CHOLINE IN THE TREATMENT OF RAPID-CYCLING BIPOLAR DISORDER - CLINICALAND 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 exhi bited a substantial rise in the basal ganglia concentration of choline -containing compounds. Choline was well tolerated in all cases, Cholin e, 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 disor der and the action of choline in mania, which involves the interaction between phosphatidylinositol and phosphatidylcholine second-messenger systems.