by Erin Hawkes, MSc

Choline is physiologically important for the structure of cell walls, signaling across these walls, signaling from cell to cell, and metabolism. Humans must consume choline-containing foods in their diet, but most don’t consume enough. Vegans, vegetarians, and athletes are particularly at risk for low choline levels. Moreover, there is a high demand for choline during pregnancy. Supplements are available in the form of phosphatidylcholine (lecithin).

Likely Effectiveness: Quite likely to be effective as a preventative measure, with perinatal exposure. Unlikely to improve symptoms of schizophrenia or medication side effects, such as tardive dyskinesia.

Effective Dosage:  Men: 550 to 3500mg per day; women: 425 to 3500mg per day; pregnant/lactating women: 450/550 to 3500mg per day. Meat, eggs, dairy, and grains are examples of high-choline foods.  In the most recent study the women took approximately 6 grams (6,000 mg) per day of Choline, and that level seemed to be the most effective.

Research: Fair; not replicated/confirmed; conflicting results across studies.

Risks:  No side effects at therapeutic doses. The U.S. Federal Drug Administration (FDA) considers it safe.

Selected references

1) Ross RG, Hunter SK, McCarthy L, et al.. Perinatal Choline Effects on Neonatal Pathophysiology Related to Later Schizophrenia Risk. Am J  Psychiatry. 2013 [Epub ahead of print].

In this recent, well-designed study, 100 women (93 infants) in their second trimester of pregnancy received either placebo or 900 mg phosphatidylcholine. There were no side effects for either mother or baby. Most of the 46 infants who were exposed to choline, as opposed to the 47 infants exposed to placebo, did not display an abnormality in their brain responses to specific stimuli similar to that seen in most adults with schizophrenia (6% displayed this response in the choline group, compared to 91% for the placebo group). This paper suggests that prenatal treatment with choline reduces the chance (by about 75%) the child will go on to develop schizophrenia. This hypothesis is also supported by work done with rodent models.

2) Ross RG, Stevens KE, Proctor WR, et al.. Research review: Cholinergic mechanisms, early brain development, and risk for schizophrenia. J Child Psychol Psychiatry. 2010; 51: 535-549.

This paper addresses the goal of finding a potential preventative treatment for those at risk of developing schizophrenia. Attention dysfunction in young children (around age six) has been accepted as a reliable early marker of schizophrenia. Ross and colleagues, however, reviewed infants’ responses to specific auditory stimuli and found that even this was consistent with a physiological response shared by adults with schizophrenia (“P50 sensory gating”). This demonstrates that there is a specific attention dysfunction even in infants who are more likely to develop schizophrenia.

3) Théberge J, Al-Semaan Y, Drost DJ, et al. Malla AK. Duration of untreated psychosis vs. N-acetylaspartate and choline in first episode schizophrenia: a 1H magnetic resonance spectroscopy study at 4.0 Tesla. Psychiatry Res..2004; 131: 107-114.

Théberge and colleagues examined brain scans of 19 people who had schizophrenia but were not taking antipsychotics (for up to 31 months). For both areas of interest in the brain, choline levels were increased with relationship to the duration of untreated psychosis. This rise in choline levels may reflect brain cell loss or damage. While this report is significant, other studies conflict with regards to levels of choline in the brains of people with schizophrenia. However, this is the first study to examine patients who had no current treatment with antipsychotics.