Serotonin: How low levels can wreck you & how to increase it

Updated: Jun 14, 2020

In family medicine, some of the most common complaints patients come in with include anxiety, sleep issues, chronic pain, poor digestion, headaches, and fatigue.

As a provider who integrates both plant medicine and prescriptions into my patient’s care (integrative medicine), I believe in the mind-body connection. Often with symptoms, it is a “what came first, the chicken or the egg?” scenario.

By way of brief introduction, I am a nurse practitioner trained in family medicine with experience in integrative medicine. I have a passion for helping patients with anxiety and depression because I’ve experienced it personally. I left a fast-paced primary care practice seeing 25+ patients a day, 10-15 minutes at time, to start my own practice, Hearthside Medicine Family Care. Now, I limit my day to 8-10 patients and spend 30-60 minutes on average with them at each appointment so I can help patients identify the root cause of their symptoms.

Chronic pain can cause depression and anxiety. Poor sleep can cause depression and anxiety. Chronic inflammation and uncontrolled blood sugars can cause depression and anxiety. Improper digestion can lead to depression and anxiety. But if you flip the pic, depression, stress, or anxiety that go insidiously unaddressed can also cause chronic pain, poor sleep, weight problems, headaches, irritable bowel syndrome, and much more.

Regardless of what came first, I want to help patients stop the cycle. Being stuck in this cyclone can feel isolating and be devastating; it can rob us of quality of life—I know, because I’ve been there.

So how to interrupt the cycle, you ask?

Of course we need to identify the root cause—which is why finding a provider who is willing to take the time to investigate with you is crucial. It is also crucial to recognize that what likely took years to develop may not be solved overnight. You and your provider may have to meet several times to get to the root cause.

Sometimes, my patients and I discover that the root cause is an underlying autoimmune disorder, sleep disorder, hormone imbalance, food allergy, genetic disorder, etc. Sometimes we discover that unaddressed trauma, stress, or childhood depression is the root cause.

In almost all of these scenarios, we need to help the body retain and make more serotonin—the chemical in the brain that becomes depleted with chronic pain, chronic digestive issues, chronic stress or anxiety, poor sleep, poor nutrition, etc.

To help the body restore proper serotonin levels, which helps the body regulate its pain response, appetite, digestion, sleep, energy, mood, libido, and more, we can use plant-based medicine, food, supplements, prescription medications, or a combination of all of these. Working with a therapist to re-train the soft-wiring of the brain to aid in physical and emotional response is also often a critical component. This can be done with talk therapy, EMDR, Cognitive Behavioral Therapy, or neurofeedback techniques.

So what are my options to increase serotonin?

Well, when it comes to prescriptions for anxiety and depression, there are seven main categories of medications often prescribed. Exercise, therapy, meditation, sufficient sleep, and quality nutrition are all highly effective and necesary as well for increasing serotonin. There are also many herbal/plant-based medicines available, which I have an entirely separate blog about found here: Calming Anxiety and Insomnia Without Meds

The purose of this particular blog is highlight conventional prescription options, but please refer to my other blog above if you'd like to incorporate integrative medicine options into your care.

Prescription options:

Selective Serotonin Reuptake Inhibitors (SSRI)

For patients with frequent anxiety or difficulty sleeping or depression, I will often advise selective serotonin reuptake inhibitors (SSRIs) if they do not first wish to try other measures or plant-based medicine. SSRIs are mostly know as antidepressants, but they are commonly prescribe them to people with anxiety and obsessive-compulsive disorder (OCD).

SSRIs work by helping your brain maintain normal levels of the neurotransmitter serotonin, which we need to regulate our mood, energy, thinking, appetite, sleep, libido, and more.

Examples for anxiety include:

  • citalopram (Celexa)

  • escitalopram (Lexapro)

  • fluoxetine (Prozac)

  • fluvoxamine (Luvox)

  • paroxetine (Paxil, Pexeva)-not preferred for women of childbearing age

  • sertraline (Zoloft)