Serotonin: Happy hormone or stress hormone?

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So the myth that serotonin is somehow a "happy hormone", and therefore that "more is better", has been pushed on people by Big Pharma ever since the development of selective serotonin-reuptake inhibitor (SSRI) antidepressant medications. As most people here are probably aware, SSRI medications have been MASSIVELY unsuccessful since they were introduced. It is clear that these drugs only provide temporary relief (in some cases) and actually seem to perpetuate the psychological issues they are purported to remedy. Increasing the bio-activity of serotonin makes depression worse!

But we can go even further with this and see that serotonin is not only intimately tied with depression and other psychiatric disorders, but it directly implicated in stress, metabolic dysfunction, and physiological degradation.

First, for some background information on serotonin's role in the brain and on psychological health, see this article by Dr Kelly Brogan. She highlights some very important points about serotonin in relation to depression (of which only a couple of excerpts are below):
...In a review of serotonin theories of depression, Andrews et al. turn the paradigm on its head and conclude:
we propose that depressed states are high serotonin phenomena, which challenges the prominent role the low serotonin hypothesis continues to have in depression research (Albert et al., 2012). We also propose that the direct serotonin-enhancing effects of antidepressants disturb energy homeostasis and worsen symptoms. We argue that symptom reduction, which only occurs over chronic treatment, is attributable to the compensatory responses of the brain attempting to restore energy homeostasis.

In this paper, they work to deconstruct our indoctrination around serotonin as a “happy chemical”, and elucidate its complex role in redirecting energy production when a creature is under duress. It is only when we perturb the system with medication that the body’s response can sometimes result in a chemically adaptive state, that is temporary, at best (accounting for relapse rates, while on medication, of up to 60%). Even this analysis is a theoretical offering in the service of challenging the dominant paradigm.

A New England Journal of Medicine review on Major Depression, stated:

” … numerous studies of norepinephrine and serotonin metabolites in plasma, urine, and cerebrospinal fluid as well as postmortem studies of the brains of patients with depression, have yet to identify the purported deficiency reliably.”

[..]

The foundational “data” for the modern serotonin theory of mood utilizes tryptophan depletion methods which involve feeding volunteers amino acid mixtures without tryptophan and are rife with complicated interpretations.

Simply put, there has never been a study that demonstrates that this intervention causes mood changes in any patients who have not been treated with antidepressants.

In an important paper entitled Mechanism of acute tryptophan depletion:is it only serotonin?, van Donkelaar et al caution clinicians and researchers about the interpretation of tryptophan research. They clarify that there are many potential effects of this methodology, stating:

In general, several findings support the fact that depression may not be caused solely by an abnormality of 5-HT function, but more likely by a dysfunction of other systems or brain regions modulated by 5-HT or interacting with its dietary precursor. Similarly, the ATD method does not seem to challenge the 5-HT system per se, but rather triggers 5HT-mediated adverse events.

Andrews goes further to include this interpretation in a long list of arguments against the role of low serotonin in depression (Box 1).


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So if we cannot confirm the role of serotonin in mood and we have good reason to believe that antidepressant effect is largely based on belief, then why are we trying to “boost serotonin”?

-Social Anxiety Disorder Linked to High Serotonin Levels
-Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature
-Is serotonin an upper or a downer? The evolution of the serotonergic system and its role in depression and the antidepressant response
-Low Serotonin Levels Don’t Cause Depression
-What has serotonin got to do with depression?
-Researchers Suggest Anxiety Is Caused By Too Much Serotonin


Anti-serotonin drugs = anti-depressant
[quote author=http://www.functionalps.com/blog/2012/10/30/serotonin-reuptake-enhancer-as-an-anti-depressant/]The predominant theory of depression suggests that a deficiency of serotonin (the “feel good neurotransmitter” or “happy chemical”) is a major player in depression. However, a more unified & integrated approach sees serotonin as prime facilitator of stress and degeneration that synergizes with other stress substances like estrogen, polyunsaturated fats, excitatory amino acids, prolactin, and glucocorticoids to create vicious, stress stimulating loops.

The proven anti-depression effects of tianapetine (Stablon, Coaxil, Tatinol), a selective serotonin reuptake enhancer (SSRE), calls into question the current model of depression since it has the opposite effect of the selective serotonin reuptake inhibitors (SSRI) drugs commonly used to treat depressives. Instead of inhibiting the uptake of serotonin like an SSRI, an SSRE increases uptake of serotonin, lowering serotonin’s activity. Tianeptine is well tolerated, decreases the excitatory effects of glutamate, prevents or reverse stress-related brain changes, doesn’t cause dependence or withdrawal symptoms, improves memory, and does not impair cognitive function.

SSRI drugs can sometimes cause very adverse side effects including increased symptoms of depression and suicide, as the Boston Globe article “Prozac Revisited” discusses. Making a Killing: The Untold Story of Psychotropic Drugging is a documentary that reveals how the current model for treating depression needs modification.

Tianeptine is referred to as an “atypical” anti-depression treatment. With a different perspective on physiology and the stress response, it’s the SSRI treatments that are atypical. Hopefully, the efficacy of tianeptine will open the mainstream’s consciousness to the stress-promoting effects of serotonin. This new consciousness can lead to a better understanding of other stress-related health problems.

Tianeptine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depression and coexisting anxiety and depression.
Tianeptine is a novel antidepressant agent, both structurally (modified tricyclic) and in terms of its pharmacodynamic profile. Unlike other antidepressant agents, tianeptine stimulates the uptake of serotonin (5-hydroxytryptamine; 5-HT) in rat brain synaptosomes and rat and human platelets, increases 5-hydroxyindoleacetic acid (5-HIAA) levels in cerebral tissue and plasma, and reduces serotonergic-induced behaviour. Tianeptine reduces the hypothalamic-pituitary-adrenal response to stress, antagonises stress-induced behavioural deficits and prevents changes in cerebral morphology. The antidepressant efficacy of tianeptine, as shown in 2 trials of patients with major depression or depressed bipolar disorder with or without melancholia, is greater than that of placebo. In patients with major depression without melancholia or psychotic features, depressed bipolar disorder or dysthymic disorder, the antidepressant efficacy of short term (4 weeks to 3 months) tianeptine therapy appears to be similar to that of amitriptyline, imipramine and fluoxetine and may be superior to that of maprotiline in patients with coexisting depression and anxiety.

