Objective To analyze the relationship between impulsive aggressive behavior （IAB） and ventromedial prefrontal cortex （vmPFC） neurometabolism in adolescent bipolar depression （ABD） using proton magnetic resonance spectroscopy （1 H-MRS） technology. Methods From January to July 2023， 23 ABD patients admitted to the Outpatient and Inpatient Departments of Clinical Psychology of People's Hospital of Xinjiang Uygur Autonomous Region without any treatment within 30 days were retrospectively selected as the study subject. Patients with a total score of over 70 on the Barratt Impulsiveness Scale version 11 （BIS-11）， a weighted total score of less than 4 on the Modified Overt Aggression Scale （MOAS）， and a score of 0 on the physical aggression item were included in the group with IAB. Patients with a BIS-11 total score of less than 70， a MOAS weighted total score of less than 5， and a physical aggression score of 0 were included in the group without IAB. This study used single voxel 1 H-MRS to scan vmPFC and compared the ratios of N-acetyl-aspartate/creatine （NAA/Cr）， choline/creatine （Cho/Cr）， and myo-inositol/creatine （mI/Cr） in the vmPFC brain region of two groups of patients. Results There were 11 patients in the group with IAB and 12 patients in the group without IAB. The NAA/Cr values of ABD patients in the group with IAB were （1.45±0.16）， lower than those in the group without IAB （1.69±0.08）， and the difference was statistically significant （t=4.548， P ＜ 0.001）. There was no statistically significant difference in the Cho/Cr and mI/Cr values ［（0.64±0.10） vs （0.66±0.08）， （0.49±0.19） vs （0.54±0.08）］ between the two groups of patients （t=0.530，0.751； P ＞ 0.05）. Conclusions The NAA/Cr values of patients with ABD and IAB decrease. The IAB of ABD patients may be related to a decrease in the density of vmPFC neurons or the presence of neuronal dysfunction.