How Does Alcohol Affect Serotonin?

What is happiness? Now there’s a head-scratcher. This seemingly simple yet infinitely complex question has boggled the minds of ancient philosophers, psychologists, fantasy novel writers, and spiritual seekers alike. 

Unfortunately, it’s also a question that can lead us astray once “happiness-boosting” substances such as alcohol come into the picture. Creating joy on demand is tricky business, and we can inadvertently end up in dangerous waters, especially if we’re not careful about how we drink or what we mix with alcohol.

As far as the brain is concerned, however, it all comes down to neurochemicals, with serotonin taking center stage. How does alcohol affect serotonin? And how can it contribute to the potentially dangerous serotonin syndrome? Let’s find out!

What Is Serotonin?

Serotonin is a neurotransmitter — a molecule that acts as a chemical messenger, helping neurons communicate with one another. But did you know that only about 10% of serotonin is actually produced in the brain? That’s right — 90% of this essential chemical is found “downstairs,” in the gut, where it acts as a hormone.

While serotonin is best known for its role in those happy emotions we all know and love, it actually has a range of functions in the body. Here’s an overview:

• Mood control. By far the best-known job of serotonin, the ability to regulate our mood, is what earned serotonin nicknames like “the happy chemical” or “the feel-good molecule.” While higher levels of serotonin are associated with well-being, low levels often trigger depression and anxiety. (But, as we’ll see later, there’s a catch — too much of a good thing can spell trouble, and serotonin is no exception.)
• Digestion management. Given that most serotonin is found in the gut, it makes sense that it plays a significant role in digestion. For example, serotonin helps regulate our appetite and balance hunger and satiety cues.
• Sleep regulation. In addition to regulating digestion, serotonin is involved in another important daily task — sleep. It helps regulate our body’s sleep cycles, telling our brain when it’s time to hit the snooze button and doze off.
• Wound healing. Platelets in our blood release serotonin to help in the wound-healing process. Serotonin also helps slow down blood flow to allow for clotting. 
• Pain management. As it turns out, it’s not just about the physical process of healing. Serotonin also affects how we perceive pain, making us more tolerant to it.
• Bone health. Last but not least, serotonin affects the density of our bones. High levels can make our bones weak, leading to osteoporosis.

With so much on its task list, serotonin is one busy chemical. It’s no wonder that any disruptions to its normal functioning can wreak havoc on the body and mind. Low serotonin levels can lead to anxiety, depression, and problems with digestion and sleep. Scientists and doctors have found a number of solutions that can help, ranging from getting more sunlight and exercise to taking antidepressants that increase serotonin levels, often by keeping them from getting cleared out of nerve synapses.

Serotonin is produced from tryptophan, an essential amino acid that can’t be produced from scratch and must come from the foods we eat. Some good tryptophan sources? Animal proteins, as well as legumes, nuts, seeds, and whole grains.

But what about alcohol? How does it factor into the picture? 

Alcohol and Serotonin

Alcohol and serotonin have a complex relationship. Let’s explore it in more detail.

Alcohol and Serotonin: The Short-Term Effects

While dopamine — the “reward” neurotransmitter — usually gets mentioned first when it comes to the “happy chemicals” alcohol enhances, serotonin is an important part of the picture. Drinking boosts our levels of serotonin, with a single drinking session being enough to cause a noticeable shift. That warm, fuzzy, “I just love everyone in this room” kind of feeling? That’s serotonin in action. However, this effect is temporary. Plus, there’s often a rebound effect the next day as serotonin levels fall, contributing to that “blah” feeling of the morning-after hangover.

Alcohol and Serotonin: In the Long Term

In the long term, there’s more potential trouble when it comes to alcohol and serotonin. As the rush of pleasure-inducing neurochemicals (including serotonin) becomes the “new normal,” the brain puts the brakes on its natural production. So those feel-good movies, heart-to-heart conversations with old friends, and cuddles with our Golden Retriever don’t produce the same rush of serotonin they used to in the past. 