Neurobiological and clinical effects of the antidepressant tianeptine.
Clinically, tianeptine is an antidepressant effective in reducing symptoms of depression in mild to moderate-to-severe major depression, including over the long term. Tianeptine is also effective in alleviating the symptoms of depression-associated anxiety. It is generally well tolerated, with little sedation or cognitive impairment. The efficacy profile of tianeptine could be explained by its neurobiological properties observed in animal models. Tianeptine prevents or reverses stress-associated structural and cellular changes in the brain and normalizes disrupted glutamatergic neurotransmission. In particular, in the hippocampus, it prevents stress-induced dendritic atrophy, improves neurogenesis, reduces apoptosis and normalizes metabolite levels and hippocampal volume. Tianeptine also has beneficial effects in the amygdala and cortex and can reverse the effects of stress on neuronal and synaptic functioning.

Can a serotonin uptake agonist be an authentic antidepressant? Results of a multicenter, multinational therapeutic trial.
Tianeptine is clearly active in classical animal models predictive of antidepressant activity, and is also active in behavioral screening tests: it antagonizes isolation induced aggression in mice and behavioral despair in rats. Biochemical studies have revealed that in contrast to classical tricyclic antidepressant, tianeptine stimulates 5-HT uptake in vivo in the rat brain. This somewhat surprising property was observed in the cortex and the hippocampus following both acute and chronic administrations. This increase in 5-HT uptake has also been confirmed in rat platelets after acute and chronic administrations. Moreover, in humans, a study in depressed patients demonstrated that tianeptine significantly increased platelet 5-HT uptake after a single administration as well as after 10 and 28 days of treatment.
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Animal Hibernation - Energy redirection

Serotonin plays an important role in preparing animals for hibernation:

[quote author=http://www.open.edu/openlearn/nature-environment/natural-history/animals-the-extremes-hibernation-and-torpor/content-section-6.5]The activity of tryptophan hydroxylase (TPH), a key enzyme in the biosynthesis of another monoamine transmitter, serotonin, undergoes marked changes in the brain during entry into hibernation, and arousal in Spermophilus erythrogenys. An increase in TPH activity was found in several regions of the brain during the pre-hibernation period in euthermic ground squirrels. A further increase in TPH activity to 150% was observed during the entry into hibernation. Significant elevation was found not only in potential TPH activity measured at the incubation temperature of 37° C but also at incubation temperature of 7° C, approximating the body temperature in hibernation. Serotonin may also contribute to the chemical induction and maintenance of hibernation.
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-Does serotonin play a role in entrance into hibernation?
-Brain serotonin metabolism in hibernation.]
-The influence of the neurohumor serotonin on hibernation in the golden-mantled ground squirrel, Citellus lateralis

Why would this be? It seems that serotonin can successfully redirect energy and distribute it appropriately throughout the system in response to environmental conditions.

In other words: When the body perceives there is danger/a lack of food availability/environmentally stressful conditions, it will redirect energy toward survival-only functions, and downregulate other non-essential functions such as reproduction etc.

The paper already mentioned by Andrews et al includes the following:
Table 4 lists the symptoms of three reliably diagnosed depressive states: sickness behavior, starvation depression, and
melancholia. Each involves an altered balance between metabolically expensive processes (Fig. 1). In sickness behavior, limited energetic resources are devoted to immune function at the expense of growth and reproduction. In starvation depression, energy is
devoted to maintenance functions at the expense of growth, reproduction, and immune function. In melancholia, there is an upregulation in sustained cognition at the expense of growth and reproduction. The energy regulation hypothesis suggests serotonin transmission is elevated in these states to coordinate tradeoffs in energy allocation. In melancholia, this tradeoff is coordinated by serotonin transmission to various regions, including the hypothalamus, amygdala, hippocampus and lateral prefrontal cortex (PFC) (Fig. 2). In the hippocampus and lateral PFC, the processes involved in sustained cognition are energetically expensive and can only be sustained with aerobic glycolysis (the generation of lactate from the metabolism of glucose stored in astrocytes).


energy_red.png

Possible reason for the observed benefits of taking SSRI's and 5HT supplements is that it induces an adaptive response (an increase in protective allopregnenalone production):

Elevation of brain allopregnanolone rather than 5-HT release by short term, low dose fluoxetine treatment prevents the estrous cycle-linked increase in stress sensitivity in female rats.

All these effects were blocked by short-term administration of fluoxetine (2 × 1.75 mg kg(-1) i.p.) during LD. This dosage increased the whole brain concentration of ALLO, as determined using gas chromatography-mass spectrometry, but was without effect on the extracellular concentration of 5-HT in the dorsal PAG, as measured by microdialysis. We suggest that fluoxetine-induced rise in brain ALLO concentration during LD offsets the sharp physiological decline, thus removing the trigger for the development of anxiogenic withdrawal effects.

Allopregnanolone regulates neurogenesis and depressive/anxiety-like behaviour in a social isolation rodent model of chronic stress.
The neurosteroid allopregnanolone (3α,5α-THP; ALLO) has been shown to be reduced in depressed patients. ALLO is "stress responsive" and plays a major role in regulating hypothalamic-pituitary-adrenal (HPA) axis function. We propose that reduced ALLO levels following chronic stress leads to HPA hyperactivity due to diminished ALLO regulation. This will result in increased glucocorticoid levels and reduced BDNF expression, leading to impaired hippocampal neurogenesis and the precipitation of depression/anxiety.

