Seasonal affective disorder (SAD)
Winter blues
Holiday Depression

If you’ve found yourself dreading the 5 p.m. darkness and are struggling to feel motivated to do everyday life, you’re experiencing what many people wrestle with every winter. With this time of year comes the holiday season, which is supposed to be about connection, joy, and celebration. But for many, it feels more like a slog marked by exhaustion, emotional withdrawal, and a sense of emptiness.

Winter can be hard on your mental health, and the cultural pressure to be festive and grateful can make that struggle even heavier. When everyone around you seems to be thriving while you’re struggling emotionally, it’s easy to believe something is fundamentally wrong.

But the truth is more compassionate and nuanced: Your struggle isn’t a personal failing or a lack of willpower or gratitude.

It’s simply science. If you’re tired of struggling to navigate through the holiday season, this article offers a different path forward. Below, you’ll see that you’re not alone, and there are actionable strategies for protecting your mental health during the winter

→Read More: Depression Defined: What to Know

Winter Mental Health Challenges: SAD Is More Than Just a Bad Mood

When the winter months feel difficult, it helps to really understand what’s going on from a scientific and biological perspective. The official term for “winter blues” is seasonal affective disorder (SAD), a type of depression prompted by a change in seasons, mainly fall and winter, when we experience less daylight and sunshine.

5%

of people in the U.S. affected by SAD annually

2-3%

of Canadians experience SAD each year

It significantly affects as many as 5% of people in the United States and 2-3% of people in Canada each year. But even if you don’t have a true SAD diagnosis, winter can still significantly impact your emotional well-being.

Those affected by winter blues may become more withdrawn, don’t eat as well, avoid going outside, and experience a low, dysthymic mood that leaves them not feeling like themselves. While these symptoms can vary from person to person, you don’t need to hit a clinical threshold for your experience to be valid or worthy of attention. If the holidays or winter in general, consistently makes life feel harder, cloudier, or lonelier, that’s enough reason to seek support and implement strategies that help.

Why Winter Hits Different: The Science Behind SAD and The Winter Blues

Winter blues is science: your body is responding to real environmental changes in predictable, biological ways. Researchers believe it’s connected to changes in light exposure that disrupt our circadian rhythm and neurotransmitter activity, especially serotonin and melatonin, which help regulate mood and sleep.

How Light Affects Your Mood

Sunlight Exposure

→

Vitamin D Production

→

Increased Serotonin

Through our eyes and through our skin, when we have exposure to daylight, our bodies create vitamin D from that sunlight, and that increases serotonin, which helps us balance our good feelings. When we don’t have that exposure to sunlight, our vitamin D levels go down, and therefore our serotonin goes down.

Plus, during the holidays, many people experience complicated feelings like grief over lost loved ones, stress about family dynamics and social commitments, financial anxiety, or more. These psychological stressors compound the biological struggles that winter already creates.

This isn’t about your character, your resilience, or your ability to “think positive.” Your brain chemistry is literally being affected by environmental conditions beyond your control.

4 Ways to Protect Your Mental Health This Time of Year

When it comes to navigating SAD or winter blues, you don’t have to suck it up and get through it. Instead, try these behavioral strategies that can make this time of year not feel so heavy.

Create Structure When Your Brain Craves Hibernation

When your motivation disappears and everything feels effortful, structure becomes your friend. Prioritizing light exposure by getting outside or light machines, sticking to your daily routine, and maintaining social connections can make a meaningful difference when holiday chaos and winter cold feel overwhelming.

Consider the following:

• Setting a consistent wake-up time, even on weekends
• Planning one small task you accomplish each day
• Scheduling social commitments in advance (so you can’t talk yourself out of them later)
• Building in activities that historically bring you even mild enjoyment

The goal isn’t productivity for productivity’s sake. It’s preventing the downward spiral that happens when isolation, inactivity, and irregular routines feed depression.

Rethink Your Relationship With Light

Maximizing exposure to natural sunlight, especially for at least 20 minutes in the morning, is a simple and effective way to reduce SAD symptoms. But when it’s freezing outside, and you’re already feeling depleted, “just going outside” can feel like an impossible ask.

