy box.

Food

Serotonin isn't in any foods, but tryptophan is an amino acid that's converted to serotonin. Good sources of tryptophan are chicken, eggs, salmon, turkey, milk, cheese, peanuts, chocolate, as well as pumpkin and sesame seeds. And research suggests that consuming tryptophan-rich foods along with 30 grams of carbohydrates will help more tryptophan pass the blood-brain barrier and reach your brain.

Exercise

Aerobic exercise increases tryptophan levels in the blood, and it can decrease the amount of other amino acids, which increases the possibility of more tryptophan getting to the brain.

Massage and Human Contact

Research has shown that serotonin levels increase by 28% after a 60-minute massage. But it's not only massage, hugs and other shows of affection, including sex, increases serotonin levels.

Supplements

There are several supplements that can raise your tryptophan levels, but talk to your doctor before you start. If you're taking any medications that increase your serotonin levels, and you add supplements that also raise your serotonin, it could cause serotonin syndrome. 

Some supplements that can raise your serotonin levels include:

  • St. John's wort
  • 5-HTP
  • SAMe (S-adenosyl-L-methionine)
  • probiotics

Meditation, Visualization, and Listening to Music

A study published in the National Institutes of Health referred to several studies that have shown a rise in the breakdown products of serotonin in the urine of meditators after they meditated. In one study involving Transcedental Meditation practitioners, the urine samples of meditators were higher than the control group before they meditated, and much higher after. This is why Dr. Avdesh Sharma has referred to meditation as "future medication."

Researchers from McGill University concluded “Preliminary studies have shown that music listening and performing modulate levels of serotonin, epinephrine, dopamine, oxytocin, and prolactin. Music can reliably induce feelings of pleasure, and indeed, people consistently rank music as among the top ten things in their lives that bring pleasure, above money, food, and art.”

If meditation or listening to music aren't good options for you, simply remembering positive events and visualizing positive future outcomes could raise serotonin production in the anterior cingulate cortex, which is behind the prefrontal cortex, the area that controls attention. Remembering sad events decreases serotonin production in the same area of the brain. Psychology Today also recommends that if you're having a hard time remembering positive events, talk to an old friend, look at photographs, or read your diary.