Another possible reason for "feeling great" is the activation of stress hormones - which temporarily induce feelings of 'bliss':

Serotonergic stimulation of corticotropin-releasing hormone and pro-opiomelanocortin gene expression.

The neurotransmitter serotonin (5-HT) stimulates adrenocorticotropic hormone (ACTH) secretion from the anterior pituitary gland via activation of central 5-HT1 and 5-HT2 receptors. The effect of 5-HT is predominantly indirect and may be mediated via release of hypothalamic corticotropin-releasing hormone (CRH). We therefore investigated the possible involvement of CRH in the serotonergic stimulation of ACTH secretion in male rats. Increased neuronal 5-HT content induced by systemic administration of the precursor 5-hydroxytryptophan (5-HTP) in combination with the 5-HT reuptake inhibitor fluoxetine raised CRH mRNA expression in the paraventricular nucleus (PVN) by 64%, increased pro-opiomelanocortin (POMC) mRNA in the anterior pituitary lobe by 17% and stimulated ACTH secretion five-fold.

Excess serotonin is excitotoxic - via increased activity of glutamate in the brain:

One effect of sustained serotonin transmission is to activate cortical networks, which are primarily glutamatergic (Puig and Gulledge, 2011). Current research suggests depression is associated with elevated glutamatergic activity in many regions (Alcaro et al., 2010; Sanacora et al., 2012). (C) During acute SSRI treatment, blockade of the serotonin transporter (SERT) shifts the balance of serotonin into the extracellular compartment. Extracellular serotonin is therefore perturbed above the depressed equilibrium. Since SERT blockade mimics the effects of a sustained increase in serotonin transmission, glutamatergic activity rises above the depressed equilibrium (Fu et al.,
2012) and symptoms often worsen (Cusin et al., 2007; Oswald et al., 1972). (

Some quotes from Dr Ray Peat on the subject:

In hibernating animals, the stress of a declining food supply causes increased serotonin production. In humans and animals that don’t hibernate, the stress of winter causes very similar changes. Serotonin lowers temperature by decreasing the metabolic rate. Tryptophan and melatonin are also hypothermic. In the winter, more thyroid is needed to maintain a normal rate of metabolism.

-The protective, defensive reactions involving serotonin's blocking of certain types of reaction to ordinary stresses, are similar to the effects of serotonin in hibernation and in Alzheimer's disease (Mamelak, 1997; Heininger, 2000; Perry, et al., 2002). In those extreme conditions, serotonin reduces energy expenditure, eliminating all brain functions except those needed for simple survival. These parallels suggest that improving energy production, for example by providing ketones as an alternative energy source, while reducing the stress hormones, might be able to replace the defensive reactions with restorative adaptive nerve processes, preventing or reversing Alzheimer's disease.

One of the factors promoting excess cortisol production is intestinal irritation, causing absorption of endotoxin and serotonin. Fermentable fibers (including pectins and fructooligosaccharides) support the formation of bacterial toxins, and can cause animals to become anxious and aggressive. Fed to horses, some types of fiber increase the amount of serotonin circulating in the blood. Grains, beans, and other seeds contain fermentable fibers that can promote intestinal irritation.

– Overdose with the serotonin reuptake inhibitors, or with 5-hydroxytryptophan [or 5-HTP], which has effects similar to serotonin, can cause the sometimes fatal “serotonin syndrome.” Symptoms can include tremors, altered consciousness, poor coordination, cardiovascular disturbances, and seizures. Treatment with anti-serotonin drugs can alleviate the symptoms and usually can prevent death.

– The high serotonin syndrome has been reported in users of St. John’s wort as an antidepressant.

– Although several amino acids can be acutely or chronically toxic, even lethal, when too much is eaten, tryptophan is the only amino acid that is also carcinogenic. (It can also produce a variety of toxic metabolites, and it is very susceptible to damage by radiation.) Since tryptophan is the precursor of serotonin, the amount of tryptophan in the diet can have important effects on the way the organism responds to stress, and the way it develops, adapts, and ages.

Decreasing tryptophan or decreasing serotonin improves learning and alertness, while increased serotonin impairs learning.

Serotonin’s contribution to high blood pressure is well established. It activates the adrenal cortex both directly and through activation of the pituitary. It stimulates the production of both cortisol and aldosterone.
 
Serotonin and gut health - Endotoxin (Lipopolysaccharride)

90% of the serotonin is produced in the gastrointestinal tract and is derived from the conversion of tryptophan amino acids. Serotonin’s other names include thrombotonin, thrombocytin, enteramine.

[quote author=http://raypeat.com/articles/articles/serotonin-depression-aggression.shtml]“Serotonin’s other names include thrombotonin, thrombocytin, enteramine, and 5-HT, its chemical name (5-hydroxytryptamine). These historical names derive from its role in the intestine and in blood vessels. In 1951, it was discovered that enteramine and thrombotonin were a single substance, and its involvement in circulatory disease, especially hypertension and vascular spasms, was the focus of research. (The increase in the number of “cardiovascular events” recently seen in the study of women using estrogen is what might be expected from something which increases serotonin dominance.) It causes vasoconstriction and vasospasm, and promotes clotting, when it’s released from platelets. Especially when it is released from mast cells, it is considered to be an inflammatory mediator, along with histamine. Edema, bronchoconstriction, immunosuppression, and joint swelling are produced by the release of serotonin from platelets or other cells. As inflammatory mediators, serotonin and histamine are directly involved in asthma, hives, gastrointestinal damage from alcohol, nerve cell damage, edema, and shock.”
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Endotoxin is a structural component/metabolic product of most bacteria and is present in small amounts in the gut. When bacteria metabolise undigested starches and fermentable fibres, they release small amounts of endotoxin. Bacteria which die release large amounts of endotoxin.

A normal (small) amount of endotoxin plays useful physiological roles, but large amounts (10-50 times as much) can cause sepsis and even death. Smaller increases such as 2-3 times as much cause mild immune-disrupting symptoms such as the common cold or fatigue.

