Objective To explore the changes in neurobiochemical metabolites in the ventromedial prefrontal cortex of patients with bipolar depression accompanied by somatic symptoms and their correlation with psychological status， so as to provide an objective basis for clinical identification and intervention. Methods A total of 40 patients with bipolar depression who were treated at the Department of Clinical Psychology of the People's Hospital of Xinjiang Uygur Autonomous Region from January to October 2025 were selected as the study group. Participants were divided into a bipolar depression with somatic symptom group（ n=23） and a bipolar depression without somatic symptom group（ n=17） according to whether there were somatic symptoms. During the same period， 20 healthy volunteers were recruited from various communities and schools in Urumqi， to serve as the healthy control group. Hamilton Anxiety Scale（ HAMA）， 24-item Hamilton Depression Scale（ HAMD-24）， Young Mania Rating Scale（ YMRS）， and Symptom Checklist 90（ SCL-90） were used to assess the psychological status of all participants. Neurobiochemical metabolite ratios of N-acetylaspartate/creatine（ NAA/Cr）， choline/ creatine（ Cho/Cr）， inositol/creatine（ mI/Cr）， and glutamate-glutamine complex/creatine（ Glx/Cr） in the ventromedial prefrontal cortex were measured in all participants using MRS. Differences in psychological status and neurobiochemical metabolites were compared across the three groups. Pearson or Spearman correlation analysis was used to examine the correlation between somatic symptoms and neurobiochemical metabolites. Binary Logistic regression was used to analyze the influencing factors of somatic symptoms in patients with bipolar depression. Results There were statistically significant differences in the HAMA， HAMD-24， YMRS， and SCL-90 scores among the three groups of participants（ Z=40.806， 40.358， 13.082， 42.655； all P ＜ 0.05）. Post-hoc analysis showed that the SCL-90 total scores were higher in the bipolar depression with somatic symptom group than in the bipolar depression without somatic symptom group， and the difference was statistically significant（ Z=-3.622， P=0.001）. The differences in NAA/Cr and Glx/Cr among the three groups of participants were statistically significant（ Z=9.113， 11.237； both P ＜ 0.05）. Post-hoc pairwise comparisons， adjusted using the Bonferroni method， revealed that the NAA/Cr in the bipolar depression with somatic symptom group was lower than that in the bipolar depression without somatic symptom group， and the Glx/Cr in the bipolar depression with somatic symptom group was higher than that in the healthy control group， and these differences were statistically significant（ Z=2.931，3.217；both P＜0.05）. There were no statistically significant differences in Cho/Cr and mI/Cr among the three groups of participants（ F/H=2.206，4.539； both P ＞ 0.05）. Correlation analysis showed that the SCL-90 somatization factor was positively correlated with Glx/Cr（ r=0.406， P＜ 0.05）， negatively correlated with NAA/Cr（ r=-0.334， P＜ 0.05）； no statistically significant correlations were found with Cho/Cr or mI/Cr（ both P＞ 0.05）. Binary Logistic regression analysis showed that an elevated NAA/Cr ratio was a protective factor for patients with bipolar depression accompanied by somatic symptoms ［OR=0.020， 95%CI（ 0.000， 0.801）， P ＜ 0.05］； an elevated Glx/Cr ratio was a risk factor for patients with bipolar depression accompanied by somatic symptoms［ OR=19.435， 95%CI（ 1.202， 314.218）， P ＜ 0.05］. Conclusions Bipolar depression patients exhibit significant symptoms of anxiety and depression， as well as neurobiochemical metabolic abnormalities. In patients with bipolar depression accompanied by somatic symptoms， the NAA/Cr ratio is reduced and the Glx/Cr ratio is elevated in the ventromedial prefrontal cortex. Somatic symptoms in patients with bipolar depression may be associated with NAA/Cr and Glx/Cr ratios in the ventromedial prefrontal cortex. NAA/Cr may be a protective factor for patients with bipolar depression accompanied by somatic symptoms， while Glx/Cr may be a risk factor for such patients.