Panic Disorder Treatment Medications That Increase Serotonin By Sheryl Ankrom, MS, LCPC Sheryl Ankrom, MS, LCPC LinkedIn Sheryl Ankrom is a clinical professional counselor and nationally certified clinical mental health counselor specializing in anxiety disorders. Learn about our editorial process Updated on March 11, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. 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 Review Board Print Jonathan Nourok/Getty Table of Contents View All Table of Contents SSRIs SNRIs Triptans Tricyclic Antidepressants MAOIs Other Psychiatric Medications Analgesics Antibiotic/Antiretroviral Drugs Dietary Supplements Other Drugs That Affect Serotonin Potential Serotonin Drug Interactions Serotonin is a neurotransmitter, a type of chemical messenger. It plays an important role in regulating a variety of body functions and feelings. Neurotransmitters act as communication agents between different brain cells. There are a number of different substances, including medications and supplements, that can increase serotonin levels in the brain. Because low serotonin levels have been linked to depression and anxiety, serotonin drugs are sometimes prescribed to treat mental health conditions. This article explores some of the medications that can increase serotonin levels in the brain. It also discusses the potential risks of interactions when taking more than one type of serotonin drug. Signs of Too Much Serotonin Selective Serotonin Reuptake Inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin in the brain. Reuptake is a process where neurotransmitters in the brain are reabsorbed and deactivated or recycled for future use. When reuptake of serotonin is inhibited, more serotonin is available in the brain. This leads to an increase of serotonin levels, resulting in improved mood, decreased anxiety, and inhibition of panic. SSRIs are considered the first-line treatment for conditions such as depression and panic disorder. SSRI medications include: Celexa (citalopram) Lexapro (escitalopram) Luvox (fluvoxamine) Paxil (paroxetine) Prozac (fluoxetine) Trintellix (vortioxetine) Viibryd (vilazodone) Zoloft (sertraline) SSRIs are approved in the treatment of a variety of mental health conditions including generalized anxiety disorder (GAD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and social anxiety disorder (SAD). Recap SSRIs are antidepressant medications that work by blocking the reuptake of the neurotransmitter serotonin. This results in increased serotonin levels in the brain, which can improve mood and reduce anxiety. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) SNRIs inhibit the reabsorption of both serotonin and norepinephrine in the brain. Norepinephrine is a neurotransmitter that influences sleep and alertness. It is believed to be correlated to the fight-or-flight stress response. Some SNRIs include: Cymbalta (duloxetine) Effexor (venlafaxine) Fetzima (levomilnacipran) Pristiq (desvenlafaxine) Savella (milnacipran) Triptans Triptans are a class of drugs commonly used to treat migraine or cluster headaches. They act on serotonin receptors in the brain, thereby affecting serotonin levels. Examples of triptans include: Amerge (naratriptan)Axert (almotriptan)Frova (frovatriptan)Imitrex (sumatriptan)Maxalt and Maxalt-MLT (rizatriptan)Relpax (eletriptan)Zomig and Zomig ZMT (zolmitriptan) Tricyclic Antidepressants Tricyclic antidepressants (TCAs) are named after the drugs’ three-ringed molecular structure. Prior to the introduction of SSRIs in the late 1980s, TCAs were the medication of choice for the treatment of major depressive disorder, panic disorder, and other anxiety disorders. TCAs are also used to treat certain pain syndromes and nocturnal enuresis (bedwetting). It is believed that TCAs function by increasing levels of norepinephrine and serotonin in the brain. Examples of TCAs include: Elavil (amitriptyline)Tofranil (imipramine)Sinequan (doxepin)Anafranil (clomipramine) TCAs are used less frequently today in the treatment of depression because they tend to produce more unwanted side effects compared to SSRIs. Monoamine Oxidase Inhibitors (MAOIs) MAOIs are a class of antidepressants believed to increase levels of norepinephrine, serotonin, and dopamine (another neurotransmitter) in the brain. They are effective for the treatment of the major depressive disorder, panic disorder, and other anxiety disorders. Examples of MAOIs include: Nardil (phenelzine)Parnate (tranylcypromine)Marplan (isocarboxazid)Emsam (selegiline) Because of potentially dangerous interactions with certain foods, beverages, and other drugs, particularly those that influence serotonin, MAOIs are usually not considered as a first-line treatment for depression. Other Psychiatric Medications There are also other psychiatric medications that can influence serotonin levels in the body. BuSpar (buspirone): BuSpar affects the neurotransmitters serotonin and dopamine. It acts as an agonist on serotonin receptors, which means that it increases the actions of these receptors. As a result, this medication can be useful for relieving symptoms of anxiety. Eskalith (lithium): This medication is a mood stabilizer that is used in the treatment of bipolar disorder. It works by restoring the balance of neurotransmitters, including serotonin. Desyrel (trazodone): Desyrel is an antidepressant medication that works by increasing the amount of serotonin available in the body. It also has sedative effects, which is why it is sometimes used to treat insomnia. Analgesics (Painkillers) A number of analgesic drugs can also affect serotonin levels in the body. These medications are often used to treat pain, but they are also sometimes misused and can lead to dependence and addiction. Some painkillers that act on serotonin include: Codeine Fentanyl Tramadol Antibiotic/Antiretroviral Medications Some antibiotics and antiretroviral medications may also affect serotonin. This can potentially lead to drug interactions when people are taking other medications such as