Metabolic dysfunction in youth with major mood disorders: Implications for prevention and early intervention.

Early intervention for premature cardiovascular disease is critical for reducing the increased mortality rates associated with major mood and affective disorders. Alongside smoking, a greater emphasis has now been placed on metabolic dysfunction as a causal pathway, with higher body mass index being proposed as a key modifiable risk factor. Accordingly, early intervention frameworks currently promote nutritional counselling, lifestyle interventions, and medication switching to address early metabolic risk factors in youth with major mood disorders. Yet there is currently limited evidence that such approaches benefit metabolic outcomes in this population, even when they lead to weight loss. The current paper is a narrative review based on searches of Google Scholar, PubMed and Scopus. It will summarise four key areas of research: (1) Evidence that young people presenting to early interventions services show higher rates of metabolic dysfunction to the general population, particularly insulin resistance, despite normal rates of being overweight and normal blood glucose; (2) Evidence that complex pathophysiological mechanisms other than weight gain link mood disorders and metabolic dysfunction; (3) Evidence regarding traditional lifestyle interventions on metabolic outcomes for individuals with mood disorders; and (4) Alternative intervention approaches (such as metformin and circadian therapies) showing promising results for improved metabolic outcomes. This evidence has important implications for monitoring and early treatment of metabolic dysfunction in young people with major mood disorders.