“Chemical Imbalance” Reconsidered

How PTSD, TBI, and Brain Energy Mismatch Drive

Mental Health Symptoms

Many people are told they have a “chemical imbalance” when they struggle with depression, anxiety, PTSD, or mood instability. While this phrase is familiar, it is rarely explained in a way that helps patients understand what is actually happening in their brains or what can be done about it.

For veterans, first responders, and individuals with a history of trauma or traumatic brain injury (TBI), the issue is often not a mysterious imbalance of neurotransmitters. Instead, it is a mismatch between the brain’s energy demands and its ability to produce and regulate energy.

At Brain Treatment Center NoVA, we see this pattern every day. Understanding it changes how mental health symptoms are interpreted and how effective treatment plans are built.

The Brain Is an Energy-Intensive Organ

The human brain accounts for approximately 2% of total body weight, yet it consumes close to 20% of the body’s total energy supply (Raichle & Gusnard, 2002). This energy is required for every aspect of brain function, including:

• Emotional regulation

• Attention and focus

• Memory formation

• Impulse control

• Stress response and recovery

This energy is delivered in the form of adenosine triphosphate (ATP), the primary energy currency of the cell. Without sufficient ATP, the brain cannot regulate efficiently, regardless of motivation, insight, or effort.

What ATP Is and Why It Matters

ATP is produced inside cells by mitochondria, which convert oxygen and nutrients (such as glucose, fatty acids, and amino acids) into usable energy. In the brain, ATP fuels:

• Neurotransmitter synthesis and reuptake

• Neuronal firing and network communication

• Recovery after stress or cognitive load

• Regulation of autonomic nervous system responses

When ATP production is compromised, the brain shifts priorities. Regulation becomes secondary to survival. Clinically, this often presents as anxiety, irritability, depression, cognitive slowing, and reduced stress tolerance.

How PTSD and TBI Disrupt the Energy System

PTSD and TBI affect mental health in two critical and compounding ways:

1. They increase the brain’s energy demand

   Chronic hypervigilance, threat detection, and emotional suppression require sustained neural activation, which dramatically raises ATP requirements.

2. They impair the brain’s ability to produce and use energy

   Trauma, blast exposure, inflammation, oxidative stress, and microvascular injury can all disrupt mitochondrial function and cerebral metabolism.

   
   

The result is a system under constant strain, a brain that is being asked to do more with less.

The “Chemical Imbalance” Reframed

When neurotransmitter systems cannot keep up with demand due to energy and metabolic constraints, signaling becomes unstable. This instability is what is often labeled a “chemical imbalance.”

In other words:

The imbalance is not the cause; it is the consequence of an energy mismatch.

This helps explain why symptoms fluctuate, why stress tolerance erodes over time, and why medication alone may provide only partial or temporary relief.

Where Methylation Fits In

Methylation is a foundational biochemical process involved in neurotransmitter synthesis and breakdown, gene expression, detoxification, inflammation regulation, and hormone metabolism. Importantly, methylation reactions are energy-dependent.

When ATP production is impaired, methylation efficiency declines. Conversely, impaired methylation can further strain mitochondrial function, creating a self-reinforcing cycle of dysregulation (Scaini et al., 2017).

Clinically, impaired methylation is often associated with:

• Mood swings and emotional lability

• Anxiety and panic

• Obsessive or looping thoughts

• Sensory sensitivity

• Poor recovery from stress

This is especially relevant for individuals with genetic variants such as MTHFR or COMT, or those with long-standing stress or brain injury.

Functional Evidence on qEEG Brain Mapping

While quantitative EEG (qEEG) does not diagnose biochemical disorders, it allows clinicians to assess functional brain efficiency. In individuals with energy and metabolic strain, qEEG often reveals:

• Reduced network coherence

• Diffuse slowing or excessive fast activity

• Poor adaptability under cognitive load

• Patterns consistent with fatigue, over-activation, or under-arousal

When these findings align with symptoms and functional health data, they help clarify why regulation is difficult, even when structural imaging appears normal.

Why Medication Alone May Not Be Enough

Psychiatric medications can be effective and, in many cases, essential. They can reduce symptom severity and create stability. However, medications primarily modulate signaling, they do not restore cellular energy production, mitochondrial efficiency, or metabolic flexibility.

When the underlying energy mismatch remains unaddressed, patients may experience partial response, diminishing benefit over time, or persistent side effects.

This does not mean medication is inappropriate. It means it is often incomplete without addressing root physiological drivers.

A Brain-First, Systems-Based Approach

At Brain Treatment Center NoVA, we integrate multiple evidence-based modalities to address both symptoms and underlying mechanisms, including:

• qEEG brain mapping to assess functional regulation

• TMS and MeRT neuromodulation to improve network efficiency

• Functional health evaluation to assess inflammation, nutrient status, and metabolic stress

• Integrative psychiatry that considers brain injury and physiology

• Ketamine-assisted therapy when appropriate

• Occupational therapy and nervous system regulation programs

• Health and nutrition coaching to support sustainable change

This approach is particularly effective for veterans and military families, and we proudly participate in the VA Community Care Network (VACCN) and bill TRICARE for qualifying services.

Conclusion

Mental health symptoms are not simply “all in your head.”

They are deeply connected to how the brain produces and uses energy.

When PTSD, TBI, and chronic stress increase demand while disrupting supply, symptoms follow. Understanding this reframes the concept of “chemical imbalance” into something actionable, and treatable.

When the brain’s energy systems are supported, regulation improves. Resilience returns. And healing becomes more sustainable.

References

Papakostas, G. I., Shelton, R. C., Zajecka, J. M., et al. (2012). L-methylfolate as adjunctive therapy for SSRI-resistant major depressive disorder. American Journal of Psychiatry, 169(12), 1267–1274. https://doi.org/10.1176/appi.ajp.2012.11071114

Raichle, M. E., & Gusnard, D. A. (2002). Appraising the brain’s energy budget. Proceedings of the National Academy of Sciences, 99(16), 10237–10239. https://doi.org/10.1073/pnas.172399499

Scaini, G., Rezin, G. T., Carvalho, A. F., et al. (2017). Mitochondrial dysfunction in psychiatric disorders: Evidence, pathophysiology and translational implications. Neuroscience & Biobehavioral Reviews, 68, 694–713.

Berk, M., et al. (2013). Mitochondria, oxidative stress and neuroprogression in bipolar disorder. Bipolar Disorders, 15(5), 523–536.

Roffman, J. L., et al. (2013). Genetic variation throughout the folate metabolic pathway influences neurocognitive function in schizophrenia. Biological Psychiatry, 73(6), 611–619.