Endotoxin promotes the release of serotonin from platelet cells, and is allowed entry into the blood stream in increased quantities during stress (via the tight junctions in the epithelial cells aka leaky gut). High levels of endotoxin disrupts all body systems including - liver, thyroid, kidney, immune, cardiovascular etc. = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795398

Serotonin's main function in the gut is to initiate gut-movement (peristalsis) to expel waste. If there is too much serotonin (caused by too much endotoxin) - there is diarrhoea - and eventually tissue fibrosis.

[quote author=http://www.resonantfm.com/biocast-episode-12-endotoxin-serotonin-and-depression/]http://jem.rupress.org/content/114/6/857.full.pdf
EFFECTS OF BACTERIAL ENDOTOXIN ON RABBIT PLATELETS

So the first link included looks at the effect of endotoxin on rabbit blood samples. It found that a relatively low dose of endotoxin would cause serotonin to move from the blood platelets into the blood plasma.

https://www.ncbi.nlm.nih.gov/pubmed/11458992
http://sci-hub.cc/10.1007/s007020070003
Lipopolysaccharide administration produces time-dependent and region-specific alterations in tryptophan and tyrosine hydroxylase activities in rat brain

The next study looks at the effect of endotoxin on tyrosine hydroxylase, and tryptophan hydroxylase in regions of rat brain. Tyrosine hydroxylase is the enzyme that converts the amino acid l-tyrosine to L-dopa, L-dopa is an important precursor for the neurotransmitter dopamine. Tryptophan hydroxylase is involved in the synthesis of serotonin from tryptophan. Both of these enzymes are described as the rate limiting factors in the synthesis of these neurotransmitters.

The paper cites references that demonstrated long-term isolation would increase tyrosine hydroxylase while auditory stress would increase the activation of tryptophan hydroxylase in certain parts of the brain. The paper suggests that these models of stress may look similar to the addition of endotoxin as a model of stress. Another substance that used in the experiments was NSD 1015, this is a decarboxylase inhibitor and it was used in order to prevent the destruction of the two enzymes in order that they could be measured.

The study found a significant increase in cortical and midbrain concentrations of serotonin but in the striatum their analysis showed no significant effect on serotonin. There was a significant effect on L-dopa only in the midbrain. The paper states that both enzymes are activated in response to peripheral endotoxin, varying with time and region of the brain.

The paper cites references showing increases in serotonin activity in the rat hippocampus, hypothalamus, frontal cortex ,and brainstem of rodents.

So the next paper then takes a step back to the gut and looks at the synthesis of serotonin in the colon.

http://www.cell.com/abstract/S0092-8674%2815%2900248-2
http://sci-hub.cc/10.1016/j.cell.2015.02.047
Indigenous Bacteria from the Gut Microbiota Regulate Host Serotonin Biosynthesis

Tells us that the gastrointestinal tract contains most of the body’s serotonin but that the mechanisms are controlling serotonin synthesis were to this point unclear. The paper mentioned some of serotonins known effects on gastrointestinal diseases immune response and bone development along with cardiac function. Adult germfree mice are known to be quite the paper calls deficient in serum and plasma serotonin controls. These germfree mice have significantly lowered levels of colonic and faecal serotonin. The germfree rodents were found to have lowered levels of the tryptophan hydroxylase one enzyme, which catalyses the conversion from tryptophan to serotonin.

When a crossover of gut bacteria was performed from the germfree mice, that is they transplanted gut bacteria from conventional mice into germfree mice they found that the serum and colon levels of serotonin were increased to those seen in conventional mice. Then in an attempt to reverse the effects on serotonin the mice were giving an antibiotic treatment of four different antibiotics. Significant decreases in serotonin were seen with the antibiotics.

The paper also shows that platelets, also thrombocytes, which are a component of the blood whose function is to stop bleeding, by increasing clotting would uptake serotonin produced in the gut and delivered to sites of clotting around the body. Germfree rodents were seen to have slower clotting time be related to the levels of serotonin in the platelet from the gut. In the previous podcast I looked at endotoxin’s effects on other clotting factors possibly involved in dementia, fibrin and fibrinogen.The paper also noted that metabolites of some bacteria like butyrate and propionate, often said to have a beneficial effect on the gut function, can increase serotonin expression, at least in a cell culture model.

http://sci-hub.cc/10.1002/jnr.490400316
Endotoxin Administration Stimulates Cerebral Catecholamine Release in Freely Moving Rats as Assessed by Microdialysis

The last paper then on the effect of endotoxin on serotonin is a study on rodents. The rodents received either endotoxin or a saline solution and had probes in various parts of their brain record markers of catecholamines, including a breakdown product of serotonin 5HIAA. It seems from my reading so far that the synthesis of serotonin or the release of serotonin from the platelet might be more important than 5H IAA in determining its potential pathological effects, however increased 5HIAA might be an indicator of increased synthesis. The paper explains that concentrations of serotonin could not be measured reliably in this model so they used 5H IAA as a proxy measurement.

They found elevations of 5H IAA in both of the brain regions that were tested, along with significant increases in norepinephrine and dopamine which peaked around two hours and returned to baseline two hours after that in one area of the brain only, the medial hypothalamus.

They also tested the effects of a non-steroidal anti-inflammatory drug called Indomethacin. This is a Cox two inhibitor, similar to aspirin in that regard and it inhibits the production of prostaglandins. Previous experiments had shown no effect from indomethacin on ACTH and corticosteroid after endotoxin treatment. Another experiment showed that indomethacin prevented the increase in catecholamines. In this experiment the indomethacin pretreatment completely prevented any increase in 5HIAA or other catecholamine or measured metabolites.
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A good article on endotoxin = Gram Negative Bacteria and Obesity

Some of serotonin's effects:

Activation of glycolysis and suppression of mitochondrial oxidative metabolism (read the Methylene Blue thread to see the implications of this long-term)

Activation of membrane skeleton-bound phosphofructokinase in erythrocytes induced by serotonin.
We show here that serotonin, both in vivo and in vitro, induced a marked activation of phosphofructokinase, the rate-limiting enzyme in glycolysis, in the membrane-skeleton fraction from erythrocytes. Concomitantly, the hormone induced a striking increase in lactate content, reflecting stimulation of glycolysis. The enzyme’s activity in the cytosolic (soluble) fraction remained unchanged. These results suggest a defense mechanism in the erythrocytes against the damaging effects of serotonin, whose concentration in plasma increases in many diseases and is implicated as playing an important role in circulation disturbances.

