By Jennifer Theriault, PMHNP-BC | Warrior ReWild Functional Psychiatry & Wellness

🔍 The Overlooked Pattern

In functional psychiatry, we’re trained to look for inflammation, cortisol dysregulation, and neurotransmitter imbalances. But what about the patients who present with:

Fatigue that feels like gravity
Emotional flatness, low motivation
Brain fog, poor stress tolerance
High BMI, low lean mass
Low A1c despite insulin resistance
Flat glucose tolerance curves

These aren’t just signs of depression or burnout. They’re often markers of a hypometabolic compensatory state—a cellular and systemic slowdown in energy production, triggered by trauma, chronic stress, or mitochondrial dysfunction.

🧠 When Metabolism Looks Like Mental Illness

These patients are frequently misdiagnosed with:

Mental Health Diagnosis

Overlapping Hypometabolic Features

Major Depression

Anhedonia, fatigue, low motivation, emotional flatness

ADHD (Inattentive)

Brain fog, poor task initiation, low dopamine tone

Generalized Anxiety

Wired-but-tired physiology, poor stress recovery

Bipolar II (Depressive phase)

Low energy, emotional numbness, poor exertion tolerance

Somatic Symptom Disorder

Vague fatigue, malaise, poor interoception

The problem? These symptoms aren’t always rooted in neurotransmitter imbalance—they’re often metabolic, mitochondrial, and trauma-driven.

🧬 What’s Really Going On?

Hypometabolic states reflect a protective downshift in energy demand. The body reduces ATP production, oxygen consumption, and fuel turnover in response to:

Mitochondrial dysfunction
HPA axis suppression
Cell Danger Response (CDR)
Polyvagal freeze physiology
Hormonal downregulation (thyroid, cortisol, sex hormones)

This isn’t pathology—it’s compensation. But it’s often missed in conventional labs, especially when A1c is low and glucose curves are flat.

🧾 Clinical Flags to Watch For

Flat GTT curve

Low ATP demand, adrenal suppression

Low A1c + high BMI

Under-utilization of glucose

Lipid-based insulin resistance

Triglycerides ↑, HDL ↓, waist:hip ↑

Emotional flatness

Vagal dominance, trauma overlay

Low fasting insulin

Mitochondrial underdrive

🧠 Trauma-Informed Metabolic Care

These patients often live in freeze physiology:

Blunted hunger, exertion, and emotional signaling
Low sympathetic tone
Post-exertional malaise
Poor stress resilience

They don’t need stimulants or SSRIs—they need mitochondrial reactivation, adrenal tonics, and emotional safety.

🧪 Protocol Highlights

Phase 1: Stabilize & Prime

Phosphatidylserine, magnesium, low-dose Rhodiola
Morning light, protein-forward meals, gentle movement

Phase 2: Activate & Mobilize

Berberine, NAD⁺, CoQ10
Adaptogens, trauma-informed pacing

Phase 3: Rewire & Rebuild

Peptides (MOTS-c, BPC-157), inositol, taurine
Polyvagal practices, nature-based interventions

💡 Final Thought

When we misread hypometabolic states as purely psychiatric, we miss the root. These patients aren’t broken—they’re braked. And when we honor the body’s protective strategies, we can gently guide them from freeze to flow, from flatness to vitality.