Choline in the treatment of rapid-cycling bipolar disorder: clinical and neurochemical findings in lithium-treated patients.
This study examined choline augmentation of lithium for rapid-cycling bipolar disorder. Choline bitartrate was given openly to 6 consecutive lithium-treated outpatients with rapid-cycling bipolar disorder. Five patients also underwent brain proton magnetic resonance spectroscopy. Five of 6 rapid-cycling patients had a substantial reduction in manic symptoms, and 4 patients had a marked reduction in all mood symptoms during choline therapy. The patients who responded to choline all exhibited a substantial rise in the basal ganglia concentration of choline-containing compounds. Choline was well tolerated in all cases. Choline, in the presence of lithium, was a safe and effective treatment for 4 of 6 rapid-cycling patients in our series. A hypothesis is suggested to explain both lithium refractoriness in patients with bipolar disorder and the action of choline in mania, which involves the interaction between phosphatidylinositol and phosphatidylcholine second-messenger systems.
Stoll
A L
AL
Psychopharmacology Unit, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Sachs
G S
GS
Cohen
B M
BM
Lafer
B
B
Christensen
J D
JD
Renshaw
P F
PF
D000328:Adult; D000339:Affect; D018692:Antimanic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001479:Basal Ganglia / Q000378:metabolism; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D002794:Choline / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D018021:Lithium Chloride / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018697:Nootropic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales
D018692:Antimanic Agents; D018697:Nootropic Agents; D018021:Lithium Chloride; D002794:Choline