Serotonin-induced decrease in brain ATP, stimulation of brain anaerobic glycolysis and elevation of plasma hemoglobin; the protective action of calmodulin antagonists.
1. Injection of serotonin (5-hydroxytryptamine) to rats, induced a dramatic fall in brain ATP level, accompanied by an increase in P(i). Concomitant to these changes, the activity of cytosolic phosphofructokinase, the rate-limiting enzyme of glycolysis, was significantly enhanced. Stimulation of anaerobic glycolysis was also reflected by a marked increase in lactate content in brain. 2. Brain glucose 1,6-bisphosphate level was decreased, whereas fructose 2,6-bisphosphate was unaffected by serotonin. 3. All these serotonin-induced changes in brain, which are characteristic for cerebral ischemia, were prevented by treatment with the calmodulin (CaM) antagonists, trifluoperazine or thioridazine. 4. Injection of serotonin also induced a marked elevation of plasma hemoglobin, reflecting lysed erythrocytes, which was also prevented by treatment with the CaM antagonists. 5. The present results suggest that CaM antagonists may be effective drugs in treatment of many pathological conditions and diseases in which plasma serotonin levels are known to increase.

Serotonin stimulates mouse skeletal muscle 6-phosphofructo-1-kinase through tyrosine-phosphorylation of the enzyme altering its intracellular localization.

Serotonin (5-HT) is a hormone implicated in the regulation of many physiological and pathological events. One of its most intriguing properties is the ability to up-regulate mitosis. Moreover, it has been shown that 5-HT stimulate glucose uptake on skeletal muscle, suggesting that 5-HT may regulate glucose metabolism of peripheric tissues.
...
Altogether, our results support evidences that 5-HT augments skeletal muscle glucose consumption through stimulation of glycolysis key regulatory enzyme, PFK, throughout tyrosine phosphorylation and intracellular redistribution of the enzyme.

Serotonin can reduce the production of energy by inhibiting mitochondrial respiratory enzymes (Medvedev, 1990, 1991), and by reduction of oxygen delivery to tissues by vasoconstriction. It also appears to interfere with the use of glucose (de Leiva, et al., 1978, Moore, et al., 2004).

The primary mediator of Fibrosis:

Serotonin paracrine signaling in tissue fibrosis.
The molecule serotonin (5-hydroxytryptamine or 5-HT) is involved in numerous biological processes both inside and outside of the central nervous system. 5-HT signals through 5-HT receptors and it is the diversity of these receptors and their subtypes that give rise to the varied physiological responses. It is clear that platelet derived serotonin is critical for normal wound healing in multiple organs including, liver, lung heart and skin. 5-HT stimulates both vasoconstriction and vasodilation, influences inflammatory responses and promotes formation of a temporary scar which acts as a scaffold for normal tissue to be restored. However, in situations of chronic injury or damage 5-HT signaling can have deleterious effects and promote aberrant wound healing resulting in tissue fibrosis and impaired organ regeneration. This review highlights the diverse actions of serotonin signaling in the pathogenesis of fibrotic disease and explores how modulating the activity of specific 5-HT receptors, in particular the 5-HT2 subclass could have the potential to limit fibrosis and restore tissue regeneration. This article is part of a Special Issue entitled: Fibrosis: Translation of basic research to human disease.

Wikipedia article for Turgeride medication
"...Serotonin stimulates the proliferation of pulmonary artery smooth muscle cells, and induces fibrosis in the wall of pulmonary arteries. Together, this causes vascular remodeling and narrowing of the pulmonary arteries. These changes result in increased vascular resistance and PAH. Due to the potential anti-proliferative and anti-fibrotic activity of terguride, this potential medicine could offer the hope of achieving reversal of pulmonary artery vascular remodeling and attenuation of disease progression."

Serotonin is elevated in multiple pathological conditions

Role of serotonin in the pathophysiology of the irritable bowel syndrome
Altered 5-HT signalling may lead to both intestinal and extraintestinal symptoms in IBS. 5-HT directly and indirectly affects intestinal motor and secretory function and abnormalities may lead to either constipation or diarrhea. 5-HT modulates sensation and perception of visceral stimulation at peripheral and central sites. Therapeutic agents targeting altered 5-HT signalling may provide new, effective treatments for patients with IBS.

The Role of 5-HT Dysregulation in Inflammatory Bowel Disease

Serotonin and GI Disorders: An Update on Clinical and Experimental Studies

The regulation of 5-HT- and 5-HT-expressing EC cells is intimately associated with the inflammatory processes that drive many GI disorders. Recent studies on EC cells and 5-HT have generated a number of concepts that provide insight into how the immune and endocrine systems of the gut interface. It is evident from these studies that mediators from immune cells such as cytokines have an important role in EC cell biology and production of 5-HT in the gut. In addition, 5-HT has a key role in the pathogenesis of experimental colitis and in generation of pro-inflammatory mediators from immune cells. If this is not complex enough, this entire relationship is occurring in the presence of varying diets and mediators secreted by the microbiota, which may directly or indirectly influence the EC cell function.

Recently, Margolis et al.75 has shown that inhibition of 5-HT synthesis using a specific inhibitor of the TpH1 enzyme reduces the severity of trinitrobenzene sulfonic acid-induced colitis in mice. This finding furthers supports our observation that 5-HT is a critical molecule in pathogenesis of colitis and suggest that targeted inhibition of 5-HT synthesis may ultimately help in the development of improved therapeutic strategies in GI inflammatory disorders.

