Serotonin is a hormone and a neurotransmitter that is involved in the function of several different organ systems in the body.
A Happy Chemical: Serotonin and Mood
Serotonin is sometimes known as the happy chemical, because it appears to play an important role in regulating mood, and low levels of serotonin in the brain have been associated with depression. (1)
While there’s a link between low levels of serotonin and depression, it’s not clear whether low serotonin levels cause depression or whether depression causes a drop in serotonin levels. (1)
As a neurotransmitter, serotonin sends messages between nerve cells in the brain. That makes serotonin an important molecule for influencing mental health and brain function.
The Role of Serotonin in Brain Function
In addition to depression, serotonin may play a role in other brain and mental health disorders, including anxiety disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), phobias, and even epilepsy.
Serotonin plays an important role in many other body functions, too. It’s involved in appetite and digestion (bowel function and bowel movements), bone health, sex, and sleep.
Serotonin is a precursor to melatonin, a chemical that helps regulate the body’s sleep-wake cycle. (2) Certain antidepressants that raise serotonin levels have been associated with sexual dysfunction.
Gut Bacteria and Serotonin Production
Scientists have found that gut bacteria help to produce serotonin and that most of the body’s supply of serotonin can actually be found in the lining of the stomach and intestines. (3)
It’s not clear yet whether — or how — altered serotonin levels in the gut influence brain activity. Some researchers have postulated that serotonin in the gut may stimulate the vagus nerve, the long nerve that connects the digestive tract to the brain. (4)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Commonly prescribed SSRIs include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- vilazodone (Viibryd)
How Do SSRI Drugs Work?
SSRIs are thought to work by increasing serotonin levels in the brain. SSRIs do this by blocking the absorption of serotonin by nerve cells, keeping more of it available for passing along further messages between nerve cells in the brain.
Other groups of antidepressants, called serotonin and norepinephrine reuptake inhibitors (SNRIs)?and serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRIs), block the absorption of serotonin and the other neurotransmitters norepinephrine and dopamine. (5)
SSRIs?are sometimes called second generation antidepressants. In general, these antidepressants have fewer side effects than older tricyclic antidepressants.
Still, there are still several common side effects associated with SSRI use. These may include: (6)
- Dry mouth
- Nervousness (jitters)
- Weight gain
- Sexual dysfunction
Some people?—?especially children, teens, and young adults?—?may have an increase in suicidal thoughts while taking SSRIs.
These side effects are most common when people first start to take SSRIs?—?or when they change a dose?—?and tend to lessen over time.
Who Benefits From Use of SSRIs?
SSRIs appear to work best for people with major or severe depression. A 2018 review of studies found that most antidepressants, including commonly prescribed SSRIs, offered a modest benefit over a placebo treatment for people with major depressive disorder. (7) According to another report, antidepressants, including SSRIs, helped to relieve depression symptoms in about 20 percent of people compared to the placebo. (8)
The benefits of SSRIs for people with mild to moderate depression remain unclear.
Some researchers have shown that SSRIs are most effective when they are combined with talk or behavior therapies that help depression sufferers learn new strategies for coping with troublesome thoughts. One study suggested?that serotonin may help to speed learning, which could help to explain these findings. (9)
Serotonin Foods and Supplements
Serotonin isn’t found in foods, but its precursor,?tryptophan, is. Tryptophan is an essential amino acid that is important in the production of serotonin. Amino acids are the building blocks of protein.
Scientists have shown that the tryptophan in the diet is linked to levels of serotonin in the brain, with lower amounts of dietary tryptophan causing brain levels of serotonin to drop. (10)
Tryptophan is present in most protein-rich foods. Foods high in tryptophan include:
- Nuts and seeds
- Turkey and other poultry
- Soy foods
Some studies have proposed that eating tryptophan-rich foods may increase levels of serotonin in the brain and help treat depression symptoms. Other studies have found no correlation between tryptophan-rich foods or supplements and depression symptoms, according to a 2016 review. (11)
Most research indicates that any serotonin boost you might get from eating high-tryptophan foods is probably small. That’s because foods rich in tryptophan tend to be rich in other amino acids as well —?and these molecules all have to compete with one another to be absorbed into the brain. (11)
The dietary supplement 5-HTP (5-hydroxytryptophan), a chemical by-product of tryptophan, also helps to increase serotonin production in the brain. The supplement may be effective in reducing symptoms of depression in some people.?(12)
But larger studies are needed to prove that 5-HTP is safe and effective, and to date 5-HTP has not been approved by the Food and Drug Administration (FDA) as a treatment for depression.