Instead, start smaller. Open your blinds as soon as you wake up. Move your workspace closer to a window. Take your coffee outside for five minutes, even if it’s cold. These aren’t cure-alls, but they’re practical steps that work with your reality rather than against it.

For some people, light therapy using a specialized light box can be helpful. Light therapy involves sitting near a specially designed light box for about 20-30 minutes each morning to help trick your body into responding as if there’s more daylight.

Stay Connected Even When You Want to Disappear

One of the biggest ironies of winter depression is that the time when you most need social support is when reaching out feels most difficult. Staying socially connected is an important way to manage symptoms of Seasonal Affective Disorder, even across physical distance.

You don’t need to force yourself into large gatherings or pretend to be cheerful when you’re not. Small, authentic connections are what matter. A text exchange with a friend, a brief phone call with a loved one, or committing to attend one social event per week, even for an hour, can help you stay connected with others. Making a plan to limit social time with those during the holidays who add stress, rather than calm, to your life is also a good way to ensure you build social connections without depleting your social battery.

→Read More: Discover More Benefits of Community

Move Your Body Any Way You Can

Regular exercise can boost serotonin levels and improve mood, working wonders for your mental health. But working in physical activity doesn’t have to mean grueling gym sessions or outdoor runs in the cold. Here are a few accessible movement ideas that you can work into your routine:

• A 10-minute walk around your block
• Gentle stretching while watching TV
• Dancing while you cook in your kitchen
• Indoor workouts, such as yoga or home-based cardio exercises

The goal is consistency and compassion for your body and mind, not punishment. Any movement that gets you out of your head and into your body can help interrupt rumination and boost mood-regulating chemicals.

When Self-Help Strategies Aren’t Enough: The Role of Therapy

Sometimes, no amount of light exposure, social connection, or routine-building is enough to get you through winter. That’s not a failure: you just may need more tailored support to help you navigate this season. The right therapist can provide exactly that.

What Therapy Offers That Self-Help Can’t

A therapist provides tips and techniques for addressing your mental needs, but they offer a space where your experience is heard without judgment, where patterns you can’t see on your own become visible, and where you can build personalized coping strategies tailored to your specific situation.

Cognitive Behavioural Therapy (CBT) has been shown to be particularly effective in treating Seasonal Affective Disorder. CBT helps you identify and challenge the thought patterns that keep you stuck (like “I’ll never feel better” or “something is wrong with me”) and replace them with more balanced, helpful perspectives.

Therapy is about reframing thoughts and understanding the full picture of what you’re dealing with. Depression often happens with other conditions, such as physical ones or other mood disorders, substance abuse, or anxiety. A trained therapist can help you understand how different factors in your life interact and affect your mental health.

→Read More: Want to Find the Right Therapist? See Our Step-by-Step Guide

How to Start the Therapy Conversation

At GoodTherapy, we know that making the step to ask for help can feel overwhelming. Knowing you need help is different than actually seeking it.

If this sounds like you, start by admitting this: “I need to talk about something I’ve been dealing with.” That’s it. You don’t need to have everything figured out or articulate your entire mental health history perfectly. A good therapist will help you find the words and understand what you’re experiencing. The sooner you reach out, the more tools you have to work with before symptoms intensify.

Don’t just talk to anyone, though: finding the right therapist matters, too. At GoodTherapy, our therapist quiz helps you find professionals based on specific concerns, treatment approaches, insurance, location, and availability. You can look for therapists who specialize in depression, seasonal affective disorder, and related mental health challenges. Someone who understands your experience can create a space where you feel heard and supported.