As a result, the stage is set for alcohol dependence, which develops in part as a response to the neurochemical shifts in the brain. Research supports this: studies show that serotonin transporter densities are reduced in people with alcohol dependence. And while the brain can certainly return to normal, it will take some time. (For a deeper look, check out “Alcohol Misuse and Depression: What’s the Connection?”)

Serotonin Syndrome: When Serotonin Gets Serious

If serotonin is a “happy chemical,” more of it should be a good thing, right? Not so. In fact, when serotonin levels get too high, we can end up with a dangerous (and potentially life-threatening) condition known as serotonin syndrome. 

While serotonin syndrome can happen from alcohol alone, it’s much more likely to be triggered by a combination of alcohol and another serotonin-boosting substance. The list of possible culprits is pretty huge. (Note: most of these substances are safe when used as directed. It’s only when we mix them with booze that we run into trouble.)

• SSRI antidepressants. By far the most common serotonin syndrome trigger? A combo of alcohol and SSRIs — antidepressant drugs from the selective serotonin reuptake inhibitor class. Some common ones include citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro).


  
  SSRIs can be a lifeline for those struggling with depression and anxiety. They work by inhibiting the reuptake of serotonin, which increases its availability in the brain. In addition to potentially leading to serotonin syndrome, combining SSRIs and alcohol can make them less effective. (For more information, take a look at “Alcohol and Antidepressants: A Dangerous Combo.”)
• Other drugs that increase serotonin levels. Many other drugs also inhibit serotonin reuptake, including painkillers such as meperidine, tramadol, and pentazocine; metoclopramide (an anti-nausea drug); valproate and carbamazepine (used to treat epilepsy and bipolar disorder); dextromethorphan (an OTC cough medication); cyclobenzaprine (a muscle relaxant); and trazodone (an anti-depressant often prescribed for insomnia).
• Dopamine-norepinephrine reuptake inhibitors. Even though medications such as bupropion work primarily on dopamine, they raise serotonin levels as well. 
• Tricyclic antidepressants. A different class of antidepressants, these meds are also not alcohol-friendly. 
• Monoamine oxidase inhibitors (MAOIs). Older types of antidepressants that works by inhibiting serotonin breakdown, MAOIs are some of the most dangerous meds to mix with alcohol, since the effects can be the most intense. Some examples include phenelzine, tranylcypromine, isocarboxazid, and selegiline.
• Some supplements. Saint-John’s-wort, an innocent-looking yellow flower that’s a staple in health food stores in the form of teas and supplements, is known to increase serotonin levels. Likewise, the aforementioned tryptophan that boosts serotonin formation is often sold in supplement form and can be dangerous in the wrong combination. 
• Other drugs. Amphetamines, cocaine, and MDMA all boost serotonin release.

While substances on this list can cause serotonin syndrome when mixed with alcohol, we should also avoid mixing them with each other. Any combination of serotonin boosters could get us in the danger zone!

The Science of Serotonin Syndrome 

So what is serotonin syndrome, scientifically speaking? In short, the serotonin receptors in our central and peripheral nervous system get overwhelmed, leading to an all-out system overload. 

Symptoms of Serotonin Syndrome

Serotonin syndrome symptoms aren’t always catastrophic, but they are important to recognize and address right away, since they can easily escalate. They tend to range from mild to severe.

• Nervous system effects. We’re likely to feel agitated, anxious, and restless.
• Cognitive symptoms. We might feel confused and disoriented.
• Cardiovascular signs. Our heart rate might increase.
• Hyperthermia. We could feel unusually warm and have flushed skin.
• Gastrointestinal effects. We’re likely to experience nausea and vomiting. It’s important to pay attention to any extra belly rumbling, since increased bowel sounds are another sign.
• Muscle glitches. We might feel our muscles (especially our legs) go rigid or shake.
• Other signs. Additional symptoms include dilated pupils, dry mucous membranes, and the so-called “Babinski reflex” (an abnormal fanning out of the toes when the sole is stroked).

