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Clinical Signs of Serotonin Imbalance Low serotonin (fast MAOA) may present as: Seasonal affective disorder (SAD) Poor sleep (serotonin converts to melatonin) Panic attacks, depression Carbohydrate cravings, comfort eating Constipation High serotonin (slow MAOA) may show as: Agitation, mania, hallucinations Psychotic features, excess sweating, tremors OCD, restlessness Diarrhoea Enter BH4: The Forgotten Cofactor That Controls Neurotransmitter Synthesis BH4 (tetrahydrobiopterin) is one of the most crucial molecules in serotonin productionyet its rarely discussed