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How Are Serotonin Syndrome and Substance Use Connected?

Eric Patterson, LPCEmily Guarnotta, PsyD
Published on December 22, 2021

Key takeaways:

  • Serotonin is an important chemical in your brain and body that helps control your sleep patterns, your thinking, and your mood.

  • If you have too little serotonin in your brain, you may use alcohol or other drugs to feel better, but over time, substance use can result in even lower levels of serotonin and more problems.

  • Serotonin syndrome is a medical condition caused by too much serotonin in the brain, which can happen if you are on several medications or drugs that increase your serotonin levels.

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Serotonin is one of the most important and influential chemicals in the body, and keeping balanced levels of it is key. Having too little or too much can result in serious mental and medical health conditions, like depression and serotonin syndrome. Your activities, medications, and substance use can all affect serotonin levels, so check with your healthcare provider to be sure your levels are safe and your risk is low.

Read on to learn more about serotonin, serotonin syndrome, and how substance use affects levels.

What is serotonin?

Serotonin is one of the natural chemicals your body produces to feel well and function normally. It carries messages throughout your body and brain, and your body depends on serotonin to control and manage many functions. 

Serotonin is sometimes called a “calming chemical” because it can help counteract the excitement of other chemicals, like dopamine. Serotonin helps you:

  • Lower tension and stress

  • Decrease anxiety and aggression

  • Manage sleep patterns and sexual desires

  • Remember important things

When all is well in your body and brain, serotonin levels will be balanced and steady. Having too little serotonin can lead to unwanted symptoms like:

  • Problems with memory

  • Feeling sad and depressed

  • Craving junk food

  • Trouble sleeping

  • Low self-esteem

  • Problems with sexual desire or functioning

The lower the levels of serotonin you have, the more frequent and intense symptoms you will experience.

What affects my levels of serotonin?

Your family history and chemical makeup determine how much serotonin you have naturally. But the activities you do every day can affect your levels, too. Some of the daily activities that impact your serotonin levels include:

  • The amount of time you spend outside

  • Your level of exercise and physical activity

  • The foods you eat and drink

  • Your levels of relaxation and meditation

  • The medications you take. Selective serotonin reuptake inhibitors (SSRIs) help increase the chemical in your brain.

Other activities and situations can produce an intense or unexpected surge in serotonin. For example, having a tumor in your stomach or lungs can create large amounts of the chemical. Also, using alcohol and other drugs can also impact the levels of serotonin you experience.

What is serotonin syndrome?

Just as too little serotonin is a problem, having too much serotonin is a concern that results in a medical condition called serotonin syndrome. Serotonin syndrome is potentially life-threatening and causes symptoms like:

  • Agitation and irritability

  • Nausea, vomiting, and diarrhea

  • Fever and heavy sweating

  • Confusion

  • High energy

  • Shivering, shaking, and muscle spasms

  • Hallucinations

  • Unstable blood pressure

Serotonin syndrome can be hard to diagnose because it can be confused with other medical problems, like infections, drug intoxication or withdrawal, and hormonal issues. Fortunately, once identified, serotonin syndrome can be treated with:

  • A drug that blocks serotonin production

  • Medications to decrease agitation 

  • IV fluids

What causes serotonin syndrome?

Maybe the most important step in treating serotonin syndrome is stopping the cause of the condition. In most cases, serotonin syndrome is triggered by being on too many medications or drugs that interact with serotonin. 

If you are on an SSRI and your provider adds a medication to help with migraines, you could experience serotonin syndrome. Some painkillers and cough medicines can spark the condition.

Also, serotonin syndrome could be caused by mixing prescription medications with drugs that increase serotonin like:

  • MDMA (ecstasy or Molly)

  • Cocaine

  • LSD (acid)

  • Amphetamine/methamphetamine 

Whatever the case, you should always take time to research and understand the medications you are putting into your body. Seek your healthcare provider’s advice before starting or changing any medications.

What role does serotonin play in mental health conditions?

Serotonin might be the most important chemical for your mental health. It is linked to many mental health conditions, and many mental health medications aim to increase the offered amounts of serotonin in the brain. 

The amount of serotonin in your brain is a factor in your mental health, but so is how well your brain can use the chemical when it is available. Some people may have enough of the chemical in their brain, but they cannot use it correctly to create the desired results. 

Experts are studying the influence of serotonin in various mental health conditions like:

  • Depression

  • Other mood disorders, including bipolar disorder

  • Anxiety disorders

  • Obsessive-compulsive disorder (OCD)

  • Schizophrenia

  • Attention-deficit/hyperactivity disorder (ADHD) 

  • Autism spectrum disorder

Even though only about 2% of your body’s total serotonin is in your brain, it has such a powerful influence on how you feel, sleep, and think.

What role does serotonin play in addiction, relapse, and recovery?

Serotonin is tightly connected to substance use, addiction, and other mental health concerns. Low serotonin levels will make you feel unhappy and unwell, and many people look for quick solutions to feel better quickly.

Using drugs could be more tempting if you suffer from the symptoms of low serotonin levels. People usually start using drugs to feel good or to feel better. Then you get hooked on the way you feel while serotonin levels are high.

Using drugs to produce more serotonin and change the way you feel is a problem, but the problem spreads. When drugs trick your brain to release more of the chemical, you may end up with lower levels of serotonin in the following days, which leaves you feeling even worse than when you started.

This dip in serotonin after use could help explain why the early days of sobriety and recovery are so challenging for people and why relapse can seem more appealing.

How can you get help for low serotonin levels or serotonin syndrome?

Having too much or too little serotonin can present problems, so it’s always important to pay attention to how you feel and possible explanations. If you are suddenly starting to feel odd or uncomfortable after starting a new medication or using drugs, be cautious of serotonin syndrome and consider getting emergency care quickly. 

Serotonin syndrome is dangerous, but once professionals discover the problem, you may only need 24 hours in the hospital.

If low serotonin is your concern, start by making a few lifestyle changes to correct the problem: 

  • Eliminate or cut back on substance use

  • Increase your levels of exercise

  • Eat healthy foods

  • Spend some time outside to get more sunlight

  • Practice meditation

If you are not feeling better with these changes, it may be time for therapy and medication. Many anti-depressant medications help boost serotonin in your system, and therapy has been shown to do the same with little risk of side effects.

The bottom line

Serotonin, serotonin syndrome, and substance use share a close association. Your low serotonin levels may be uncomfortable, but substance use and serotonin syndrome will only create discomfort and danger. Be sure to work with professionals to balance your serotonin levels safely and effectively.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-HELP (4357) to learn about resources in your area.


Brown, C. H. (2010). Drug-induced serotonin syndrome. U.S. Pharmacist.

HealthDirect. (2021). Serotonin.

View All References (4)

Lin, S. H., et al. (2014). Serotonin and mental disorders: A concise review on molecular neuroimaging evidence. Clinical Psychopharmacology and Neuroscience.

MedlinePlus. (2020). Serotonin syndrome.

National Institute on Drug Abuse. (2014). Word of the day: Serotonin.

National Institute on Drug Abuse. (2020). What is drug addiction?

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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