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Take our quick quiz to connect with the right professional for your needs

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Building Your Winter Mental Health Survival Plan: Mental Health Checklist to Fight Depression

Reading about strategies is one thing, but actually implementing them when you’re in the thick of winter and holiday depression is another. That’s why we have an easy checklist you can follow to turn knowledge into action this winter:

This week:

• Choose one small structural change (like a consistent wake time)
• Reach out to one person you trust
• Open your blinds first thing every morning
• Notice without judgment how you’re actually feeling

This month:

• If symptoms persist, research therapists who specialize in depression or SAD
• Consider talking to your doctor about vitamin D levels
• Schedule at least one social activity, even if it’s virtual
• Experiment with one form of gentle movement

This season:

• Build a support team, whether that’s a therapist, close friends, or both
• Track what actually helps (not what you think “should” help)
• Give yourself permission to scale back on obligations that drain you
• Celebrate small victories, like getting outside or showing up for therapy

Remember: Mental health struggles don’t resolve in a single conversation or with one perfect coping strategy. This is about building sustainable support systems and being willing to learn what works for you.

Don’t Wait for Spring: Take Action Now

The most important shift you can make isn’t about suffering your way through another winter. It’s about exploring what you need, what strategies work, and recognizing that asking for help is not weak: it’s self-love.

With the right tools, support, and professional help, you can navigate these months with more resilience, self-compassion, and stability. The holidays can add pressure to feel happy and joyful, but don’t let social expectations guilt you. Your struggle is real, your experience matters, and help is available right now.

You Deserve More Than Survival

Ready to find support? GoodTherapy’s directory makes it easy to connect with therapists who understand seasonal mental health challenges and can help you build a personalized plan for coping. You deserve more than just survival: you deserve to feel like yourself again, even in the middle of winter.

Start Finding Your Therapist

References:

Mayo Clinic: Seasonal Affective Disorder

Cleveland Clinic: Seasonal Depression (Seasonal Affective Disorder)

National Library of Medicine: When Routines Break: The Health Implications of Disrupted Life

National Library of Medicine: “Shedding Light on Light”: A Review on the Effects on Mental Health of Exposure to Optical Radiation

Across Boundaries: Seasonal Affective Disorder in Canada, with a Special Lens on Racial Dynamics

Neurotransmitters are chemical messengers that carry electrical signals between neurons in the brain. Dopamine and serotonin are two important neurotransmitters for mental health. They affect your mood, memory, sleep, libido, appetite, and more. Imbalances can contribute to addictions, mood conditions, memory issues, and attention difficulties.

Over the past several decades, the world has seen an increase in medications for serotonin and dopamine imbalances. These prescriptions can treat symptoms of many mental health conditions. Yet they have a long list of potential side effects, from dizziness to insomnia. Also, their effectiveness varies from person to person.

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Some people want to try some non-drug treatments before committing to medication. Others take medication but want to supplement it with other strategies. Below are 10 ways to increase dopamine and serotonin that don’t require a pill:

1. Exercise

Regular exercise for at least 30 minutes each day improves one’s overall mood. Research has revealed that long-term cardiovascular exercise boosts serotonin levels in the brain. Serotonin can lower hostility and symptoms of depression. It also encourages agreeableness.

(More: Move for Your Mood: The Power of Exercise to Help Lift Depression)

2. Spend Time in Nature

In previous generations, humans spent most of their time outdoors. These days, many people work indoors, sitting at a desk under artificial lighting. Researchers have found as little as five minutes outdoors in a natural setting can improve mood, increase motivation, and boost self-esteem. The amount of time spent in sunlight correlates with serotonin and dopamine synthesis. Even a brief walk in the park can improve your well-being.

(More: 5 Ways Nature Can Help You Feel Better)

3. Nutrition

Diet can also influence one’s mental health. Coffee increases your serotonin and dopamine levels … for as long as you take it. Once you stop drinking coffee, you will go into withdrawal. Your brain, used to the high levels of neurotransmitters, will act as if there is a deficiency. It can take up to 12 days of caffeine-free diet for the brain to return to its normal state.

Omega-3 fatty acids boost serotonin levels without the withdrawal. They help serotonin trigger nerve cell receptors, making transport easier. Many studies have shown that omega-3s help reduce depressive symptoms. You can find omega-3s in cold-water fish like salmon.