SSRIs or MAOIs. Because of these risks, you should always tell your healthcare provider about other medications, drugs, or supplements you are currently taking. Zyvox (linezolid): Zyvox is an antibiotic that is sometimes prescribed to treat serious bacterial infections. In addition to inhibiting bacterial growth, this medication also affects serotonin. This affect can be more pronounced when Zyvox is combined with other serotonin medications.Norvir (ritonavir): Norvir is an antiviral medication that is used to treat HIV infection. When combined with other medications, it works to slow the progress of the disease. Herbal Drugs/Dietary Supplements It is important to be aware that some herbal medicines and dietary supplements can have an effect on serotonin levels. St. John’s Wort St. John's wort (hypericum perforatum) is a type of flowering plant that is sometimes used as an herbal remedy, particularly to relieve symptoms of depression. It is also used for other conditions including anxiety, premenstrual syndrome (PMS), menopause symptoms, smoking cessation, and seasonal affective disorder. Researchers are not entirely sure of exactly how St. John's wort works to elevate mood, but it is believed to increase neurotransmitter levels in the brain, including serotonin. Ginseng Ginseng is a root that is often used as an herbal supplement. Purported benefits include improved immunity, energy, and cognition. Ginseng acts on serotonin and other transmitters and also affects hormones, receptors, and signaling molecules. Research suggests that ginseng is associated with interactions with some psychotropic medications, including SSRI and SNRI antidepressants. Other Drugs That Affect Serotonin There are also a number of other substances that can affect serotonin levels in the body. Amphetamines Amphetamine stimulants are often prescribed to treat attention-deficit hyperactivity disorder (ADHD). These medications can also increase serotonin levels. While usually not enough to present a risk when taken as prescribed, stimulant medications such as Adderall may increase the risk of serotonin toxicity if they are misused or are combined with other serotonin medications. Cocaine Cocaine blocks the reuptake of serotonin. This can be potentially risky if people use cocaine while they are taking antidepressants, triptans, or other medications that also increase serotonin levels. LSD Lysergic acid diethylamide (LSD) is a hallucinogenic drug that affects thinking and moods. These effects are the result of the impact of the drug on serotonin. The drug binds to certain receptors in the brain and changes how the brain responds to serotonin. Combining antidepressant medications and LSD has the potential to produce unwanted effects associated with serotonin toxicity. Potential Serotonin Drug Interactions Taking one or more medications that impact serotonin levels can be potentially dangerous. It can lead to a condition known as serotonin syndrome, where high serotonin levels in the brain cause symptoms such as: Blood pressure changesComaConfusionFeverIncreased heart rateHallucinationsNauseaSeizures According to the U.S. Food and Drug Administration, there is an increased risk of serotonin syndrome as a result of combining selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors SSNRIs with migraine headache medications called triptans. Serotonin medications can cause unwanted side effects if more than one serotonergic drug is used at the same time or if the prescribed dose is exceeded. To avoid this risk, talk to your healthcare provider about all substances, medications, and supplements you are taking, and always take your medication as prescribed. A Word From Verywell When serotonin levels are disrupted, it can result in unwanted symptoms including anxiety or depression. Medications that help balance serotonin levels can help you find relief from these symptoms, but it is important to be aware of how these serotonin medications affect the body and how they may interact with other substances. This list is not meant to be all-inclusive. To avoid increasing your risk of side effects, including serotonin syndrome, tell your healthcare provider about all drugs and dietary supplements you are taking. If you develop symptoms of serotonin syndrome, seek immediate medical attention. 7 Sources Verywell Mind 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. Aminiahidashti H, Shafiee S, Mousavi SJ, Hajiaghaei G. Tramadol pill alone may cause serotonin syndrome. Chin Med J (Engl). 2016;129(7):877-878. doi:10.4103/0366-6999.178957 U.S. Food and Drug Administration. FDA drug safety communication: Updated information about the drug interaction between linezolid (Zyvox) and serotonergic psychiatric medications. Apaydin EA, Maher AR, Shanman R, et al. A systematic review of St. John’s wort for major depressive disorder. Syst Rev 5, 148 (2016) doi:10.1186/s13643-016-0325-2 Woroń J, Siwek M. Unwanted effects of psychotropic drug interactions with medicinal products and diet supplements containing plant extracts. Psychiatr Pol. 2018;52(6):983-996. doi:10.12740/PP/OnlineFirst/80998 Vo K, Neafsey PJ, Lin CA. Concurrent use of amphetamine stimulants and antidepressants by undergraduate students. Patient Prefer Adherence. 2015;9:161-172. doi:10.2147/PPA.S74602 Khan A, Lahmar A, Asif H, Haseeb M, Rai K. Serotonin syndrome precipitated by the use of cocaine and fentanyl. Cureus. doi:10.7759/cureus.22805 Kraehenmann R, Pokorny D, Aicher H, et al. LSD increases primary process thinking via serotonin 2a receptor activation. Front Pharmacol. 2017;8:814. doi:10.3389/fphar.2017.00814 Additional Reading U.S. Food and Drug Administration. Potentially life-threatening serotonin syndrome with combined use of SSRIs or SNRIs and triptan medications. By Sheryl Ankrom, MS, LCPC Sheryl Ankrom is a clinical professional counselor and nationally certified clinical mental health counselor specializing in anxiety disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? 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