Lecithin, Choline & Bipolar Syndrome

© www.PeterSmithUK.com (2013 #2)
Combine the Anti-Mania Effects Lecithin and Choline
with the Antidepressant effects of Omega-3 Oil for a Mood
Stabilising Effect on Bipolar.

Taking the nutritional supplements choline bitartrate and lecithin supplies the body with more of the raw materials it needs to make acetylcholine and the scientific literature suggests that taking lecithin can helpful during phases of mania but should be avoided or kept to an absolute minimum during periods of bipolar depression.  
However supplementing lecithin and its derivatives (phosphatidylcholine, choline and inositol) enhances the absorption, transportation and utilisation of oil molecules throughout the body including the antidepressant omega-3 oils. My personal and clinical experience is that taking lecithin for its anti-mania properties and omega-3 oils for their antidepressant properties together at the same time can produce a gentle but useful mood stabilising effect to help you live well with bipolar syndrome. 
High doses of choline and lecithin may produce a depressant effect however combining a small dose of lecithin with omega-3 fish oils enhances the antidepressant effectiveness of the oils without causing any noticeable depressant effect.
During times of mania increasing the lecithin to a high dose produces an anti-mania effect and combining this with omega-3 fish oils at the same time provides some protection against swinging into bipolar depression. 

A small dose would be ½ to 1 teaspoon of lecithin granules, a high dose would be 2-4 or even 6 tablespoons (to confirm ½-1 teaspoons to 2-6 tablespoons).
Once you have learned how to monitor you bipolar by reading the signs so you can determine the state of your condition (manic or depressed) you can adjust the dose of the lecithin to help you control it. See How to Monitor your Bipolar
As with all supplements I recommend personal experimentation:
If you are in a depressed phase or more prone to them than mania try taking your omega-3 fish oils on their own or with half a teaspoon of lecithin granules to assist the transportation of the oils to your brain, if this combination is going to improve your bipolar depression it should be observable within 3 to 5 days.  The inclusion of lecithin with your oils is especially indicated if you also tend to get dry skin; the quality of the moistness of your skin is primarily influenced by how well hydrated you are and how well your body is supplied with nutritional oils.  Some people find that even when they supplement adequate amounts of water and nutritional oils their skin remains dry and that the inclusion of lecithin along with supplemental choline and inositol solves this problem because they improve the utilisation and transportation of oil molecules through the body all the way to the skin.  (see my page on lymph cleansing in my self-help pages for information on how to hydrate your body)
If you are in a manic phase or more prone to them than depression try taking omega-3 fish oils and say 2 tablespoons of lecithin granules. You can try increasing the dose to 4 and then 6 table spoons every 5 days and see how it affects you. What you are looking for is the dosage that produces a useful therapeutic effect, so you know how much to take in the future when you need to treat mania. The maintenance dose you need is likely to be less than the treatment dose. 
Don’t worry if you overdo it and make yourself depressed the effect are only temporary and will wear off within about three days of ceasing supplementation and the experience will give you valuable experience that lecithin can affect you and at the right dose can treat your manic phases. 

The Cholinergic Hypothesis of Bipolar Depression

Acetylcholine is one of the four major neurotransmitters in the brain. It primarily appears to play a role in the memory circuits of the brain, it gives the brain quick and sharp thinking. 
Acetylcholine appears to play a role in mood disorders. It has been observed that administration of drugs that increase the release of acetylcholine can decrease manic symptoms during manic phases but may worsen depression during depression phases or even precipitate depression.  It has also been observed that people with bipolar syndrome, schizophrenia and depression have slight elevations in the level of choline (the precursor and metabolite acetylcholine) in their red blood cells [Stoll et al], suggesting metabolism of acetylcholine is altered in people with these conditions. 
During manic phases it has been observed that both drugs that increase acetylcholine activity in the brain and supplementing lecithin have useful anti-mania affects.  In a 1982 study by Cohen et al it was demonstratedthat lecithin is a non-toxic and effective agent capable of reducing bipolar mania. One study found that the addition of lecithin to a prescription of lithium enhanced its effectiveness compared to a placebo plus lithium.  See below