The serotonin system in autism spectrum disorder: From biomarker to animal models.

Elevated whole blood serotonin, or hyperserotonemia, was the first biomarker identified in autism spectrum disorder (ASD) and is present in more than 25% of affected children. The serotonin system is a logical candidate for involvement in ASD due to its pleiotropic role across multiple brain systems both dynamically and across development. Tantalizing clues connect this peripheral biomarker with changes in brain and behavior in ASD, but the contribution of the serotonin system to ASD pathophysiology remains incompletely understood. Studies of whole blood serotonin levels in ASD and in a large founder population indicate greater heritability than for the disorder itself and suggest an association with recurrence risk. Emerging data from both neuroimaging and postmortem samples also indicate changes in the brain serotonin system in ASD. Genetic linkage and association studies of both whole blood serotonin levels and of ASD risk point to the chromosomal region containing the serotonin transporter (SERT) gene in males but not in females. In ASD families with evidence of linkage to this region, multiple rare SERT amino acid variants lead to a convergent increase in serotonin uptake in cell models. A knock-in mouse model of one of these variants, SERT Gly56Ala, recapitulates the hyperserotonemia biomarker and shows increased brain serotonin clearance, increased serotonin receptor sensitivity, and altered social, communication, and repetitive behaviors. Data from other rodent models also suggest an important role for the serotonin system in social behavior, in cognitive flexibility, and in sensory development. Recent work indicates that reciprocal interactions between serotonin and other systems, such as oxytocin, may be particularly important for social behavior. Collectively, these data point to the serotonin system as a prime candidate for treatment development in a subgroup of children defined by a robust, heritable biomarker.
An overlooked connection: serotonergic mediation of estrogen-related physiology and pathology
Most research on pathologies in women's health has centered on changes in E2. Our review of data from a variety of fields suggests that serotonin is one way that estrogen is exerting its effects on physiology and pathology in women. The primary function of E2 is reproductive, and serotonergic mediation of the estrogen system likely provides reproductive benefits that are not yet understood. Several of the effects we have discussed could produce reproductive benefits: immune suppression during pregnancy could decrease the chance of lost pregnancies, postpartum activation of the immune system could increase antibodies in milk, increased clotting and vasoconstriction in the uterus could prevent bleeding during birth, and increased available calcium during lactation could improve the quality of breast milk. Notably, the same mechanism that results in these potential benefits in the reproductive system also produces changes in the remainder of the body that have consequences for women's physiology and pathologies. Whether the potential reproductive benefit of these effects is adequate to account for the maintenance of the estrogen/serotonin link remains to be explored. We suggest serotonergic mediation might contribute to explaining E2's effects on some pathologies, including heart attacks, multiple sclerosis, and breast cancer. Altering specific aspects of the serotonergic system, rather than simply increasing E2, could allow clinicians to target treatments in particular tissues or towards particular receptor types, alleviating undesirable side effects of E2 administration. Further studies are needed in order to unmask the precise molecular relationship between estrogen and serotonin and to document the clinical applications of this putative relationship.

for some information on estrogen see: The Health and Wellness Show - Keeping it Rill about the Pill

Increased levels of free serotonin in plasma of symptomatic asthmatic patients.

RESULTS:
The clinical severity rating and levels of free serotonin, norepinephrine, epinephrine, dopamine, and cortisol were significantly higher in symptomatic asthmatic patients than those in asymptomatic patients (P < .001, in all cases). FEV1 was significantly lower in symptomatic patients than in asymptomatic patients. In symptomatic patients, the level of free serotonin correlated positively with the clinical severity rating (r = .564, P < .01) and negatively with FEV1 (r = -.959, P < .001). In addition, the clinical severity rating showed a negative correlation with FEV1 (r = -.359, P < .01). No significant correlations were found in asymptomatic patients.
CONCLUSION:
Our finding that free serotonin was the only neuroendocrine factor closely associated with clinical severity and pulmonary function suggests that this factor plays an important role in the pathophysiology of acute asthma.

Serotonin modulates the cytokine network in the lung: involvement of prostaglandin E2
Serotonin, well known for its role in depression, has been shown to modulate immune responses. Interestingly, the plasma level of serotonin is increased in symptomatic asthmatic patients and the use of anti-depressants, known to reduce serotonin levels, provokes a decrease in asthma symptoms and an increase in pulmonary function. Thus, we tested the hypothesis that serotonin affects alveolar macrophage (AM) cytokine production, altering the cytokine network in the lung and contributing to asthma pathogenesis. AMs were treated with different concentrations of serotonin (10-11−10-9 M) or 5-HT1 and 5-HT2 receptor agonists for 2 h prior stimulation. T helper 1 (Th1) and Th2 cytokines, prostaglandin-E2 (PGE2) and nitric oxide (NO) were measured in cell-free supernatants. Serotonin significantly inhibited the production of tumour necrosis factor (TNF) and interleukin (IL)-12, whereas IL-10, NO and PGE2 production were increased. These immunomodulatory effects of serotonin were mimicked by 5-HT2 receptor agonist but were not abrogated by 5-HT2 receptor antagonist, suggesting the implication of other 5-HT receptors. Inhibitors of cyclooxygenase and antibody to PGE2 abrogated the inhibitory and stimulatory effect of serotonin on TNF and IL-10 production, respectively, whereas NO synthase inhibitor eliminated serotonin-stimulated IL-10 increase. Furthermore, PGE2 significantly increased AM IL-10 and NO production. These results suggest that serotonin alters the cytokine network in the lung through the production of PGE2. The reduction of Th1-type cytokine by serotonin may contribute to asthma pathogenesis.