Never ignore these signs. If you notice them, seek medical help right away!

Treatment for Serotonin Syndrome

Treatment for serotonin syndrome symptoms will usually happen in a hospital setting. Here’s what will probably happen should we get there.

• Tests. The doctor will run some tests, including blood work, an electrocardiogram, and possibly a brain scan (if our symptoms are really severe). These tests will rule out other issues and will help get to the root of the problem.
• Fluids. Replenishing lost fluids and electrolytes is key, so we’ll probably receive plenty of intravenous fluids.
• Cyproheptadine (Periactin). Cyproheptadine blocks serotonin production and is useful in treating serotonin syndrome.
• Anxiety management. We might be treated with benzodiazepines (such as diazepam or lorazepam) to ease anxiety and seizure-like symptoms.

Serotonin syndrome is treatable, but it’s crucial to get help in time. Always err on the side of safety!

Serotonin Safety Tips

Here are some tips to avoid the potential dangers that come with alcohol and serotonin-boosting substances.

• Watch your intake. Avoid mixing alcohol with drugs that might increase your serotonin levels. And, if you decide to leave booze behind, keep an open mind. Be honest with yourself about how you’re feeling — you might just be surprised at the benefits and want to keep going, even when you’re no longer on an SSRI or another medication that increases serotonin.
• Be honest with your doctor. It’s crucial to provide your doctor with the most accurate information possible, so don’t leave anything out. Remember, even some innocent-looking herbs can be dangerous if mixed with certain meds.
• Follow the instructions. Always follow the directions your doctor gives you about how to take your medication. 

Don’t hesitate to ask your doctor or pharmacist if you have questions about medication interactions or possible reactions with alcohol. Safety is key!

A Natural Serotonin Boost

Finally, did you know that there are plenty of ways to boost serotonin naturally? Here are a few go-tos that are scientifically proven to work.

1. Spend time with loved ones. Socializing with people we care about will boost serotonin naturally. It’s all about nurturing authentic connections!

2. Eat a serotonin-boosting diet. This one is simple yet crucial. As you now know, serotonin is produced from the essential amino acid, tryptophan. So load up on animal proteins (go for healthy options such as lean meats or fish), legumes, whole grains, and nuts to boost your levels.

3. Exercise. What goes hand-in-hand with diet? Exercise. Science shows that being physically active naturally promotes serotonin release (along with other “happy” chemicals, such as endorphins and dopamine). A bonus? It also keeps alcohol cravings at bay!

4. Write it out. Putting thoughts on paper can be cathartic and is a time-tested way to boost serotonin levels and feel more at peace.

5. Talk it out with a therapist. Sometimes identifying the root of the problem by talking to a pro can take a load off your mind, leaving you feeling more relaxed and unburdened. 

6. Spend time outside. Exposure to natural light is a scientifically proven way to boost serotonin levels. So if the sun is out, take a few minutes (or more, if you can) to take a walk around the block. Skip public transportation and walk to work if you live in a big city. Or, just simply set aside some time to lounge on your porch or in the backyard!

There are plenty of ways to tap into the natural serotonin-producing powers of our brain. It’s designed for it!

Finding Happiness

To sum up our discussion of serotonin, let’s get philosophical again for a moment. True happiness gives life that spark that makes us excited to get up in the morning and gives us memories we can treasure when things get difficult. But it can’t be found in a substance like alcohol — at best, all that we end up with is an illusion.

As Karen Weinreb writes in The Summer Kitchen, “Happiness is the greatest paradox of nature … It comes from within … Happiness consists not of having, but of being; not of possessing, but of enjoying … Happiness is the soul's joy in the possession of the intangible. It is the warm glow of a heart at peace with itself.” So let’s let it glow the way it’s meant to, booze-free!