Lecithin and Choline makes Lithium more Effective
Making Very Low and Safe Doses Lithium Useful

I recommend trying the combination of lecithin, very low dose lithium and omega-3 fish oils to help manage both bipolar mania and bipolar depression.  
A properly done double-blind, placebo-controlled trial done by Cohen, Lipinskini, Altersman in 1982 showed that the combination of lecithin and lithium was more effective at controlling mania than the combination of lithium and a placebo. I believe this may be one of the reasons why I am able to achieve a useful therapeutic effect from very low doses of lithium.  The form of lithium I use is an organically bound amino acid chelate as opposed to the inorganic lithium carbonate used in pharmaceutical medicine and the dosage I use is hundreds of times lower.  
I find this research very interesting because in my practice I obtain therapeutic effects form very low safe doses of lithium from a product called Lithinase or Lithium Orotate. The doses I recommend and use myself are so low they would be considered ineffective by most conventional medics, I believe these low doses work because I combine them with lecithin, omega-3 fish oils, vanadium lowering vitamin C, anti-inflammatory NAC cysteine, good diet etc. etc. If you want to self-medicate and live well with bipolar syndrome I recommend you include lecithin in your medicine chest. 
There are several major advantages to being able to use such a low dose of lithium: firstly it’s non-toxic, in fact there’s a little evidence that a very low dose of lithium (in the range that I regularly take) has anti-ageing and life extending properties, secondly I experienced none of the unpleasant mind and personality “numbing” affects that people experiences with the higher standard doses of pharmaceutical lithium carbonate and thirdly I find no problem at all in starting and stopping the dosage on an as-and-when required basis, something you cannot do with the pharmaceutical lithium carbonate drug.  Please note stopping and starting lithium may NOT be appropriate for your version of bipolar. 
If you’ve been prescribed lithium carbonate for mania by a psychiatrist you should stay on it unless you have established viable alternative treatments.  
In the case of hyper-mania I would also include:
Glycine usual dose 2-3 g on an empty stomach once or twice per day.   
In his book Healing Nutrients Within Dr Braverman says he tried 15 to 30 g of glycine with two manic individuals during acute attacks and it caused a cessation of the manic episode and calmness within one hour.  As he says further clinical trials are warranted.   
Taurine has an anti-mania affect similar to lithium 500 mg before each meal and optionally before bed.   
Total Darkness see Bright Light and Total Darkness Treatment chapter.  
Make sure you have not forgotten to take your EPA/DHA (omega-3) supplements.   If you increase your usual dose of omega-3 by half as much again it can help antidote mania but may induce a mini depression lasting 3 days.  
Lecithin increased to 2 teaspoons per day 1 with breakfast and the other with the omega-3’s
For me this combination reliably starts to stop a hyper-manic within half a day and terminates it within a couple of days, after which I would continue the Lithinase for perhaps another 5 days to consolidate my balance.
Nothing is straightforward with regards to mental illness and brain chemistry and sometimes medications produce paradoxical or opposite affects, I always recommend real-world experimentation.

My Personal Prescription Includes Lecithin

The first time I experimented with high doses of lecithin I was in a balanced state neither depressed nor manic, what happened was it did not make me feel depressed possibly because I always take a lot of anti-depressant remedies but it made me sleepy; over about five days I started to have longer and longer sleeps, normally I sleep 7 ½ hours by the end of 5 days on the lecithin I sleep a whopping 12+ hours and even wanted a siesta in the afternoon. Obviously this was totally pointless at that time but in a manic phase when I don’t feel the need to sleep lecithin’s sleep inducing effect are very helpful. It’s totally safe and even gives your liver a little detox. 
On a daily basis I take omega-3 fish oil containing 900 mg of EPA along with half a teaspoon of lecithin and a very low dose of lithium as and when needed. 
When I notice my need for sleep becoming unhealthily diminished I take 5 mg lithium orotate and 2-4 tablespoons of lecithin a day which corrects the imbalance within a few days. 

