Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde demonstrates that “good” and “evil” can exist within a single person. As you might remember, Dr. Jekyll ingests a formula and is transformed from a mild-mannered English physician into an antisocial, violent criminal.

Any formula that interferes with the actions of serotonin in the brain can bring about changes that resemble Jekyll’s transformation to Hyde. While less dramatic than the Mr. Hyde effect, serotonin deficiency can create tendencies toward anxiety, depression, out-of-control impulsivity, and violence toward self and others. Considering our current understanding of neurochemistry, Jekyll’s formula may well have contained a potent anti-serotonergic drug (http://www.life-enhancement.com/article_template.asp?ID=208).

Researchers have found that violence related to low serotonin levels can be either inner- or outer-directed. P. Placidi and colleagues studied 93 individuals suffering from depression. These researchers found that a higher level of aggression was strongly associated with lower cerebrospinal fluid levels of 5-hydroxyindolacetic acid (5-HIAA). 5-HIAA is a major metabolite of serotonin. Their data also revealed that lower levels of 5-HIAA were found in successful suicide attempters (Placidi, et al., 2001).

A group of Danish scientists measured levels of 5-HIAA in 16 men convicted of homicide, 22 men who attempted suicide and 39 healthy male controls. The lowest levels of 5-HIAA were found in those men who had killed a sexual partner or had attempted suicide (Lidberg, et al., 1985).

Many studies have found that low serotonin levels are linked to aggression, alcohol abuse and mental illness. At the National Institutes of Health (NIH) Primate Center in Poolesville, Md., researchers Suomi and Higley studied the link between behavior, serotonin and environment in rhesus monkeys. They found that 5 to 10 percent of monkeys in the wild and laboratory populations have elevated impulsivity and aggression. These monkeys also have the lowest levels of serotonin when compared to the rest of the population. In the lab, they’re antisocial, inappropriately aggressive and will drink to intoxication. In the wild, these monkeys seek out danger. They will make risky leaps between trees that other monkeys would never attempt (http://faculty.riohondo.edu/mpilati/psych101/serotonin.htm).

It has been more than one hundred years since Stevenson’s literary masterpiece. In recent years, pharmaceutical companies have created a number of pharmacological agents that can produce Jekyll-and-Hyde-like changes.

The appetite-suppressors fenfluramine (Pondimin and Ionamin) and dexfenfluramine (Redux) both act by depleting serotonin and may permanently destroy serotonergic neurons in the brain. Even weight-loss diets that are extremely low in fat have caused Hyde-like behavior patterns in some people.

Severe irritability and aggression have been attributed to cholesterol-lowering medications called “statins” (www.americanchiropractor.com/print.asp?articleid=276&category=4). Among the best studied of the “statins” are Lopid, Questran, Lescol, Mevacor, Zocor and Pravachol. In another study, patients with low cholesterol showed hypersensitivity to detecting anger and sadness in themselves (Penttinen, 1995). Low serotonin levels appear to be involved.

The relationship between alcohol, depression, and violence is well known. A high proportion of suicide victims are found to have been drinking heavily at the time of their death. Similarly, perpetrators of violent crimes are often intoxicated when they commit a crime (Murdoch, et al., 1990).

In animal studies, some drugs that decrease serotonin activity increase alcohol consumption. When animals are given drugs that enhance serotonin activity (serotonin, tryptophan, 5-HTP or an SSRI), they drink less alcohol. Rats that have been bred to prefer drinking alcohol to water have been found to have reduced serotonin activity compared with normal rats (Pihl, et al., 1993).

Human studies have consistently demonstrated reduced alcohol intake among various groups, including social drinkers and alcohol-dependent males, taking SSRIs (Pihl, et al., 1993). Alcoholics have also been shown to have reduced serotonin activity as indicated by low levels of 5-HIAA (LeMarquand, et al., 1994). As alcoholics progress in their illness, they become less able to control their emotions and physical actions.

Pihl, et al., state that people with low serotonin are likely “to appear depressed and aggressive, more driven by appetites (more motivated by food, water, sex, and drugs of abuse), and more impulsive (less able to control behavior) in the face of threat.” They may also be more likely to use aggression to achieve rewards. Specifically with regard to alcohol, decreased serotonin may lead to an inability to terminate drinking once started. And if a person with low serotonin levels starts drinking, they likely will exhibit an increase in aggressive behavior.

In some people and in some situations medications that can enhance life can also create unhealthy dispositions. In every situation, risk must be measured versus benefit. Because of the serotonergic lowering effects caused by such drugs as the “statins”, for some the risks outweigh the benefits. Mr. Hyde-like problems make there use untenable. In the case of Redux and fenfluramine (the “fen” in fen-phen), both drugs have been removed from the market in great part due to the underlying anti-serotonergic effects. The actions of serotonin in the brain are not extremely well understood. What does seem clear is that alterations of serotonin levels can have far-reaching cognitive, emotional and behavioral impact.

Cardwell C. Nuckols, MA, PhD ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is President of Cardwell C. Nuckols and Associates, LLC, a national and international training and consulting
organization.

Reference

http://faculty.riohondo.edu/mpilati/psych101/serotonin.htm
http://www.theamericanchiropractor.com/print.asp?articleid=276&category=4
http://www.life-enhancement.com/article_template.asp?ID=208
Lidberg, L., Tuck, J., Asberg, M., Scalia-Tomba, G., Bertilsson, L. Homicide, suicide and CSF 5-HIAA. Acta Psychiatr Scand. 1985;71:230-236.
Murdoch D, Pihl R, Ross D. Alcohol and crimes of violence: present issues. Int J Addict. 1990;25:1065-1081.
Penttinen J. Hypothesis: low serum cholesterol, suicide, and interleukin-2. Am. J Epidemiol. 1995;141:716-718.
Pihl R, Peterson J. Alcohol, serotonin and aggression. Alcohol Health Res World. 1993;17:113-117.
Placidi, G. P., M. A. Oquendo, K. M. Malone, Y. Y. Huang, S. P. Ellis, and J. J. Mann, Biological Psychiatry, Vol. 50, No. 10, November 15, 2001, 783-91.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2005, v.6, n.2, pp.46-47

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