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Considering Lactate in Psychiatric Disorders & Drug Development (2023 Review)

Lactate, traditionally viewed as a simple metabolic byproduct, is emerging as a significant player in the realm of psychiatric disorders.

Recent research reveals its intricate role as both an energy source and a signaling molecule, potentially influencing a wide array of mental health conditions.


  • Shift in Lactate Perception: The review highlights a paradigm shift in the understanding of lactate, from a mere metabolic byproduct to a critical signaling molecule with significant implications for brain function and psychiatric disorders.
  • Lactate’s Role in Psychiatric Conditions: Altered lactate dynamics are consistently observed across various psychiatric disorders such as depression, anxiety, bipolar disorder, and schizophrenia, suggesting a complex interplay between lactate metabolism and mental health.
  • Therapeutic Potential and Challenges: Targeting lactate pathways are a novel approach for psychiatric treatment.

Source: Neural Regeneration Research (2023)

Evaluating Lactate in Psychiatric Disorders (2023 Review)

A comprehensive review analyzed the potential of lactate as a therapeutic target in psychopharmacology, especially in the context of psychiatric disorders.

Literature Search: The researchers meticulously searched the National Library of Medicine (PubMed) database for English-language articles published up to December 2022. They used an array of keywords to capture studies related to lactate and its association with a spectrum of psychiatric disorders.

Review Strategy: The study synthesized findings from a diverse array of sources, including preclinical animal studies, clinical trials, biochemical analyses, and brain imaging studies, to understand the multifaceted role of lactate in psychiatric illnesses and its therapeutic potential.

Lactate: Metabolic Waste & Neurotransmitter

Evolution of Understanding

Lactate’s role has evolved in scientific understanding from being merely a waste byproduct of glucose metabolism to a critical glial-neuronal signaling molecule.

This paradigm shift has opened new avenues for psychopharmacological research.

Astrocyte-Neuron Lactate Shuttle

The hypothesis posits that lactate is shuttled between astrocytes and neurons, playing a crucial role in energy provision and signaling.

This shuttle system suggests a more nuanced understanding of brain metabolism and neuronal function.

Lactate as a Potential Target for New Drugs

For decades, the primary focus in psychopharmacology has been on monoamine neurotransmitters like serotonin, dopamine, and norepinephrine.

Drugs targeting these pathways, such as SSRIs and SNRIs, have been the cornerstone of treating disorders like depression and anxiety.

However, a significant subset of patients does not respond adequately to these treatments, highlighting the need for alternative targets.

Recent advances in neuroscience have shed light on lactate, not merely as a metabolic byproduct but as a crucial signaling molecule and energy source in the brain.

This revelation has sparked interest in lactate as a potential target for psychiatric drugs (e.g. antipsychotics), offering a new direction beyond the traditional monoamine pathways.

Lactate in Psychiatric Disorders

Depression: Studies consistently show altered lactate dynamics in depression. Interestingly, while endogenous lactate levels are altered, exogenously administered lactate has shown antidepressant effects in animal models, suggesting a complex role in mood regulation.

Anxiety: Intravenous lactate infusion can precipitate anxiety attacks in predisposed individuals. This response has been used to model anxiety in research settings, although the precise mechanisms linking lactate to anxiety responses remain unclear.

Bipolar Disorder: Increased lactate levels have been observed in various brain regions of patients with bipolar disorder. The review discusses how this might be related to mitochondrial dysfunction and altered energy metabolism in the brain.

Schizophrenia: Findings on lactate levels in schizophrenia are mixed, but a considerable number of studies indicate elevated levels. The review discusses how this might relate to the complex pathology of schizophrenia, including issues related to synaptic plasticity and energy deficits.

Other Mental Illnesses: The review briefly touches on the less-studied areas of OCD and PTSD, where the data are limited but suggest potential roles for lactate.

What are the implications of the review’s findings?

