Metabolites include N-acetylaspartate (NAA), creatine (Cr), trimethylamines/ choline containing compounds (Cho) and glutamine (Gln). These derivatives are indirect indicators of biochemical activity. Alteration in levels of NAA/Cr ratio is associated with reduction in the protective myelin sheath surrounding neurons. Decreased levels of NAA are associated with neuron death, or injury to the part of the neuron that connects to other cells, the axon. Alterations in some neurometabolites have been found in bipolar disorder and schizophrenia, and these have been investigated in PTSD.

What is the evidence for neurometabolite alterations in people with PTSD?

Moderate quality evidence found medium-sized reductions in NAA concentration in the hippocampus and the anterior cingulate cortex of people with PTSD compared to controls. NAA/Cr ratio may also be reduced.

August 2021

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Products of normal chemical metabolism may be altered in bipolar disorder. Changes in metabolite levels may be indicative of altered biochemical activity. Magnetic resonance spectroscopy (MRS) has been used to measure levels of metabolites, such as N-acetylaspartate (NAA), creatine (Cr), trimethylamines/ choline containing compounds (Cho) and glutamine (Gln). These derivatives are indirect indicators of biochemical activity. Alteration in levels of NAA/Cr is associated with the protective myelin sheath surrounding neurons, which is used as a marker of neural cell viability. Decreased levels of NAA are associated with neuron death, or injury to the part of the neuron that connects to other cells, the axon. Gln is a metabolite of the neurotransmitter, glutamate (Glu).

What is the evidence for changes in neurometabolites in people with bipolar disorder?

Moderate quality evidence suggests a medium-sized effect of decreased NAA levels in the basal ganglia, a large effect of decreased NAA/Cr ratio in the hippocampus, and a small trend effect of increased NAA levels in the frontal lobes of people with bipolar disorder compared to controls. There were no differences in Cr and Cho levels, or NAA and other ratios in any other brain region.

December 2021

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