| 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.
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