Choline Supplementation for Bipolar Disorder

Choline for bipolar disorder

This post is the fourth in a series on bipolar disorder. Previous posts briefly reviewed conventional pharmacologic treatments, uses of select amino acids and omega-3 fatty acids and a proprietary nutrient formula. This post reviews research findings of studies on the B vitamin choline in the treatment of bipolar disorder.

Findings on choline and phosphatidylcholine in bipolar disorder

Choline is a naturally occurring B vitamin necessary for the biosynthesis of the neurotransmitter acetylcholine (ACh). It has been postulated that abnormal low brain levels of acetylcholine cause some cases of mania. Findings of a small placebo-controlled trial suggest that phosphatidylcholine (15 g to 30 g/day) may reduce the severity of mania and depressed mood in bipolar patients. Case reports and case series suggest that choline reduces the severity of mania.

In a small case study of treatment-refractory, rapid-cycling bipolar patients who were taking lithium, four out of six patients responded to the addition of 2000–7200 mg/day of free choline. It should be noted that two non-responders were also taking high doses of thyroid medication at the same time. Clinical improvement correlated with higher levels of choline in a part of the brain called the basal ganglia as measured using Magnetic Resonance Imaging (MRI). The effect of choline on depressive symptoms in these patients was inconsistent.

Case reports, open trials and one small double-blind study suggest that supplementation with phosphatidylcholine 15 g to 30 g/day reduces the severity of both mania and depressed mood in bipolar patients, and that symptoms recur when phosphatidylcholine is discontinued.

Choline and phosphatidylcholine are safe and generally well tolerated when taken at doses used to treat bipolar disorder.

Because of the limited number of studies and small study size, findings on choline and phosphatidylcholine in the treatment of bipolar disorder should be regarded as preliminary.

To learn more about non-pharmacologic treatments of bipolar disorder read "Bipolar Disorder: The Integrative Mental Health Solution" by Dr. Lake.