Elevated serotonin and reduced dopamine in subregionally divided Huntington's disease striatum.
We measured the rostrocaudal distribution of serotonin, dopamine, and their metabolites in Huntington's disease striatum (caudate and putamen). Mean levels of serotonin or 5-hydroxyindoleacetic acid were elevated in most striatal subdivisions, whereas concentrations of dopamine or its metabolite homovanillic acid were slightly to markedly reduced. Dopamine and serotonin were at control levels in the nucleus accumbens and substantia nigra. Whereas the above-normal serotonin can most likely be accounted for by striatal atrophy, the reduced dopamine suggests either a marked down-regulation of nigrostriatal dopamine neurons or an actual reduction in the arborization of the striatal dopamine neurons. As experimental animal data suggest, the relative excess of striatal serotonin or one of its metabolites may facilitate the neurodegenerative process in Huntington's disease striatum.

Clopidogrel Treatment in Scleroderma Patients Shown to Induce Digital Ulcers - Scleroderma News

"...Recent research has suggested that patients with scleroderma might have abnormal activation of their blood platelets, caused by the damage to blood vessels that characterize the disease. Several platelet-linked molecules are increased in the blood of patients, and an earlier study showed that the release of serotonin, caused by platelet activation, might induce skin fibrosis in experimental animals. The data have led researchers to hypothesize that fibrosis is the result of a chain of events, starting with dysfunctional endothelial cells — forming the lining of blood vessels — over platelet activation, serotonin release and activation of fibrosis producing fibroblasts."

Pregnant rats treated with a serotonin precursor have reduced fetal weight and lower plasma volume and kallikrein levels.

Pregnant women with preeclampsia have increased serotonin levels, suggesting a possible role of this amine in abnormal pregnancy. With the hypothesis that an increase in serotonin would reduce volume expansion and cause fetal growth restriction, we evaluated the maternal and fetal effects of the administration of the serotonin precursor 5-hidroxytryptophan (5-HTP) to Sprague-Dawley rats. At pregnancy day 13 (n=19) or in random cycle nonpregnant rats (n=10), animals were assigned to a single injection of 5-HTP (100 mg/kg IP) or to a control group. Animals were studied at day 21, after overnight urinary collection. Additional pregnant rats received ketanserin (1 mg/kg), a 5-HT(2) receptor antagonist, 1 hour before 5-HTP injection. In pregnant rats, 5-HTP lowered plasma volume (control: 22+/-1.1; 5-HTP: 17+/-0.7 mL; P<0.001) and creatinine clearance, whereas serum creatinine and urinary protein excretion were increased; no changes were observed in nonpregnant rats. Systolic blood pressure did not change significantly. Urinary kallikrein activity and plasma aldosterone levels decreased only in pregnant animals. Fetal (control: 5.5+/-0.1; 5-HTP: 4.2+/-0.2 g; P<0.001) and placental weights were reduced. In nonpregnant and pregnant animals, 5-HTP caused profound renal morphological alterations and decreased kallikrein immunostaining. Preadministration of ketanserin abolished all of the changes associated with the use of 5-HTP. These data indicate that the administration of a serotonin precursor to pregnant rats limits plasma volume expansion and fetal growth via 5-HT(2) receptors, suggesting a possible role for serotonin in abnormal pregnancy. We postulate that an increased vascular resistance, both at the placental and renal levels, mediates these effects.


Anti serotonin drugs treat various serotonin-mediated pathology

Effects of antidepressant mirtazapine on fibromyalgia symptoms.

PURPOSE:
Fibromyalgia syndrome (FS) is a form of non-articular rheumatism. The main criteria are the widespread musculoskeletal pain and tender points at multiple characteristic sites which are associated with several vegetative and functional symptoms. Depression is the most frequent psychiatric concomitant of FS. Etiology is unknown, connection between disturbances of serotonin metabolism and pathogenesis is postulated. Pharmacological therapy with analgetic and nonsteroidal antiinflammatory drugs is not very effective. Positive effects were reported in some patients treated with antidepressant drugs, especially serotonergic agents.

MATERIAL AND METHODS:
In the study a novel antidepressant drug mirtazapine was used characterized by selective blockade of 5-HT2 and 5-HT3 receptors. In an open trial participated 29 patients with FS, who met 1990 ACR criteria for fibromyalgia. All were treated with mirtazapine for 6 weeks. Intensity of pain, sleep disturbances, fatigue and other symptoms were measured using visuale analogue scale, severity of depression was evaluated with HDRS and BDI.

RESULTS:
An open trial completed 26 patients, the majority of them experienced a clinical improvement at the end of the study as a consequence of > or = 40% reduced intensity of fibromyalgia symptoms as well as reduced severity of depression. The significant correlation between reduction in depression after 6 weeks of mirtazapine treatment with the reduction on all four main symptoms of FS suggests a common pathophysiology of depression and symptoms of fibromyalgia. The data thus far obtained indicate the blockade of 5-HT2 and 5-HT3 receptors with mirtazapine as an effective and promising method in FS.

CONCLUSIONS:
Further double-blind placebo-controlled study are required to confirm our results.

LX-1031, a Tryptophan 5-hydroxylase Inhibitor, and Its Potential in Chronic Diarrhea Associated with Increased Serotonin
Background
LX-1031 is an oral, small-molecule tryptophan 5-hydroxylase (TPH) inhibitor that reduces serotonin (5-HT) synthesis peripherally. It has potential for illnesses characterized by excess 5-HT, such as diarrhea-predominant irritable bowel syndrome (IBS-D) and carcinoid diarrhea. In vitro, inhibition of TPH1 occurred in 10−8 – 10−7 M range. In vivo in rodents, LX-1031 has no effect on brain 5-HT while dose-dependently reducing 5-HT, particularly in the small bowel.

Conclusion
LX-1031 appears promising for chronic diarrhea associated with increased 5-HT expression including IBS-D. Optimal doses, efficacy and safety in IBS clinical trials need to be fully elucidated; low systemic exposure, selectivity for TPH1 over TPH2, and lack of effect on brain 5-HT in several species suggest that LX-1031 is unlikely to cause affective disorders.

