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AcAc-CoA then combines with another acetyl-CoA molecule to form 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA)

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3 PUFAs serve as precursors to prostaglandins such as prostaglandin E3, which are powerful hormone-like substances that reduce inflammation [185], and inhibit arachidonic acid, derived 2-series prostaglandins, and the 4-series leucotrienes, which are known to modulate the production of proinflammatory and immunoregulatory cytokines [186]

This syndrome is characterized by clinical symptoms of sickness behavior such as leaden paralysis of the limbs, hypersomnia, and hyperphagia/weight gain, while mood reactivity is unimpaired, i.e., mood brightens in response to positive events (according to DSM-5 criteria for MDD with atypical features), while still suffering from lack of concentration and higher levels of exhaustibility as in melancholic MDD [99]