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The Emerging Field of Metabolic Psychiatry: From Basic Science to Clinical Applications

For centuries, talk therapy and medications intended to address perceived chemical imbalances in the brain have been the mainstays of mental health care. However, a new paradigm in psychiatric research known as Metabolic Psychiatry has emerged as a result of recent developments in biotechnology and neuroscience. This multidisciplinary field integrates concepts from neurology, psychiatry, and related fields like genetics and immunology with those from metabolomics, the large-scale analysis of small molecule metabolites in biological systems. Through the examination of internal cellular chemical reactions and their connection to physiological processes, researchers studying metabolism seek to understand the fundamental reasons behind different mental health conditions and create new approaches to diagnosis, treatment, and prevention. This article will go over some of the main benefits that Metabolic Psychiatry has to offer, such as its ability to better understand disease mechanisms, find new targets for drugs, provide individualised treatment plans, and expand our understanding of the connections between gut flora, nutrition, and cognition.

Knowing the Mechanisms of Disease

The ability of metabolic psychiatry to provide light on the molecular processes that give rise to mental health disorders is among its most important contributions. Protein activity, especially that of neurotransmitters like serotonin, dopamine, and norepinephrine, has historically been a major focus of psychiatric research. Although this field of study has produced important findings, it falls short of fully encapsulating the intricacy of cellular physiology, which includes a wide range of additional biochemical processes. On the other hand, metabolic psychiatry places a strong emphasis on the role that metabolism—the series of chemical reactions that cells go through to transform food into energy and the building blocks needed for growth, maintenance, and reproduction—plays in determining both normal and pathological brain function.

There is growing evidence that alterations in metabolic homeostasis, whether inherited or acquired during an individual’s lifetime, can result in the presentation of mental health symptoms. For example, in patients with depression, schizophrenia, and autism spectrum disorder, studies have found abnormalities in metabolic pathways involving lipid biosynthesis, mitochondrial respiration, and glucose utilisation. The postmortem brains of depressed subjects showed reduced expression of genes encoding lipogenic enzymes, such as fatty acid synthase (FAS) and stearoyl-CoA desaturase (SCD); lymphocytes isolated from individuals with schizophrenia showed impaired oxidative phosphorylation; and children with autistic traits showed elevated plasma levels of kynurenine, a tryptophan derivative linked to inflammation and stress responses. Through a thorough characterization of these metabolic perturbations, researchers can gain insight into their role in the genesis and development of disease, as well as potentially inform the development of effective interventions.

Furthermore, metabolic analyses could uncover relationships between seemingly unrelated phenotypes that were previously overlooked, adding to our understanding of psychiatric disorders. For instance, a 2019 systematic review found that people with bipolar disorder frequently exhibit insulin resistance, hypoglycemia, and hyperglycemia simultaneously, pointing to a possible connection between mood instability and the metabolism of carbohydrates. Similarly, higher urinary excretions of trimethylamine N-oxide (TMAO), a compound formed upon bacterial degradation of carnitine in the gut, independently predicted worse academic performance later in life in a follow-up study of adolescents with attention deficit/hyperactivity disorder (ADHD), regardless of the symptoms of ADHD. These instances show how complementary perspectives on psychological disorders provided by metabolic measures allow clinicians to manage patients’ overall health from a more holistic perspective.