Inositol and Choline in Mental Health Care

Inositol in depressed mood and anxiety disorders

Inositol is a member of the B family of vitamins and is synthesized in the body in the form of myo-inositol. Inositol is the precursor of phosphatidyl inositol, a second messenger molecule required for normal nerve cell function. Some research findings suggest that Inositol in doses up to 20 gm per day may improve depressed mood; however these findings are inconsistent. A systematic review and meta-analysis of seven randomized placebo-controlled studies (242 subjects) on the benefits of inositol for mood and anxiety disorders found non-significant benefits for inositol over placebo for depressed mood, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety, and a trend toward superior response over placebo for premenstrual dysphoric disorder.

In a four-week, double-blind, crossover study (21 subjects), inositol at a dose of 12 gm per day and imipramine (a tricyclic antidepressant) were equally effective in reducing the frequency and severity of panic attacks in individuals diagnosed with panic disorder with and without agoraphobia. In a small crossover study (20 subjects), inositol (up to 18 gm per day) and fluvoxamine (150 mg per day) had comparable efficacy in reducing the frequency of panic attacks. Larger studies are needed to evaluate possible synergistic effects of inositol when used in combination with antidepressants or mood stabilizers such as lithium and valproic acid. Inositol is generally safe however some patients taking inositol report gastrointestinal distress.

Choline, phosphatidyl-choline and CDP-choline

Case reports suggest that choline (a vitamin in the B family) reduces the severity of mania. Choline is required for synthesis of acetylcholine (Ach) a neurotransmitter that is important for memory. In an open trial (six subjects) on choline in the treatment-refractory, rapid-cycling bipolar disorder patients on maintenance lithium therapy, four patients experienced reductions in the severity of manic symptoms, with 2 to 7.2 gm per day of free choline. Open trials and one small controlled trial suggested that supplementation with phosphatidylcholine (PC) at 15 to 30 gm per day might reduce the severity of both mania and depressed mood in bipolar patients and that symptoms worsened when PC was discontinued.

Cytidine 5-diphosphocholine (CDP-choline) is a precursor of PC and other important structural phospholipids in neuronal cell membranes. CDP-choline increases mitochondrial energy production, increases central nervous system (CNS) noradrenaline and dopamine levels, and has general neuroprotective effects following hypoxic or ischemic brain injury. Preliminary findings suggest that CDP-choline (1,000 mg per day) may improve cognitive performance in the early stages of Alzheimer disease. Two systematic reviews concluded that CDP-choline has consistent positive effects on recovery rate following stroke and mitigates the severity of cognitive impairment related to cerebrovascular disease in elderly individuals.

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