Cyproheptadine: An anti-serotonin + anti-histamine compound

Taken from one post by haidut on the Raypeatforum:

1. Cyproheptadine may have strong anti-cancer properties:
http://www.ncbi.nlm.nih.gov/pubmed/23076705
http://www.ncbi.nlm.nih.gov/pubmed/18502826

2. Cyproheptadine may treat autism:
http://www.ncbi.nlm.nih.gov/pubmed/15068403
http://www.ncbi.nlm.nih.gov/pubmed/12231270

3. Cyproheptadine may treat schizophrenia. This raises serious questions if schizophrenia is "caused by excessive dopamine" as the current mainstream dogma holds since cyproheptadine would in theory increase dopamine and its effects:
http://www.ncbi.nlm.nih.gov/pubmed/11728834
http://www.ncbi.nlm.nih.gov/pubmed/10319907

4. Cyproheptadine may treat depression and other similar mental issues:
http://www.ncbi.nlm.nih.gov/pubmed/7667171
http://www.ncbi.nlm.nih.gov/pubmed/23442031
http://www.ncbi.nlm.nih.gov/pubmed/9304415

5. Cyproheptadine may be heart-protective (Ray said that anti-serotonin drugs like ondansetron protect the heart):
http://www.ncbi.nlm.nih.gov/pubmed/19346455
http://www.ncbi.nlm.nih.gov/pubmed/7976381

6. Cyproheptadine may protect the brain from the damage caused by BOTH ischemic and hemorrhagic stroke:
http://www.ncbi.nlm.nih.gov/pubmed/7976376
http://www.ncbi.nlm.nih.gov/pubmed/1757225
http://www.ncbi.nlm.nih.gov/pubmed/3982650

7. Cyproheptadine may protect the brain in a very generalized way by increasing cholesterol and phospholipids:
http://www.ncbi.nlm.nih.gov/pubmed/8225552

8. Cyproheptadine may protect from endotoxin:
http://www.ncbi.nlm.nih.gov/pubmed/11940385
http://www.ncbi.nlm.nih.gov/pubmed/1598825
http://www.ncbi.nlm.nih.gov/pubmed/8368073

9. Cyproheptadine may stimulate the immune system:
http://www.ncbi.nlm.nih.gov/pubmed/3567337

10. Cyproheptadine may have anti-endorphin action similar to naltrexone:
http://www.ncbi.nlm.nih.gov/pubmed/2995088

11. Cyproheptadine may suppress prolactin, growth hormone, aldosterone, ACTH, TSH, and cortisol:
http://www.ncbi.nlm.nih.gov/pubmed/2994332
http://www.ncbi.nlm.nih.gov/pubmed/6109449
http://www.ncbi.nlm.nih.gov/pubmed/7017408
http://www.ncbi.nlm.nih.gov/pubmed/115197
http://www.ncbi.nlm.nih.gov/pubmed/4600047
http://www.ncbi.nlm.nih.gov/pubmed/177441
http://www.ncbi.nlm.nih.gov/pubmed/177112
http://www.ncbi.nlm.nih.gov/pubmed/1201741
http://www.ncbi.nlm.nih.gov/pubmed/180050
http://www.ncbi.nlm.nih.gov/pubmed/401824

12. Cyproheptadine may suppress prostaglandin synthesis and effects (similar to aspirin):
http://www.ncbi.nlm.nih.gov/pubmed/412631
http://www.ncbi.nlm.nih.gov/pubmed/508004

13. Cyproheptadine may be helpful in the treatment of "alcoholism":
http://www.ncbi.nlm.nih.gov/pubmed/3797491
http://www.ncbi.nlm.nih.gov/pubmed/14157085

14. Cyproheptadine may be helpful in the treatment of "psoriasis":
http://www.ncbi.nlm.nih.gov/pubmed/6735444

15. Cyproheptadine may be helpful in the treatment of decompression sickness:
http://www.ncbi.nlm.nih.gov/pubmed/7233624

16. Cyproheptadine may be helpful in restoring fertility in old age:
http://www.ncbi.nlm.nih.gov/pubmed/1204806

17. Cyproheptadine may be helpful in treating myopathy (muscle weakness):
http://www.ncbi.nlm.nih.gov/pubmed/4274414
 
Thank you for sharing this. It was very good and informative. It gave me some new things to look into with my own health and my husband's health as well. I am motivated to find more information on this topic, specifically the brief mention of Estrogen in the beginning paragraph.
 
jen1221 said:
Thank you for sharing this. It was very good and informative. It gave me some new things to look into with my own health and my husband's health as well. I am motivated to find more information on this topic, specifically the brief mention of Estrogen in the beginning paragraph.
I will compile some information and start a thread on estrogen soon because it needs it's own. Until then, all I will say is that estrogen is not simply a female hormone, and is implicated in practically every known disease.
 

What You Need to Know About Estrogen and Serotonin​

Story at a glance:
  • Estrogen is an obesity promoter and well-established human carcinogen
  • The Women’s Health Initiative studies, which began in 1991, showed estrogen replacement therapy in menopausal women significantly increased the risk of heart attacks, strokes, dementia, Parkinson's disease and cancer, not just in the breast but all female reproductive organs
  • The biochemical role of estrogen is to aid in wound healing. In cases of tissue trauma, estrogen reverts the differentiated cells in that specific tissue back to a stem cell-like condition, to repair the damaged tissue. In young, healthy women, progesterone will turn off estrogen’s activity. Progesterone declines with ages, but estrogen synthesis typically does not. Hence, if your estrogen is high and progesterone low, your cancer risk will rise
  • Estrogen is antimetabolic and radically reduces the ability of your mitochondria to create cellular energy in a form of ATP
  • Elevated serotonin destroys empathy, love and wisdom, and contributes to fibrosis, impaired thyroid function, reduced metabolism and reductive stress. High serotonin is also responsible for bizarre, recurring nightmares and may play a role in PTSD as well
 

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