CFS & Fibromyalgia Symptoms Physical and Emotional Symptoms of Low Serotonin By Adrienne Dellwo Adrienne Dellwo LinkedIn Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. Learn about our editorial process Updated on May 19, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Expert Board Print Many symptoms of fibromyalgia (FMS) and possibly chronic fatigue syndrome (CFS or ME/CFS) are believed to be tied to low levels of the neurotransmitter serotonin. These can include pain, fatigue, low energy, depression, negative thoughts, irritability, anxiety, abdominal problems, binge eating, and a reduced interest in sex. The assortment of symptoms can be confusing and bewildering, not to mention no fun to live with. But as varied as the problems are, they're not the only effects related to serotonin, which is both a neurotransmitter (in your brain) and a hormone (in the rest of your body.) demaerre / Getty Images What Serotonin Does Serotonin is a regulator of all kinds of processes, so it's no wonder that when it's out of whack, nothing is regular. That's why you feel like your body is falling apart and your symptoms don't make any sense. Serotonin's dual nature, as a neurotransmitter and hormone, means it's found all over your body. In fact, there's more serotonin in your gut than in your brain. That may explain why illnesses such as irritable bowel syndrome (IBS) are extremely common in FMS and ME/CFS: IBS involves serotonin dysregulation as well. By recognizing symptoms of serotonin dysregulation, you may be able to not only understand your symptoms but actually improve your chances of proper diagnosis and treatment. Physical Serotonin-Related Symptoms Measuring neurotransmitters is not a reliable way of diagnosis. Instead, your healthcare providers rely on symptoms for making diagnoses. For that reason, it's important for you to know which symptoms may be linked to serotonin. What we call "low" serotonin may come from a couple of different causes: either your body doesn't make enough, or it doesn't use it efficiently. Some of the major physical symptoms linked to low serotonin are: Chronic fatigue in spite of adequate restDisturbed sleepLoss of appetite or carb cravings, possibly due to the body's attempt to make more serotoninHot flashes and temperature changes that aren't linked to your environmentHeadachesStomach pains Certainly, some of these symptoms can crop up in anyone's life from time to time. The key here is to recognize whether you have clusters of symptoms that tend to occur together. Serotonin levels can fluctuate, leading to symptom flares and remissions (times when symptoms are gone or at low levels). Emotional Serotonin-Related Symptoms The presence of emotional symptoms in no way implies that FMS or ME/CFS are psychological or psychiatric illnesses. In fact, we know that these conditions include numerous biological abnormalities. FMS is generally considered a neurological condition, and both of these illnesses are sometimes called neuroimmune diseases or neuroendocrine-immune diseases. Serotonin is also involved in certain mental illnesses, such as major depressive disorder. Even in these cases, serotonin dysregulation represents a physical problem. Emotional symptoms include: Social withdrawalSadness and frequent crying spellsLow self-esteem and self-confidenceChanges in personalityFeeling emotionally sensitive and taking things personallyIrritability Talk to your healthcare provider about if you have these symptoms. Depression is common in FMS and ME/CFS, and it is treatable. A Word From Verywell If you think your serotonin is low, talk to your practitioner. You may need to consider treatments that raise your available amount of serotonin. Probably the most common treatment is medication: your healthcare provider may prescribe antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclics. Some supplements and your diet can influence serotonin as well. Serotonin Dysregulation in FMS and ME/CFS Was this page helpful? Thanks for your feedback! Learn about treatment and lifestyle changes to cope with fibromyalgia and chronic fatigue syndrome. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 9 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Becker S, Schweinhardt P. Dysfunctional Neurotransmitter Systems in Fibromyalgia, Their Role in Central Stress Circuitry and Pharmacological Actions on These Systems. Pain Res Treat. 2012;2012:741746. doi:10.1155/2012/741746 Berger M, Gray JA, Roth BL. The Expanded Biology of Serotonin. Annu Rev Med. 2009;60:355-366. doi:10.1146/annurev.med.60.042307.110802 Padhy SK, Sahoo S, Mahajan S, Sinha SK. Irritable bowel syndrome: Is it "irritable brain" or "irritable bowel"? J Neurosci Rural Pract. 2015;6(4):568-577. doi:10.4103/0976-3147.169802 Meeusen R, Watson P, Hasegawa H, Roelands B, Piacentini MF. Central Fatigue: The Serotonin Hypothesis and Beyond. Sports Med. 2006;36(10):881-909. doi:10.2165/00007256-200636100-00006 Pakalnis A, Splaingard M, Splaingard D, Kring D, Colvin A. Serotonin Effects on Sleep and Emotional Disorders in Adolescent Migraine. Headache. 2009;49(10):1486-1492. doi:10.1111/j.1526-4610.2009.01392.x Aggarwal M, Puri V, Puri S. Serotonin and CGRP in Migraine. Ann Neurosci. 2012;19(2):88-94. doi:10.5214/ans.0972.7531.12190210 Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Oman Med J. 2012;27(3):192-195. doi:10.5001/omj.2012.44 Cowen PJ, Browning M. What has serotonin to do with depression? World Psychiatry. 2015;14(2):158-160. doi:10.1002/wps.20229 Nautiyal KM, Hen R. Serotonin receptors in depression: from A to B. F1000Res. 2017;6:123. doi:10.12688/f1000research.9736.1