Contrary to internet rumors, eating turkey does not raise your brain’s serotonin levels. Many people think foods rich in tryptophan can boost mood, since the brain uses tryptophan to produce serotonin. However, tryptophan competes with several other amino acids for transportation to the brain. Since it is low on the body’s priority list, it usually loses.

That said, having some tryptophan in your diet is important. If you don’t have enough, your serotonin levels will drop. If you need more tryptophan, you can get it by eating starchy foods like whole wheat bread, potatoes, and corn.

(More: Good Mood Foods to Help Fight Depression, Stress, and More)

4. Meditation

Meditation is the practice of relaxed and focused contemplation. It is often accompanied by breathing exercises. Evidence has shown that meditation increases the release of dopamine. It can relieve stress and create feelings of inner peace.

(More: Stress Reduction: Mindfulness Meditation for Beginners)

5. Gratitude

Scientific research has shown gratitude affects the brain’s reward system. It correlates with the release of dopamine and serotonin. Gratitude has been directly linked to increased happiness.

There have been many studies on a practice called the “three blessings exercise.” Every night for a week, you write down three things you are thankful for. People who complete this exercise tend to report more happiness and less depressive symptoms. Their improved mood can last up to six months.

(More: How a Simple Mason Jar Can Bring More Gratitude to Your Life)

6. Essential Oils

All essential oils come from plants. These oils often have medicinal properties. One study found that bergamot, lavender, and lemon essential oils are particularly therapeutic. Using your sense of smell, they prompt your brain to release serotonin and dopamine.

Note: Always follow the instructions on the bottle’s label. Although essential oils are “natural,” some can be dangerous when misused. Do not let young children play with essential oils.

(More: How Aromatherapy Can Boost Psychological and Physical Health)

7. Goal Achievement

When we achieve one of our goals, our brain releases dopamine. The brain finds this dopamine rush very rewarding. It seeks out more dopamine by working toward another goal.

Larger goals typically come with increased dopamine. However, it’s best to start with small goals to improve your chances of success. Short-term goals can add up to achieve a long-term goal (and a bigger reward). This pattern keeps a steady release of dopamine in your brain.

(More: How Positive Affirmations Can Help You Achieve Your Goals)

8. Happy Memories

Researchers have examined the interaction between mood and memory. They focused on the anterior cingulate cortex, the region of the brain associated with attention. People reliving sad memories produced less serotonin in that region. People dwelling on happy memories produced more serotonin.

(More: Can We Purposefully Make Memories Last Forever?)

9. Novelty

The brain reacts to novel experiences by releasing dopamine. You can naturally increase your dopamine by seeking out new experiences. Any kind of experience will work. You can do something simple like a new hobby or recipe. Or you can try something grand like skydiving. The less familiar you are with the activity, the more likely your brain will reward you with dopamine.

(More: 5 Things on My New Year’s Bucket List for My Kids)

10. Therapy

Research indicates if you change your mood, you can affect serotonin synthesis in your brain. This implies mood and serotonin synthesis have a mutual influence on each other. Psychotherapy often helps people improve their mood. It is possible therapy can help raise one’s serotonin levels as well.

(More: Benefits of Therapy)

While these 10 methods can boost your neurotransmitters, they are not a substitute for medical care. If you have mental health concerns, you should always seek a doctor’s or therapist’s advice. A mental health professional can tell you which approaches are best for your unique situation. There is no shame in taking medication or attending counseling. They are common treatment options among many.

References:

1. Coffee and hormones: Here’s how coffee really affects your health. (n.d.) Precision Nutrition. Retrieved from https://www.precisionnutrition.com/coffee-and-hormones
2. Do you need a nature prescription? (2013, June 19). Retrieved from http://www.webmd.com/balance/features/nature-therapy-ecotherapy
3. Essential oils: Poisonous when misused. (2014). National Capital Poison Center. Retrieved from https://www.poison.org/articles/2014-jun/essential-oils
4. How Do I Increase Serotonin and Dopamine Levels? (2017, August 14). LIVESTRONG Foundation. Retrieved from http://www.livestrong.com/article/301434-how-do-i-increase-serotonin-dopamine-levels/
5. Jenkins, T.A., Nguyen, J.C.D., Polglaze, K.E., & Bertrand, P.P. (2016, January 20). Nutrients, 8(1), 56. Retrieved from http://www.mdpi.com/2072-6643/8/1/56/htm
6. Lv, X.N., Liu, Z.J., Zhang H.J., & Tzeng C.M. (2014). Aromatherapy and the central nerve system (CNS): Therapeutic mechanism and its associated genes. Current Drug Targets, 8(14), 872-879. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23531112#
7. Novelty and the brain: Why new things make us feel so good. (2013, May 21). Retrieved from https://lifehacker.com/novelty-and-the-brain-why-new-things-make-us-feel-so-g-508983802
8. Omega-3 Fatty Acids and Mood Disorders. (2012). Today’s Dietitian, 14(1), 22. Retrieved from http://www.todaysdietitian.com/newarchives/011012p22.shtml
9. Thankfulness linked to positive changes in brain and body. (2011, November 23). ABC News. Retrieved from http://abcnews.go.com/Health/science-thankfulness/story?id=15008148
10. This is how your brain becomes addicted to caffeine. (2013, August 9). Retrieved from https://www.smithsonianmag.com/science-nature/this-is-how-your-brain-becomes-addicted-to-caffeine-26861037/
11. Why our brains like short-term goals. (2013, January 3). Retrieved from https://www.entrepreneur.com/article/225356
12. Young, S.N. (2007). How to increase serotonin in the human brain without drugs. Journal of Psychiatry and Neuroscience, 32(6), 394-399. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/

Serotonin is a neurotransmitter that plays a role in behavior, mood, movement, learning, and many other functions. Its technical name is 5-hydroxytryptamine or 5-HT. Like all neurotransmitters, serotonin carries a nerve signal across a synapse.

When serotonin levels are too low, this can weaken nerve signals. One of the most common symptoms of low serotonin is depression, but low serotonin levels plays a role in mood and the central nervous system and can have side effects to almost every system of the body, leading to a wide range of symptoms.

UNDERSTANDING SEROTONIN: WHAT DOES SEROTONIN DO?

Researchers have studied serotonin for more than 60 years and uncovered roles for this important neurotransmitter in numerous brain functions. All animals and even plants produce serotonin, suggesting it appeared very early in evolution.

Yet serotonin is difficult to isolate. Moreover, a wide range of neurotransmitters—as well as other factors, such as a person’s overall health, environment, and unique biology—can affect mental and physical health. This has made it difficult for researchers to establish direct correlations between serotonin and various functions.

Researchers have long thought serotonin deficiency can lead to depression. In fact, many popular antidepressants including SSRIs increase brain serotonin levels. Yet some studies throw even this widely accepted theory of serotonin into question. A 2014 study of mice, for example, found that genetically lowering serotonin levels did not lead to depression. Clinicians have long theorized that serotonin levels are genetically low in some people with depression, so this study undermines that theory.

Numerous ailments can cause symptoms of serotonin deficiency, so it’s important to see a health care provider to get an accurate diagnosis and appropriate treatment.

This mixed research means it is impossible to diagnose serotonin deficiency based on symptoms alone. People with normal serotonin levels may experience symptoms consistent with serotonin deficiency, while some people with low serotonin may have no symptoms at all. Numerous ailments can cause symptoms of serotonin deficiency, so it’s important to see a health care provider to get an accurate diagnosis and appropriate treatment.

WHAT CAUSES SEROTONIN DEFICIENCY?

Most cases of serotonin deficiency are idiopathic, meaning doctors are unable to find a specific cause. Some inherited genetic disorders may affect the body’s ability to make or metabolize serotonin. Lifestyle and other factors that may also play a role include:

• Hormonal shifts, such as due to beginning or stopping hormone replacement therapy, menopause, pregnancy, or advancing age
• Lack of sunlight
• Poor nutrition
• Certain drugs,supplements and medications, especially when used to excess or over a long period of time
• Chronic stress

If you are looking for a therapist reach out to one of our professionals in Chicago, IL or find a therapist in a city closer to you. 

