Depression makes you feel like: “Life is a “beach”.
Life just sucks, or so it feels.
Major depressive disorder (MDD) is one of the oldest well-recognized medical disorders, having been clearly described in medical texts dating back to ancient Greece.
Depression is a stress-related disorder that includes abnormalities of affect and mood, neurogenerative functions (such as appetite and sleep disturbances), cognition (such as inappropriate guilt and feelings of worthlessness), and psychomotor activity (such as agitation or retardation).
There are actually a few different types of depression, ranging from mild to severe major depression, uncoping depression and dysthymic depression (persistent depressive disorder)
Although they have some similarities, they also have quite a few differences. For example, both dysthymic and major depression has hyperactivation of the parasympathetic nervous system, whereas uncoping depression is the opposite. Where people with uncoping depression have too little neural noradrenaline levels in the brain and overactivation of the dorsal raphe nucleus, people with major depression have the opposite. That’s why people don’t react the same to meds, or specifically SSRI drugs.
For this article I want to specifically focus on the involvement of serotonin in depression. Mostly because it’s been thought (hypothesized: yep, it’s not even proved) that serotonin is low in depression and that we should boost it. Serotonin is the “happy hormone”, the “feel-good hormone”, right? That’s what everyone has been regurgitating the last couple of decades.
However, research shows that it’s not the boost in serotonin that’s beneficial, because the SSRI drugs only become effective after a few weeks, which casts dought on if serotonin is really the missing link here. The main hypothesis for why SSRI drugs only start to work after a few weeks is because SSRI drugs, such as Prozac, increase neurosteroids in the brain (such as allopregnanolone), that has pro-GABA effects. And it’s actually the GABA that has anti-depressant properties. So it takes a while for the SSRI drugs to increase allopregnanolone and when it gets high enough, the anti-depressant effect kicks in.
Additionally, it’s not only due to the increase in allopregnanolone, but also because some of these anti-depressant “SSRI” drugs also increase noradrenaline, dopamine and BDNF, antagonize and downregulate certain serotonin receptors, block adrenergic receptors, block the effect of cortisol, modulate acetylcholine, etc.
Naturally, the origin or cause of depression is never single factorial, but often, if not always, is multi-factorial. Stress and excess cortisol is one of the major persistant themes we see in depression, and it’s stress and cortisol that increases the serotoninergic system and damages the dopaminergic system.
Evidence against serotonin as the happy hormone
Elevated serotonin synthesis in depression
Stress has been shown to increase tryptophan hydroxylase type 2 (TPH2) expression, the enzyme that synthesizes serotonin in the brain, specifically in the dorsal and median raphe nucleus of the brain (R, R).
Several studies have also found increases in neuronal TPH2 mRNA and protein expression within the dorsal raphe nucleus in human depressed suicides (R).
This points to increased serotonin synthesis in certain areas of the brain, which then contributes to depression.
Reduced serotonin breakdown in depression
The enzyme monoamine oxidase-A (MAO-A) predominantly breaks down serotonin, so blocking or inhibiting it significantly increases serotonin. That’s how many SSRI drugs work, by inhibiting serotonin breakdown.
Low-expression of MAO-A (which leads to elevated serotonin) has been shown to be associated with antisocial and anxious-depressive traits in alcoholic males (R).
Most importantly, the MAOA-L allelic variation (slow MAO-A activity) is associated with an increased risk of violent behavior, aggression as well as aberrant emotional regulation (R).
Mice lacking MAO-A and catechol methyltransferase (COMT) (an enzyme that also breaks serotonin down), or mice lacking the serotonin transporter (5-HTT) display among
other alterations, anxiety-like and depression-like behaviors (R).
Elevated cortisol, due to stress, inhibits MAO-A and B in the liver, thus inhibiting serotonin and dopamine breakdown (R), which can worsen depression and anxiety.
Reduced function of the serotonin transporter (SERT) is associated with increased susceptibility to anxiety and depression and with type-2 diabetes (R). Low SERT means that more serotonin is left in the synaptic cleft which amplifies the action of serotonin. Increasing SERT lowers synaptic/free serotonin and this reduces the action of serotonin.
Sodium, zinc, Bacopa, forskolin and berberine can increase SERT and reduce free serotonin. Tianeptine is also a very effective serotonin reuptake promoter and has been shown to have anti-depressant effects.
