You’re Not Broken — You’re Running on an Energy Deficit

How “Allostatic Triage” Helps Explain Mental Health, Stress, and Chronic Illness

For decades, mental health conditions like depression, anxiety, burnout, and stress-related cognitive decline have been framed as problems of chemistry, personality, or coping skills.

Neurotransmitters were blamed.

Willpower was prescribed.

Rest was often an afterthought.

A recent scientific review proposes something more fundamental — and far more compassionate.

The Brain Under Stress: An Energy Allocation Problem

The review introduces a concept called the Allostatic Triage of Psychopathology. In simple terms, it suggests this:

When the brain is under chronic stress and energy becomes limited, it is forced to prioritize survival over performance.

Just as emergency medicine uses triage when resources are scarce, the brain reallocates its limited energy when stress is persistent. Processes essential for immediate threat detection and vigilance are preserved, while others — such as emotional regulation, cognitive flexibility, motivation, and social engagement — are down-regulated.

This reframes many mental health symptoms not as failures, but as adaptive responses to prolonged energy strain.

Low mood, brain fog, irritability, emotional numbing, and fatigue are not random malfunctions. They are signals that the system is operating in an emergency mode for too long.

Microglia, Inflammation, and the Cost of Staying Alert

The review highlights the role of microglia, the brain’s immune and maintenance cells. Under acute stress, microglial activation is protective. But with chronic stress and limited energy availability, microglia can become metabolically trapped in a pro-inflammatory, hyper-responsive state.

This sustained inflammatory signaling interferes with synaptic plasticity, learning, mood regulation, and reward processing — all while consuming more energy.

In other words, the brain becomes stuck paying the interest on a long-term stress loan.

Where This Aligns with the ERM Framework

This is where the Exposure-Related Malnutrition (ERM) framework fits naturally — and expands the picture.

ERM describes a state where chronic exposures (psychological stress, inflammation, poor sleep, metabolic disease, environmental toxins, infections, nutrient inadequacy) gradually erode bioenergetic and metabolic capacity, even when calorie intake appears “adequate.”

From an ERM perspective:

• The brain’s allostatic triage is not the starting point, but a later-stage adaptation

• Chronic stress increases energy demand

• Energy availability becomes constrained (mitochondrial dysfunction, nutrient insufficiency, inflammation)

• The system compensates by reallocating resources

• Symptoms emerge as predictable trade-offs, not isolated disorders

The ATP model beautifully explains how the brain reallocates energy under stress.ERM explains why the energy shortage develops in the first place — and why it often affects the whole body, not just the mind.

Mental Health as a Whole-Body Energy Story

Seen through this lens, mental health symptoms often coexist with:

• Chronic fatigue

• Muscle loss or weakness

• Poor exercise tolerance

• Frequent infections

• Hormonal dysregulation

• Sleep disruption

• Nutrient deficiencies

These are not separate problems. They are different expressions of the same underlying bioenergetic strain.

Psychopathology, in this view, becomes one visible surface of a deeper systemic imbalance.

Why This Matters for Recovery

Perhaps the most important implication is this:

You cannot “think your way out” of an energy deficit.

If symptoms arise because the brain and body are operating under constrained metabolic conditions, then recovery must involve restoring capacity, not just suppressing symptoms.

This includes:

• Improving sleep and circadian alignment

• Reducing chronic inflammatory and toxic exposures

• Restoring adequate protein and micronutrient availability

• Supporting mitochondrial and metabolic resilience

• Allowing time for recovery, not just adaptation

The ATP model helps us understand what the brain does when energy is scarce.

The ERM framework focuses on how to rebuild the energy economy so triage is no longer needed.

A More Humane Narrative

Both frameworks converge on a powerful message:

You’re not weak. You’re not lazy. You’re not broken.You’re exhausted — at a cellular and systemic level.

And exhaustion is not a moral failure.

It is a biological state — and one that can be addressed.

By shifting the conversation from “what’s wrong with you?” to “what has your system been forced to adapt to?”, we open the door to more effective, compassionate, and sustainable paths to recovery.

Kelley, D. P., Singleton, S. P., Venable, K., Sturm, G., Skovgaard, A., Francis, J., Neylan, T. C., Bradley, E. R., Woolley, J., Picard, M., & O’Donovan, A. (2025). The allostatic triage model of psychopathology (ATP model): How reallocation of brain energetic resources under stress elicits psychiatric symptoms. Neuroscience and Biobehavioral Reviews, 179, 106419. https://doi.org/10.1016/j.neubiorev.2025.106419