10 SEROTONIN DEFICIENCY SYMPTOMS

Serotonin never acts alone, and it’s part of a complex system. People with serotonin deficiency may also have deficiencies in other neurotransmitters, as well as metabolic or other health problems. Some common signs of serotonin deficiency include:

1. Depression

Research increasingly points to a complex relationship between depression and serotonin. We don’t fully understand how serotonin deficiency can cause depression, but most studies argue that it is a factor. Depression related to seasonal affective disorder, life events,and chronic stress and trauma, may also deplete serotonin levels. So serotonin deficiency can be both a cause and a result of depression.

2. Changes in sleep

Serotonin helps regulate the body’s internal clock, including the ability to feel sleepy, remain asleep, enter rapid eye movement (REM) sleep, and wake in the morning. People with chronic insomnia, unusual sleep patterns, chronic fatigue, or consistently vivid dreams may have serotonin deficiency.

3. Chronic pain

Serotonin affects the way the muscles behave, so low serotonin may cause chronic pain. Low serotonin is strongly correlated with fibromyalgia, a type of widespread chronic pain. People with fibromyalgia may even get relief from antidepressants that raise serotonin levels.

4. Memory or learning issues

Some studies have the role of serotonin to memory and learning, so sudden difficulties with memory or learning could signal a serotonin issue. Additionally, other symptoms of serotonin deficiency, such as sleep deprivation and depression, can make it difficult to concentrate and learn.

5. Anxiety

Anxiety, including obsessive-compulsive disorder forms of anxiety, may indicate a person has low serotonin. Anxiety that comes on suddenly and appears unrelated to something else, such as a recent trauma or stressor, is often due to a serotonin issue. Chronic stress and anxiety may also deplete serotonin.

6. Schizophrenia

Many studies have found low serotonin levels in people with schizophrenia. Unusual beliefs or behaviors, auditory or visual hallucinations, and sudden changes in mood or personality may be a sign of low serotonin.

7. Problems with the body’s internal clock

Serotonin helps regulate the body’s circadian rhythm, which is its internal clock. Though it’s common for people to have difficulties getting up in the morning or occasionally forget meals, dysregulation in the internal clock can cause serious sleep, appetite, and other issues. A person who never sleeps according to a regular schedule, who has difficulty maintaining a consistent pattern of hunger and eating, or who feels chronically tired or hyper could have a problem with their circadian rhythm. This may be due to low serotonin.

8. Appetite issues

A number of studies have found that people with low serotonin production may have appetite issues or eating disorders. This may include overeating, not eating enough, or alternating between the two. Additionally, some people with depression also experience problems with appetite.

It’s possible for a person whose blood serotonin levels appear normal to have very little usable serotonin.

9. Hyperactivity

Low serotonin can cause symptoms of attention deficit/attention-deficit hyperactivity (ADD/ADHD). A person may have trouble concentrating, constantly fidget, be chronically bored, or be unable to sit still. Children may appear to have boundless energy, behave aggressively, or frequently get into trouble at school.

10. Dementia

A handful of new studies suggest that low brain serotonin is linked to dementia and may even be an early warning sign of this group of diseases. It’s unclear if the low serotonin causes dementia or is a symptom. Because serotonin can affect memory, concentration, and other cognitive functions, however, it’s possible that drops in serotonin increase the risk of dementia as a person ages.

SEROTONIN DEFICIENCY DIAGNOSIS AND TREATMENT

A serotonin blood test can measure levels of serotonin in the blood. However, doctors usually only use this test to check for serotonin-producing tumors. Doctors don’t usually perform blood tests to assess serotonin levels because factors other than blood serotonin—such as metabolism, the behavior of serotonin receptors, and hormones—can affect the body’s ability to process and use serotonin. It’s possible for a person whose blood serotonin levels appear normal to have very little usable serotonin.