Psychopharmacology: The review suggests that expanding the focus beyond traditional neurotransmitters to include molecules like lactate could revolutionize psychiatric treatment, particularly for treatment-resistant cases.

Brain Function: Recognizing lactate’s role in brain metabolism and signaling compels a more comprehensive view of brain function, which could lead to more effective and targeted treatments.

New Therapeutic Avenues: The potential of lactate and other less-studied neurotransmitters as novel targets for drug development offers hope for more effective treatments for a range of psychiatric disorders.

Limitations of the review (lactate in psychiatry)

Causality vs. Correlation: Distinguishing whether altered lactate levels are a cause or consequence of psychiatric disorders is challenging and critical for developing targeted interventions.

Complex Mechanisms: The biological pathways and mechanisms through which lactate influences psychiatric symptoms are intricate. Understanding these in detail is crucial for translating this knowledge into practical treatments.

Practicality of Direct Intervention: While manipulating lactate levels shows promise, directly administering lactate may be impractical or harmful due to potential side effects. A more nuanced approach might involve modulating the systems that control lactate levels in the brain.

Emerging Understanding of Lactic Acid Bacteria: The antidepressant effects of lactic acid bacteria hint at a broader, more complex interplay between the gut microbiome, lactate, and brain function, suggesting an even wider scope of research and potential treatments.

The Role of Lactate in the Body & Brain Function

Lactate in General Physiology

  • Energy Metabolism: Lactate is traditionally understood as a byproduct of anaerobic glycolysis, where it forms during the breakdown of glucose in the absence of sufficient oxygen. In muscle cells during intense exercise, lactate production increases, leading to the familiar sensation of muscle fatigue.
  • Lactate Shuttle: Beyond being a mere byproduct, lactate serves as a critical energy currency in the body. The lactate shuttle hypothesis posits that lactate produced in one tissue (like muscle) can be used as an energy source in another (like the brain), indicating a complex, inter-organ system of energy balance and signaling.
  • pH Regulation: Lactate plays a role in regulating the acid-base balance within the body. Its production and removal are closely linked to the maintenance of optimal pH levels in the blood and tissues.

Lactate in Brain Function

  • Fuel for the Brain: The brain is a highly energy-intensive organ, and while glucose is its primary fuel, there’s growing evidence that lactate is also a significant energy source, particularly in conditions of high activity or low glucose availability.
  • Neurotransmitter-like Functions: Lactate is increasingly recognized as more than just an energy substrate. It appears to act as a signaling molecule, akin to neurotransmitters, influencing neuronal activity, plasticity, and memory formation.
  • Glia-Neuronal Metabolic Coupling: Lactate is a key player in the metabolic coupling between astrocytes (support cells in the brain) and neurons. Astrocytes can produce lactate and supply it to neurons, indicating a supportive and regulatory role in neuronal function and potentially in cognitive functions like learning and memory.

Lactate & Psychiatric Disorders

  • Metabolic Dysregulation: Psychiatric disorders often involve dysregulation in energy metabolism, and lactate might play a role in this. Altered lactate levels and metabolism have been observed in conditions like depression, schizophrenia, and bipolar disorder, suggesting a disruption in the normal metabolic processes that support brain function.
  • Stress Response & Anxiety: The body’s response to stress involves a complex interplay of hormonal and metabolic pathways, with lactate being a potential player. For instance, lactate levels rise during anxiety attacks induced by lactate infusion, suggesting a direct or indirect role in modulating stress and anxiety responses.
  • Potential for Neuroplasticity: Given lactate’s role in neuroplasticity, alterations in lactate metabolism might influence the brain’s ability to adapt and respond to experiences, a fundamental process that’s often disrupted in psychiatric disorders.

Medications Targeting Lactate (?)

Current Landscape: As of now, there are no medications that directly target lactate levels for the treatment of psychiatric disorders. However, some existing treatments might indirectly influence lactate metabolism. For example, certain antipsychotics and mood stabilizers might affect glucose metabolism and, by extension, lactate production and utilization.