Choline can have Paradoxical and Contradictory Effects on Bipolar Depression

If you read the literature on the relationship between mental illness, the neurotransmitter acetylcholine and the supplements choline and lecithin it presents quite a confusing picture:
Some of the literature suggests that supplementing lecithin and choline is beneficial for controlling the manic phase of bipolar syndrome, rapid cycling bipolar syndrome and augments the effects of lithium.  However you’ll also find contradictory information suggesting that people with bipolar syndrome have a kind of super sensitivity to acetylcholine perhaps possessing an increased number of what are called receptor sites for acetylcholine within the brain and that the effects of lithium are to dampen down and control excessive acetylcholine activity within the brain.  This implies that you would not want to supplement acetylcholine during a manic phases.  Once again brain chemistry turns out to be anything but straightforward.
There is a way for you as an individual to cut through this confusion and that is to conduct your own personal experiments and see what if any are of the effects of choline (sold as choline bitartrate) and lecithin on your bipolar syndrome.   Obviously you should only undertake personal experimentation with bipolar carefully and ideally with the right kind of support either from an appropriate healthcare professional or after you have developed your understanding and skills at managing your condition.
Before experimenting ask yourself:-
1.   Is now the right time to be experimenting with my medication, or am I currently going through a phase of instability, change or stress that would make this a bad time to experiment.
2.   Do I have an adequate understanding of my own condition and a good ability to self-medicate if I get into difficulties.  If you are not good at self-medicating you should absolutely work with the guidance and support of an appropriate medical practitioner.
3.   Do you have some regular contact with a psychologically qualified person such as a psychotherapist who can give you some outside independent professional perspective on the state of your mental health, or do you at least have five or six years of regular psychotherapy under your belt.
4.   If your mania and or depression can be so extreme that it may be harmful are you confident that you can cope with this and you have mastered the use of remedies and psychological techniques so that you can quickly bring yourself back into a safe place if the experimenting causes your condition to become unstable.
In the next section on my personal prescription and experiences I’ll share some pointers that you may find useful for your experimentation.


Supplementing Choline Bitartrate and Inositol

Typically choline is sold in combination with another B vitamin called inositol. Most people find choline is somewhat stimulating and that inositol has a somewhat calming effect, combined together they moderate each other. In theory one would take choline in the morning and inositol in the evening, however I’ve never observed this to be really useful. 
Very large doses of inositol have been found to be effective for people with OCD see my page on natural treatments for OCD.  
I have used choline bitartrate both personally and professionally and consider therapeutic doses to begin above 750 mg per day so I would not be at all concerned about taking the 50 mg of choline bitartrate included in let’s say a multivitamin or a B 50 complex during a phase of depression, the overall effect of a B complex is antidepressant.   
For me personally a large single doses of choline bitartrate (1200-1500mg) highly stimulating, inducing a short-term almost hypomanic condition with a subsequent low mood rebound effect within about 4-5 hours. I would only use such large doses immediately prior to exams for the short term memory enhancing effects it can produce.   
If you find that rather than helping to control the manic state choline produces a paradoxical opposite effect and is stimulating, but you want to have the memory enhansing effects of choline for let’s say a period of prolonged study I have found (at least for myself) the combination of choline with inositol -along with omega-3 fish oils- to be a balanced and worthwhile solution.   The point is that the combination of choline and inositol tends to produce a fairly neutral and balanced effect on one’s mood.  

Choline Inositol & Lecithin for Detoxification

Both choline and inositol are what are called lipotrophic substances, lipo means lipids or fats/oils and trophic means attracted to. These lipotropic vitamins attach to fats and oils and assist their transportation and utilisation throughout the body; so for example if you were to take a capsule containing 250 mg of choline and 250 mg of inositol together at the same time as your omega-3 fish oils the lipotrophic choline and inositol would assist in the transportation of the omega-3 oils through your bloodstream and into your brain where it’s needed. Supplementing high doses of choline and inositol in combination is also useful when one wants to detoxify fat soluble toxins from the liver and throughout the fatty tissues of the body. This type of detoxification programme is something I routinely do in my practice and would involve following an alcohol and fried food free diet, taking perhaps 4 X 250 mg choline and inositol capsules per day along with lecithin, supportive cofactor supplements, liver cleansing herbs, high-quality omega-3 oils and periodic therapeutic fasting. See my page on the liver detoxification for more information.