Instead of testing serotonin levels, doctors typically treat a person’s symptoms. Depending on the symptoms you have, your provider may recommend tests to rule out other causes, such as hormone imbalances or a physical injury. Then they may recommend antidepressant medication that raises serotonin levels, such as paroxetine or citalopram. In some cases, providers may also recommend lifestyle changes such as regular exercise and dietary changes.

Serotonin deficiency is a complex issue. Lifestyle and psychological factors often play a central role. Moreover, symptoms of serotonin deficiency can affect a person’s relationship and quality of life. Therapy can help in numerous ways. For people with depression related to low serotonin, a therapist can offer lifestyle management tips, a sympathetic ear, and help with mental health and relationship issues.

Therapy can also help people with low serotonin become better advocates for themselves. For example, a person with fibromyalgia or chronic pain may struggle to talk to loved ones about their symptoms or feel reluctant to request accommodations at work. Therapy can help them explore their options, adopt healthy self-care strategies, and advocate for their needs.

For help finding a therapist who can support you as you deal with low serotonin, click here.

References:

1. Al-Nimer, M. M., Mohammad, T. M., & Alsakeni, R. (2018). Serum levels of serotonin as a biomarker of newly diagnosed fibromyalgia in women: Its relation to the platelet indices. Journal of Research in Medical Sciences, 23(1), 71. doi: 10.4103/jrms.JRMS_859_17
2. Angoa-Pérez, M., Kane, M. J., Briggs, D. I., Herrera-Mundo, N., Sykes, C. E., Francescutti, D. M., & Kuhn, D. M. (2014). Mice genetically depleted of brain serotonin do dot display a depression-like behavioral phenotype. ACS Chemical Neuroscience, 5(10), 908-919. doi: 10.1021/cn500096g
3. Brain scan study adds to evidence that lower brain serotonin levels are linked to dementia. (2017, August 14). Retrieved from https://www.hopkinsmedicine.org/news/media/releases/brain_scan_study_adds_to_evidence_that_lower_brain_serotonin_levels_are_linked_to_dementia_
4. Frazer, A., & Hensler, J. G. (1999). Serotonin. In G. J. Siegel (Author), Basic neurochemistry: Molecular, cellular and medical aspects (6th ed.). Amsterdam: Elsevier Academic Press.
5. Whitney, M. S., Shemery, A. M., Yaw, A. M., Donovan, L. J., Glass, J. D., & Deneris, E. S. (2016). Adult brain serotonin deficiency causes hyperactivity, circadian disruption, and elimination of siestas. Journal of Neuroscience, 36(38), 9828-9842. doi: 10.1523/JNEUROSCI.1469-16.2016

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Serotonin is a chemical often associated with mood and happiness. A lack of serotonin can sometimes contribute to mental health issues such as anxiety and depression. Helping the body produce or maintain its level of serotonin can alleviate depressive symptoms.

Many people use psychotropic medications to adjust their serotonin levels. But there is such a thing as having too much serotonin because of medications. This phenomenon, called serotonin syndrome, can lead to extreme health issues.

What Is Serotonin Syndrome?

Serotonin syndrome occurs when someone has an excess of the neurotransmitter serotonin in their nervous system. The condition’s symptoms generally fall into three categories:

• Altered mental status (irritability, agitation, restlessness, and anxiety)
• Neuromuscular hyperactivity (tremors, shivering, muscle rigidity, and muscle spasms)
• Autonomic hyperactivity (rapid heartbeat, high blood pressure, sweating, and fever)

Because serotonin is produced primarily in the gastrointestinal tract, digestive problems like nausea and diarrhea are common. A person experiencing serotonin syndrome may also be confused, dizzy, or disoriented. In severe cases, an individual may develop hallucinations and seizures.

Serious cases of serotonin syndrome can be fatal if left untreated. However, serotonin syndrome is usually very treatable. Recovery often occurs within 24 hours of seeking medical help.

What Causes Serotonin Syndrome?

Serotonin syndrome is ultimately a bad reaction to medication. It most often occurs after a person takes multiple drugs that increase serotonin. For example, someone who uses antidepressants may take cold medication. Both drugs can boost serotonin, raising the neurotransmitter levels much higher than either medication would alone.