Also, individuals heterozygous for the SERT gene (low transporter activity) showed exacerbated ACTH response to stress (exaggerated adrenal response to stress). Additionally, low SERT in combination with a MAOA-L variation (low MAO-A activity), results in elevated ACTH response to psychological stress (R). More serotonin = greater reaction to stress = not being stress-resilient.
There are 14 known serotonin receptors, 7 main types and some of them with subtypes.
5-HT1A is the autoreceptor at the dorsal raphe (DR) nucleus in the brain, and binding to it specifically lowers DR serotonin.
5-HT1B/D are also autoreceptors, but they’re mainly expressed at the median raphe (MR) nucleus. Activating them lowers MR serotonin, but not DR serotonin.
Overactivation of the MR in the midline of the brain stem is involved in depression and anxiety (R). It’s promoted by noradrenaline (very mildly), acetylcholine, glutamate, restrained stress and certain visual and auditory stimuli and lowering it has anti-depressant effects. Symptoms of overactive MR include aggression, violence, muricidal tendencies, short fuse, apathy, “laziness”, anhedonia, suicidal tendencies, etc.
Certain SSRI drugs (e.g. Prozac) can enhance aggression, suicidal tendencies, inactivity, etc., because it promotes MR serotonin activity.
On the other hand, SSRI drugs can also induce anxiety, fear, restlessness, panic, etc. (R), if it over-activates the DR system. The DR serotonin stimulates the release of corticotropin-releasing hormone (CRH), which fuels fear. 3α, 5α-THP (of which 5α-DHP is the precursor) stops the CRH-mediated fear (R).
DR serotonin release is activated by social defeat (embarrassment and shame), 5-HT1A and 2A antagonist, noradrenaline and adrenaline (through α1-adrenoceptor signaling), amphetamine, cocaine and modafinil (also through α1-adrenoceptor signaling) (R).
So 5-HT1A agonists will lower DR, but not MR serotonin. 5-HT1A agonists have been shown to lower anxiety (R), but on the contrary, it can make depression worse. 5-HT1A agonists can worsen symptoms such as apathy, anhedonia, aggression, etc. because it leaves MR serotonin unopposed. DR serotonin inhibits MR serotonin release.
Cortisol is a 5-HT1A antagonist (which can potentiate fear), so over time it increases 5-HT1A expression and lowers DR activity, which is seen in depression. On the other hand, prenatal stress can lead to a reduction in 5-HT1A receptor expression and this increases DR activity which leads to fear and anxiety later in life (R).
5-HT1B/D agonists lower MR serotonin, but not DR serotonin, and this helps to reduce aggression, muricidal thoughts and behaviors, violence, irritation, suicidal idealizations, etc.
5-HT2 and 3 class
Next on the relevant list, we have the 5-HT2A and 2C receptors. Blocking 5-HT2A and 2C has anti-depressant and anti-anhedonic effects (R). Overactivity of 5-HT2C receptors may contribute to the etiology of depression and anxiety as some suicide victims have abnormally high expression of 5-HT2C in the prefrontal cortex (R).
The raphe obscurus (RO), another part of the brain that creates and secretes serotonin activates the vagus complex. Too much RO activation leads to overactivation of the vagal complex (VC), which in turn inhibits the C1 medullary nucleus (which creates adrenaline) via GABA. This contributes to fatigue (because of a reduction in adrenaline), which is very common in depression. RO can be inhibited by 5-HT2A and 3 antagonists and the vagal complex can be inhibited with the 5-HT3 antagonist (ginger anyone?).
Other 5-HT3 antagonists, such Ondansetron, have been shown to have anti-depressant effects (R, R, R, R)
“No in vivo studies of the cerebral 5-HT4 receptor binding in depressed patients or at-risk populations have been published so far, but a postmortem study of 19 depressed suicide victims showed increased 5-HT4 receptor density in the frontal cortex and caudate nucleus.” (R)
If you have major depression with symptoms such as:
- Violent behavior
- Short fuse
- Suicidal tendencies
…then you might benefit from antagonizing the MR nucleus with 5-HT2A antagonists (e.g. ginseng, Ginkgo Biloba, Bacopa, feverfew) and by lowering estrogen and inflammation. If you’re feeling restrained, then it would also be a good idea to get out more to reduce MR activation.
People with major depression (without anxiety) also do well on magnesium, but could do bad on zinc, methylene blue, clonidine and agmatine.