Choline as a Memory Enhancer

Supplementing large doses of choline bitartrate which is a precursor to acetylcholine is capable of at least temporarily enhanced mental abilities, making one sharper and improving one’s ability to quickly access information stored in your memory banks. The effect lasts for about 3 ½ hours and is highly recommended when doing exams.  Be warned however when it wears off it can tend to cause a wave of low blood sugar and tiredness, although this is largely preventable by consuming light snacks such as almonds with raisins and grape or pineapple juice. I suspect that the “rebound” low blood sugar I experienced was actually a direct consequence of my brain being so switched on and highly active for several hours of intense mental work. The brain is a massive consumer of glucose compared to other body tissues; it only constitutes approximately 2% of our total body weight yet it consumes almost half of all the glucose in the blood and just like your muscles when you’re working-out the brain uses even more glucose when it’s doing especially demanding mental work.  
For a longer term memory enhancing effect I recommend procaine hydrochloride in the form of ultra-H 7. I recommend buying it from a European and not American source to avoid getting an inferior product. Procaine hydrochloride can also have (mild) antidepressant effects for some people. Personally when I took procaine hydrochloride I found it to have a powerful memory enhancing effect and always produced a brief but rather severe rebound depression when I suddenly stopped taking it without gradually tailing off the dosage.
Several theories have been proposed to explain how and why lecithin enhances the effectiveness os lithium, but this is beyond focus of this page; as I have said before I am a clinician first and foremost so my focus is on discussing practical solutions rather than an academic theories, the academic reader should refer tohttps://www. acnp. org/g4/GN401000095/CH. html as a good starting point.
Pestronk Drackman: Lithium reduces the number of acetylcholine receptors in skeletal muscle. .  Science 17 of October 1980 volume 210 number 4467 pp stop 342-343.
Cohen.  Lipinskini, Altersman: Lecithin in the treatment of mania: double-blind, placebo-controlled trials.  American Journal of psychiatry 1982 of September; 139 (9): 1162-4.  
American Journal of psychiatry 2005 January: 162 (1): 137-45.  Does sustained release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders?
This study showed a reduction in both gambling behaviour and mood instability in pathological gamblers with bipolar spectrum of 83% of the people receiving sustained release lithium compared to 29% improvement in the placebo group.
Biol Psychiatry. 1996 Sep 1;40(5):382-8.
Choline in the treatment of rapid-cycling bipolar disorder: clinical and neurochemical findings in lithium-treated patients.
Stoll AL, Sachs GS, Cohen BM, Lafer B, Christensen JD, Renshaw PF.
Psychopharmacology Unit, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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.
[PubMed - indexed for MEDLINE] 


Bipolar Treatment Main Menu:

Section 1  
Understanding Bipolar Neurotransmitters & Treatment
Section 2 
How to Monitor you Bipolar Phases to Adjust your Prescription
Section 3 
Treating Bipolar Mania
Section 4 
Treating Bipolar Depression
Section 5 
Putting It All Together
How to Combine Natural Therapies to Manage and Live Well with Bipolar Syndrome
Section 6 
Universal Bipolar Helpers:
Darkness Therapy for Bipolar Mania
Sleep Cycles & Bipolar Syndrome
Stabilising Blood Sugar
Omega-3 Fish Oils for Bipolar Depression
Lithium Friend or Foe
Vanadium Toxicity & Bipolar Syndrome
Detoxifying Heavy Metals
Bipolar Treatment Articles:
Lecithin & Choline Reduce Bipolar Mania
Bipolar Drugs
Drugs & Weight Gain
Addiction & Bipolar Syndrome
NAC-Cysteine Anti-oxidant & Antidepressant
Be Well
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