title: Choline in the treatment of rapid-cycling bipolar disorder: clinical and neurochemical findings in lithium-treated patients.
abstract: 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.
authors.affiliation: Psychopharmacology Unit, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Stoll
authors.forename: G S
authors.initials: GS
authors.lastname: Sachs
authors.forename: B M
authors.initials: BM
authors.lastname: Cohen
authors.forename: B
authors.initials: B
authors.lastname: Lafer
authors.forename: J D
authors.initials: JD
authors.lastname: Christensen
authors.forename: P F
authors.initials: PF
authors.lastname: Renshaw
mesh_terms: 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
chemical_list: D018692:Antimanic Agents; D018697:Nootropic Agents; D018021:Lithium Chloride; D002794:Choline