Serotonin: From Bliss to Despair

by Joseph M. Carver, Ph.D.

Serotonin, first isolated in 1933, is the neurotransmitter that has been identified in multiple psychiatric disorders including depression, obsessive-compulsive disorder, anorexia, bulimia, body dysmorphic disorder (nose doesn't look perfect after ten surgeries), social anxiety, phobias, etc. Serotonin is a major regulator and is involved in bodily processes such as sleep, libido (sexual interest), body temperature, and other areas.

Perhaps the best way to think of Serotonin is again with an automobile example. Most automobiles in the United States are made to cruise at 70 miles per hour, perfect for interstate highways and that summer vacation. If we place that same automobile on a racetrack and drive day-after-day at 130 mph, two things would happen. Parts would fail and we would run the engine so hot as to evaporate or burnout the oil. Serotonin is the brain’s “oil”.

Like a normal automobile on a race track, when we find ourselves living in a high stress situation for a prolonged period of time, we use more Serotonin than is normally replaced. Imagine a list of your pressures, responsibilities, difficulties and environmental issues (difficult job, bad marriage, poor housing, rough neighborhood, etc.). Prolonged exposure to such a high level of stress gradually lowers our Serotonin level. As we continue to “hang on” we develop symptoms of a severe stress-produced depression.

An automobile can be one, two or three quarts low in oil. Using the automobile as an example, imagine that brain Serotonin can have similar stages, being low (one quart low), moderately low (two quarts low), and severely low (three quarts low). The less Serotonin available in the brain, the more severe our depression and related symptoms.

When Serotonin is low, we experience problems with concentration and attention. We become scatterbrained and poorly organized. Routine responsibilities now seem overwhelming. It takes longer to do things because of poor planning. We lose our car keys and put odd things in the refrigerator. We call people and forget why we called or go to the grocery and forget what we needed. We tell people the same thing two or three times.

• As stress continues and our Serotonin level continues to drop, we become more depressed. At this point, moderately low or “two quarts” low, major changes occur in those bodily functions regulated by Serotonin. When Serotonin is moderately low, we have the following symptoms and behaviors: Chronic fatigue. Despite sleeping extra hours and naps, we remain tired. There is a sense of being “worn out”
• Sleep disturbance, typically we can’t go to sleep at night as our mind/thought is racing. Patients describe this as “My mind won’t shut up!” Early-morning awakening is also common, typically at 4:00 am, at which point returning to sleep is difficult, again due to the racing thoughts.
• Appetite disturbance is present, usually in two types. We experience a loss of appetite and subsequent weight loss or a craving for sweets and carbohydrates when the brain is trying to make more Serotonin.
• Total loss of sexual interest is present. In fact, there is loss of interest in everything, including those activities and interests that have been enjoyed in the past.
• Social withdrawal is common – not answering the phone, rarely leaving the house/apartment, we stop calling friends and family, and we withdraw from social events.
• Emotional sadness and frequent crying spells are common.
• Self-esteem and self-confidence are low.
• Body sensations, due to Serotonin’s role as a body regulator, include hot flushes and temperature changes, headaches, and stomach distress.
• Loss of personality – a sense that our sense of humor has left and our personality has changed.
• We begin to take everything very personally. Comments, glances, and situations are viewed personally and negatively. If someone speaks to you, it irritates you. If they don’t speak, you become angry and feel ignored.
• Your family will have the sense that you have “faded away”. You talk less, smile less, and sit for hours without noticing anyone.
• Your behavior becomes odd. Family members may find you sitting in the dark in the kitchen at 4:00 am.

Individuals can live many years moderately depressed. They develop compensations for the sleep and other symptoms, using sleeping medication or alcohol to get some sleep. While chronically unhappy and pessimistic, they explain their situation with “It’s just my life!” They may not fully recognize the depressive component.

Very low levels of Serotonin typically bring people to the attention of their family physician, their employer, or other sources of help. Severe Serotonin loss produces symptoms that are difficult to ignore. Not only are severe symptoms present, but also the brain’s ideation/thinking becomes very uncomfortable and even torturing. When Serotonin is severely low, you will experience some if not all of the following:

• Thinking speed will increase. You will have difficulty controlling your own thoughts. The brain will focus on torturing memories and you’ll find it difficult to stop thinking about these uncomfortable memories or images.
• You’ll become emotionally numb! You wouldn’t know how you feel about your life, marriage, job, family, future, significant other, etc. It’s as though all feelings have been turned off. Asked by others how you feel – your response might be “I don’t know!”
• Outbursts will begin, typically two types. Crying outbursts will surface, suddenly crying without much warning. Behavioral outbursts will also surface. If you break the lead in a pencil, you throw the pencil across the room. Temper tantrums may surface. You may storm out of offices or public places.
• Escape fantasies will begin. The most common – Hit the Road! The brain will suggest packing up your personal effects and leaving the family and community.
• Memory torture will begin. Your brain, thinking at 100 miles an hour, will search your memories for your most traumatic or unpleasant experiences. You will suddenly become preoccupied with horrible experiences that may have happened ten, twenty, or even thirty years ago. You will relive the death of loved ones, divorce, childhood abuse – whatever the brain can find to torture you with – you’ll feel like it happened yesterday.
• You’ll have Evil Thoughts. New mothers may have thoughts about smothering their infants. Thoughts of harming or killing others may appear. You may be tortured by images/pictures in your memory. It’s as though the brain finds your most uncomfortable weak spot, then terrorizes you with it.
• With Serotonin a major bodily regulator, when Serotonin is this low your body becomes unregulated. You’ll experience changes in body temperature, aches/pains, muscle cramps, bowel/bladder problems, smothering sensations, etc. The “Evil Thoughts” then tell you those symptoms are due to a terminal disease. Depressed folks never have gas – it’s colon cancer. A bruise is leukemia.
• You’ll develop a Need-for-Change Panic. You’ll begin thinking a change in lifestyle (Midlife Crisis!), a divorce, an extramarital affair, a new job, or a Corvette will change your mood. About 70 percent of jobs are lost at this time as depressed individuals gradually fade away from their life. Most extramarital affairs occur at this time.
• As low Serotonin levels are related to obsessive-compulsive disorders, you may find yourself starting to count things, become preoccupied with germs/disease, excessively worry that appliances are turned off or doors locked, worry that televisions must be turned off on an even-numbered channel, etc. You may develop rituals involving safety and counting. One auto assembly plant worker began believing his work would curse automobiles if their serial number, when each number was added, didn’t equal an even number.
• Whatever normal personality traits, quirks, or attitudes you have, they will suddenly be increased three-fold. A perfectionist will suddenly become anxiously overwhelmed by the messiness of their environment or distraught over leaves that fall each minute to land on the lawn. Penny-pinchers will suddenly become preoccupied with the electric and water consumption in the home.
• A “trigger” event may produce bizarre behavior. Already moderately low in Serotonin, an animal bite or scratch may make you suddenly preoccupied with rabies. A media story about the harmful effects of radiation may make you remember a teenage tour of the local nuclear power plant – suddenly feeling all your symptoms are now the result of exposure to radiation.
• When you reach the bottom of “severely low” Serotonin, the “garbage truck” will arrive. Everyone with severely low Serotonin is told the same thing. You will be told 1) You’re a bad spouse, parent, child, employee, etc., 2) You are a burden to those who love or depend on you, 3) You are worsening the lives of those around you, 4) Those who care about you would be better if you weren’t there, 5) You would be better if you weren’t around, and 6) You and those around you would be better off if you were totally out of the picture. At that point, you develop suicidal thoughts.

Clinical Depression is perhaps the most common mental health problem encountered in practice. One in four adults will experience clinical depression within their lifetime. Depression is the “common cold” of mental health practice – very common and much easier to treat today than in the past.

Treatment for depression, as might be expected, involves increasing levels of Serotonin in the brain. Since the mid-eighties, medications have been available that attempt to specifically target and increase Serotonin. Known as Selective Serotonin Reuptake Inhibitors (SSRI’s), these medications such as Prozac, Zoloft, and Paxil are felt to work by making more Serotonin available in the brain.

Like all neurotransmitters, we can have too much Serotonin. While elevated levels of Serotonin produce a sense of well-being, bliss, and “oneness with the universe” – too much Serotonin can produce a life-threatening condition known as Serotonin Syndrome (SS).

Likely to occur by accident by combining two Serotonin-increasing medications or substances, Serotonin Syndrome (SS) produces violent trembling, profuse sweating, insomnia, nausea, teeth chattering, chilling, shivering, aggressiveness, over-confidence, agitation, and malignant hyperthermia. Emergency medical treatment is required, utilizing medications that neutralize or block the action of Serotonin as the treatment for Serotonin Syndrome (SS).

Like Dopamine, Serotonin can be accidentally increased or decreased by substances. One method of birth control is known to produce severe depression as it lowers Serotonin levels. A specific medication for acne has also been linked with depression and suicidal ideation. For this reason, always inform your physicians if you are taking any medication for depression. Also avoid combining antidepressants with any herbal substances reported to be of help in Depression such as St. John’s Wort.

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