Serotonin syndrome can also happen if a person starts a new medication or increases their dosage. It can be difficult to predict which medications or dosages will pose a risk though. A certain level of serotonin may be therapeutic for one person and toxic for another.

Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are the most common drugs linked to the condition. Other substances that can increase serotonin include:

• Other antidepressants (such as MAOIs)
• Triptan migraine medications
• Over-the-counter cold medicines that contain dextromethorphan
• Certain herbal supplements (St. John’s wort and ginseng)
• Certain recreational drugs (such as cocaine or LSD)

Symptoms of serotonin syndrome typically appear within the first 24 hours of starting or adjusting one’s medication regimen. There is currently no one medical test for serotonin syndrome. A doctor would likely perform several specific tests to evaluate organ function, check for hormonal imbalances, and rule out other potential conditions, such as drug overdose.

How Common Is Serotonin Syndrome?

With around 13% of Americans taking some type of antidepressant medication, many people could be at risk for serotonin syndrome. However, the vast majority of people who take antidepressants do not develop the condition. There are no known demographic risk factors like age or gender.

Historically, the number of people who experience serotonin syndrome is quite low—only several thousand per year. Just over 8,000 people were diagnosed with serotonin toxicity in 2004, the most recent year with data on the topic. Researchers acknowledge this statistic is likely an underestimation, as mild cases often go undiagnosed. Yet the average person taking antidepressants does not need to worry for their safety.

Serotonin Syndrome or Neuroleptic Malignant Syndrome?

Neuroleptic malignant syndrome (NMS) has many similarities to serotonin syndrome. Both conditions are adverse reactions to psychotropic medication, and their symptoms can look identical.

If you have any adverse reaction to taking any medication, it is very important to contact your doctor immediately.However, there are important differences. Both the onset and recovery period of NMS are much longer. Plus, NMS can be treated with a medication called dantrolene. (There is no equivalent medication for serotonin syndrome.) Thus, it can be important to distinguish between the two conditions.

Often clinicians can determine which issue a person has by evaluating their medications. Unlike serotonin syndrome, NMS is linked to drugs that affect dopamine levels. If a person’s medication history still leaves doubt, doctors may need to perform clinical tests. Clinicians can diagnose NMS by looking at white blood cell count, serum iron levels, and other physical markers.

How Is Serotonin Syndrome Treated?

In most cases, serotonin syndrome can be resolved within 24 hours. Treatment can be as simple as stopping the medication that was causing an increase in serotonin. Mild symptoms can be cleared up very quickly in this way.

If an individual has mild symptoms but requires the medication (for example, a severely depressed person taking antidepressants), they may discuss the risks and benefits with their care provider. Often a compromise can be found by reducing the medication dosage. If the current dosage is necessary, then a clinician should closely monitor the patient for any worsening of symptoms.

More severe symptoms of serotonin syndrome may require hospitalization. Doctors will likely monitor a person’s vitals and watch for any withdrawal effects. In extreme cases, someone with serotonin syndrome may require a breathing tube, feeding tube, or sedation. If the person is experiencing muscle spasms, a doctor might use a medication that temporarily paralyzes muscles as a preventative measure. This helps guard against damage to the muscle tissue and kidneys.

How to Prevent Serotonin Syndrome

While serotonin syndrome is not always preventable, you can stay safer by paying close attention to any negative reactions to medication. It is especially important to pay attention if anything changes in your prescription or dosage.

Always be transparent with medical professionals about the medication(s) and supplements you’re taking, as well as any recreational drug use. Stay in communication with your psychiatrist or health care team to help monitor the effects of medication. Communication is essential if you have a combination of prescriptions.

If you have any adverse reaction to taking any medication, it is very important to contact your doctor immediately. Left untreated, symptoms may worsen and become incapacitating. However, quick intervention can help prevent any more discomfort.

If serotonin syndrome has interfered with your medication regimen, you may be able to get relief through therapy. The right therapist can treat your mental health issues and may help reduce your need for medication.

References:

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