In addition, 5-HTP should not be taken with antidepressant drugs or other depression medication. Many drugs taken for depression or anxiety also raise serotonin levels, and increasing serotonin levels too much can cause serious side effects, including heart problems. (12)
Serotonin syndrome is most likely to occur when starting an antidepressant medication, increasing the dosage of an antidepressant medication, or when two drugs that raise the body’s levels of serotonin are taken at the same time, causing too much serotonin to accumulate in the brain.
Serotonin-raising medicines include: (14)
- Older antidepressants called monoamine oxidase inhibitors (MAOIs)
- Meperedine (Demerol), a painkiller
- Dextromethorphan (DXM or DM), a cough medicine ingredient
- Migraine drugs called triptans
- 5-HTP or other dietary tryptophan supplements
- Saint-John’s-Wort, an herbal supplement used to treat depression symptoms (15)
- Garcinia cambogia, a tropical fruit and weight loss supplement
If you take any of these medicines, be sure to read the packaging labels for warnings about the potential risks of serotonin syndrome. Talk to your doctor if you have any concerns.
Symptoms of serotonin syndrome usually occur within minutes to hours. They may include: (14)
- Rapid heartbeat or fast pulse
- High blood pressure
- Heavy sweating
- Rapid breathing
- Agitation or restlessness
- Hot, dry skin
- Shivering, goose bumps
- Dilated pupils
- Nausea and vomiting
- Rigid muscles, twitching
- Loss of coordination
Call your healthcare provider immediately if you think you may be experiencing symptoms of serotonin syndrome. Symptoms may vary from mild to severe. Patients with severe serotonin syndrome may require hospitalization in an intensive care unit.
Editorial Sources and Fact-Checking
- Serotonin. Britannica.?September 20, 2022.
- Erland L, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. Journal of Clinical Sleep Medicine. February 15, 2017.
- Yano JM, Yu K, Donaldson GP, et al. Indigenous Bacteria From the Gut Microbiota?Regulate Host Serotonin Biosynthesis. Cell. April 9, 2015.
- The Vagus Nerve May Carry Serotonin Along the Gut-Brain Axis. Psychology Today. October 6, 2019.
- Mental Health Medications. National Institute of Mental Health. June 2022.
- Selective Serotonin Reuptake Inhibitors (SSRIs). Mayo Clinic. September 17, 2019.
- Cipriani A, Furukawa TA, Salanti G,?et al. Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults With Major Depressive Disorder: A Systematic Review and Network Meta-Analysis. The Lancet. April 7, 2018.
- Depression: How Effective Are Antidepressants? InformedHealth.org. June 18, 2020.
- Iigaya K,?Fonseca?MS, Murakami?M, et al. An Effect of Serotonergic Stimulation on Learning Rates for Rewards Apparent After Long Intertrial?Intervals. Nature Communications. June 26, 2018.
- Jenkins TA, Nguyen JCD, Polglaze?KE, Bertrand PP. Influence of Tryptophan and Serotonin on Mood and Cognition With a Possible Role of the Gut-Brain Axis. Nutrients. January 2016.
- Strasser B, Gostner?JM, Fuchs D. Mood, Food, and Cognition: Role of Tryptophan and Serotonin. Current Opinion in Clinical Nutrition and Metabolic Care. January 2016.
- 5-HTP. MedlinePlus. April 4, 2022.
- Boyer EW. Serotonin Syndrome (Serotonin Toxicity). UpToDate. May 6, 2022.
- Serotonin Syndrome. MedlinePlus. March 28, 2020.
- St. John’s Wort and Depression: In Depth. National Center for Complementary and Integrative Health. December 2017.