If you have symptoms such as:
- Low appetite
- Overly emotional
…then you might do best on a 5-HT1A agonist (e.g. zinc, methylene blue (product: oxidal)), GABA promotors (5a-DHP, taurine, valerian root), glutamate antagonists, (magnesium, theanine, zinc) and agmatine.
People with anxiety tend to do worse on NMDA agonists (e.g. glycine) and 5-HT2A agonists.
As always, thanks so much for reading my article. Let me know in the comments below if you have any questions. And if you found this article to be insightful and helpful please like and share so this information can help others as well.
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10 thoughts on “Serotonin, the fraudulent anti-depressant”
You have the most amazing post. Often times I will see something that doesn’t seem quite right in peoples beliefs on certain health issues. You lay everything out showing how a lot of health related beliefs are in error. Keep up the good work.
Thanks Lee, appreciate it!
You suggested I read this article which was very informative. thank you
Does Ginseng block 5-HT2A and 2C? at the bottom you say it does but on the PSSD article you mention ginseng for 2C and not 5-HT2A? How much Ginseng mg do you recommend to block these completely?
Thanks again Hans
My pleasure man. Yes ginseng is both a 5-HT2A and 5-HT2C antagonist. Not sure about blocking them completely (very high dose of a pharma drug might be needed), but between 200-400mg is a good dose.
Bro do you have a degree is neuroscience or pharmocology or did you just self educate?
Either way I’m insanely happy I found your content. I’ve noticed a pattern for years of being put on seratonergic pych meds for diagnoses and getting worse physically and mentally. I’ve been getting into biohacking and herbs and trying to reverse engineer my symptoms to figure out what to do because the doctors aren’t fucking helping.
The one factor that doesn’t make sense is seratonin. I’ve noticed for years that seratonergic chemicals (perscribed or recreational) my pain and mental illness worse. Glad I finally found someone who agrees.
I do have very very bad ADHD symptoms. It is neurodevelopmental but I’m starting to question the model for neurodivergency and just accepting it. I want to increase my dopamine and lower my seratonin. I had ocd and ADHD as a young child. Ocd is when seratonin is too high, ADHD is dopamine being too low. It’s all starting to make sense but I have a million questions and have been researching this stuff for several years with no real answers about the interplay between these neurotransmitter systems. I also have severe nerve pain.
For now, due to needing to hold my life together so I don’t end up homeless again, I’m taking dextroamphetamine. I’ve heard it actually downregulate dopamine overtime and your post said amphetamines increase seratonin.
But I do need stimulant medication to function as of right now because off of it I can’t even keep my room clean.
Does Ritalin downregulate the dopamine system in the same way dextroamphetamine and modafinil do? What about buproprion (Wellbutrin)
I can’t afford 1000s of dollars of stacks right now my guy but all four of those meds (modafinil, buproprion, Ritalin, dextroamphetamine) help my ADHD symptoms enough to be an adult. Out of those four do you have an opinion on which one is best for getting my brain to where I want it?
Hi man, I self-educate. Lots and lots of research.
I’d say the best option would be modafinil of all of them. Nerve pain could also indicate low B12, biotin, B1, B6 and copper as some of the main reasons. Low B1 and magnesium increase serotonin and lower dopamine.
Your articles are perfect. I hve read them all. You explain everything in detail, which no one else does. keep going. I have a question, I am homozygous for serotonin transporter (sert) and almost nothing has helped me from medications. what can i do in this case??? I think you are the only one who can help me. what medicine is indicated for this case and what supplements would help me??? I also have low serotonin and ocd. Do you think Tianeptine would help me??? Thanks. I will appreciate your reply.
A different kind of question.
Are you guiding people unofficially?
Can I come to you to regulate my health?
Now, I taking some testosteron in injections, have bipolar disorder, blocking some with cabergoline/prolactin blockers, with exemestane/estro block.
I take a lot of testo 500mg/week, but I don’t have any idea how to help myself.
Know a lot of, read a lot of, but it’s too much information.
I taking in my past ssri, this shit destroy my brain and life completely.
Have some porn/masturbate addiction.
Please help me, I can even pay you a lot of money, give you per moth good salary.
I don’t speak english very well, but I’ll do everything.
I can check my blood in the lab. Thanks
What do you mean with (help people) unofficially? Please contact me on email@example.com