Potential Therapeutic Strategies: Targeting lactate metabolism directly is a relatively unexplored but promising area. Strategies could include modulating lactate production, enhancing its transport and utilization in the brain, or even targeting the signaling pathways influenced by lactate. For instance, medications that affect the function of monocarboxylate transporters (which transport lactate) could potentially influence brain lactate levels and, thereby, psychiatric symptoms.

Challenges and Considerations: Targeting lactate in the brain presents several challenges. The balance of lactate production and clearance is crucial for normal function, and disrupting this balance could have wide-ranging effects. Additionally, the blood-brain barrier presents a challenge for delivering medications effectively to the brain. Understanding the precise role of lactate in different psychiatric disorders is crucial for developing targeted therapies.

Modulating lactate to treat psychiatric disorders?

Modulating lactate levels for the relief of psychiatric symptoms is a complex and relatively unexplored area.

However, some lifestyle, diet, and supplement strategies may influence lactate metabolism, which could, in turn, impact brain function and potentially psychiatric symptoms.

It’s important to consult with healthcare professionals before making any significant changes, especially if you’re dealing with mental health issues.


  • Balanced Diet: A balanced diet rich in nutrients supports overall metabolic health, which can help regulate lactate production and utilization. Focus on a diet rich in vegetables, fruits, lean proteins, and whole grains.
  • Complex Carbohydrates: While simple carbohydrates can lead to rapid spikes in blood sugar and potentially lactate, complex carbohydrates provide a more sustained energy release, which might help stabilize lactate production during metabolism.
  • Omega-3 Fatty Acids: Found in fish, flaxseeds, and walnuts, omega-3 fatty acids are known for their anti-inflammatory effects and potential benefits for brain health and mood regulation.

Lifestyle Changes

  • Regular Exercise: Moderate exercise can improve the body’s ability to utilize lactate and enhance overall metabolic health. However, the type and intensity of exercise should be tailored to your individual health status and fitness level.
  • Stress Reduction Techniques: Techniques such as mindfulness, yoga, and deep-breathing exercises can reduce stress, which might help regulate the balance of various neurotransmitters and metabolites, including lactate.
  • Adequate Sleep: Quality sleep is crucial for metabolic and mental health. Poor sleep can disrupt various bodily processes, including those related to lactate production and clearance.


  • Magnesium: This mineral is involved in numerous biochemical reactions in the body and is sometimes used to help with anxiety and sleep. While it doesn’t directly target lactate, it supports overall metabolic health.
  • B-Vitamins: B-vitamins are crucial for energy metabolism. A deficiency might disrupt normal metabolic processes, including those related to lactate.
  • Alpha-Lipoic Acid: This antioxidant is involved in energy metabolism and might help in the conversion of lactate back to glucose.

Other Considerations

  • Hydration: Proper hydration is essential for metabolic processes, including lactate clearance.
  • Alcohol Moderation: Excessive alcohol intake can disrupt normal metabolic processes and should be avoided.
  • Avoiding Stimulants: Stimulants like caffeine can increase stress responses and potentially lactate production, so moderating intake might be beneficial.

Individuality & Lactate Levels

  • Individual Variability: The effect of diet, lifestyle changes, and supplements on lactate levels and psychiatric symptoms can vary widely among individuals.
  • Complexity of Psychiatric Disorders: Psychiatric disorders are complex and often require a multifaceted treatment approach, including psychological therapies and, in some cases, medications.
  • Professional Guidance: It’s essential to consult with healthcare and mental health professionals when considering any new treatment for psychiatric symptoms, including lifestyle and diet changes.

In summary, while there’s no direct and well-established path for modulating lactate to relieve psychiatric symptoms specifically, maintaining a healthy lifestyle, balanced diet, and possibly some supplements can support overall metabolic and mental health.


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