Serotonin in Fibromyalgia and Chronic Fatigue Syndrome

Serotonin is a neurotransmitter that helps regulate a lot of your bodily functions. Along with melatonin, serotonin is especially involved in your sleep cycle. Melatonin helps you fall asleep, while serotonin helps you wake up feeling refreshed. At least, that's what serotonin and melatonin do in people who are fortunate enough to have the right amount.
A growing pool of research suggests that people with fibromyalgia (FMS) may have low levels of serotonin. Experts are split, however, as to whether serotonin levels are high or low in people with chronic fatigue syndrome (CFS or ME/CFS). Some studies show that the problem in ME/CFS may lie in low serotonin-receptor activity, which could mean that the brain isn't using serotonin properly, even if plenty is available.

Low Serotonin
No neurotransmitter acts alone. They all work together in a complex web of activity that scientists are really just beginning to understand. Still, experts have been able to associate different neurotransmitter imbalances with certain conditions and symptoms and find some ways to help boost or decrease activity.
Serotonin activity takes place in several areas of your brain, and even elsewhere around the body (where it acts as a hormone). Those different areas of your brain use serotonin differently, and they also contain several different kids of receptors that also influence how serotonin is used.
Low serotonin levels are associated with many physical and psychological symptoms. Examples of physical symptoms include:

• Fatigue in spite of adequate rest
• Disturbed sleep
• Changes in appetite
• Hot flushes and temperature changes
• Headaches

Examples of psychological symptoms include:

• Changes in libido
• Mood disturbances
• Depression
• Irritability

When serotonin levels are extremely low, additional symptoms may include:

• Muscle cramps
• Bowel & bladder problems
• Rapid, uncontrolled thought processes
• Emotional numbness
• Emotional or behavioral outbursts
• Escape fantasies
• Memory torture (dwelling on or reliving your most traumatic experiences)
• Thoughts of harming yourself or others

Several disorders improve with medicines that increase the availability of serotonin, including depression, insomnia, restless leg syndrome, irritable bowel syndrome, headaches, obsessive-compulsive disorder, anorexia, bulimia, social anxiety, phobias, Attention Deficit Disorder (ADD/ADHD), post-traumatic stress disorder, and alcoholism.

High Serotonin Levels & Serotonin Syndrome
Naturally occurring high levels of serotonin aren't associated with many symptoms. However, taking too much of a drug that raises serotonin levels can cause a dangerous condition called serotonin syndrome. If you suspect serotonin syndrome, you should get emergency medical help as soon as possible.
Symptoms of serotonin syndrome include:

• Confusion
• Agitation
• Profuse sweating
• High fever
• Muscle rigidity
• Fluctuating blood pressure

With treatment, serotonin syndrome typically resolves within a few days. In rare cases, it can be fatal.

Increasing the Availability of Serotonin
Several prescription drugs on the market increase the amount of serotonin that's available to your brain. In people with FMS and ME/CFS, the most common ones are selective serotonin re-uptake inhibitors (SSRIs), such as Prozac (fluoxetine), Paxil (paroxetine) and Zoloft (sertraline); or serotonin norepinephrine re-uptake inhibitors (SNRIs) such as Cymbalta (duloxetine) and Savella (milnacipran), which are two of only three FDA-approved fibromyalgia treatments.

If you prefer natural treatments, several dietary supplements have been linked to higher available levels of serotonin. They include:

• SAM-e
• 5-HTP
• St. John's Wort
• Rhodiola rosea

The simplest way to boost serotonin levels is by getting more sunlight.
There are not a lot of research confirming that food can boost serotonin levels in your brain, and it could take prohibitively huge amounts to have the desired effect. Some that are commonly believed to help include:

• Carbohydrate-rich foods, especially before bed (for an energy boost during the day, add protein)
• Complex carbohydrates, including grains, beans and many starchy foods
• Watermelon
• Dark chocolate (only in small amounts)

By Adrienne Dellwo, January 26, 2009

Sources:

1. Amino Acids. 2008 Jan 15. [Epub ahead of print] All rights reserved. "Theanine, gamma-glutamylethylamide, a unique amino acid in tea leaves, modulates neurotransmitter concentrations in the brain striatum interstitium in conscious rats."
2. Goldstein, J. Alasbimn Journal2(7): April 2000. AJ07-5. "The Pathophysiology and Treatment of Chronic Fatigue Syndrome and Other Neurosomati Disorders: Cognitive Therapy in a Pill."
3. Psychoneuroendocrinology. 2008 Feb;33(2):188-97. All rights reserved. "Genetic evaluation of the serotonergic system in chronic fatigue syndrome."
4. 2007 The Trustees of Columbia University. All rights reserved. "Serotonin and foods?"