The second finding suggests that post-treatment is associated with increased choline-containing compounds in the frontal lobes of MDD patients, suggesting a potential target for treatment development in MDD. This is an important finding because it presents a potential bio-marker target for treatment efficacy. Also, it may provide insight into the pathophysiology of MDD and assist in the development of better treatment options. The frontal lobe is a region associated with decision making and executive control, and in poor executive function has been associated with MDD (Cotrena et al., 2016; Dulay et al., 2013). In-creasing choline in the frontal lobe may improve executive function and thereby assist in improving mood. However, this may contradict the previously suggested cholinergic-adrenergic hypothesis, as that theory postulates increased acetylcholine is associated with depression
Four papers reported on choline changes in the frontal lobe of the brain, specifically in areas of the prefrontal cortex. Three showed that after treatment (SSRI’s or repeated transcranial magnetic stimulation)Cho values in MDD subjects were greater, whereas one showed that sleep restriction resulted in greater total Cho in MDD patients
It’s almost a meme at this point that too much choline causes depression, but this study suggests the opposite. If you get depression from choline I suggest you look into whether other supplements are causing it too, maybe an interaction.
The paper does not claim choline causes or improves depression, it also lists multiple studies that both claim it increases and decreases depression
This literature review indicates that further research is still needed to determine the extent to which brain Cho is altered in MDD