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This theoretically preserves the cytosolic pool of NAD+ (Nicotinamide Adenine Dinucleotide), which is critical for sirtuin activation and mitochondrial oxidative phosphorylation

Notably, an ongoing RCT investigating the effects of semaglutide on pre-treatment cognitive dysfunction in patients with major depression may provide useful insights in this regard (NCT04466345 (ref

since NAD is related to niacin, pairing it with vitamin C or other supportive nutrients might improve your comfort

Its caused due to various reasons from insulin not being made by the body to not using it right, or even genetics and meds messing with how it works