Role of citicoline and choline in the treatment of post-stroke depression: an exploratory study

Abstract

Objective To compare selective serotonin reuptake inhibitors (SSRIs) and nootropic drugs in the reduction of anxiety and depressive symptoms in post-stroke patients. Methods This retrospective cohort study included patients diagnosed with post-stroke depression that were treated with either SSRIs or nootropic drugs (i.e. citicoline or choline alphoscerate). Depression and anxiety were assessed using the Hamilton Rating Scales. Statistical associations between the use of nootropic drugs and mood disorder improvements were determined by measuring assessment scores at 6-months. Results A total of 44 post-stroke patients with depression (aged 45–75 years) were enrolled in the study: 20 were treated with SSRIs and 24 received nootropic drugs. From baseline to follow-up, the SSRI group showed a large effect size with regard depression (success rate difference [SRD] 0.57; 95% confidence interval [CI] 0.21, 0.79) and anxiety (SRD 0.49; 95% CI 0.14, 0.74), whereas the nootropic group showed a small effect size for depression (SRD 0.16; 95% CI –0.17, 0.46) and a small effect size for anxiety (SRD 0.36; 95% CI –0.03, 0.62). Conclusion The administration of nootropic drugs could be a valid therapeutic strategy to manage post-stroke patients suffering from mild–moderate anxiety or anxious-depressive syndrome, but this requires further research.

The CITIDEMAGE Study: Combined Treatment with a Cholinergic Precursor in Dementia Patients

“…Its effects on mood have already been postulated through the above-mentioned mechanism on the increase in S-adenosyl-methionine and have been confirmed by a recent study that focused on post-stroke patients [51]. This article showed the effects of cholinergic precursors, such as citicoline, on post-stroke depression through its pleiotropic mechanisms [51].…”

“…Citicoline combined with an AchEI and memantine together could not only potentiate cholinergic neurotransmission but work as possible excitatory amino acid transporter activator (EAAT2), thus reducing the glutamate efflux [50]. Its effects on mood have already been postulated through the above-mentioned mechanism on the increase in S-adenosyl-methionine and have been confirmed by a recent study that focused on post-stroke patients [51]. This article showed the effects of cholinergic precursors, such as citicoline, on post-stroke depression through its pleiotropic mechanisms [51].…”

Choline deficiency and choline metabolism disorders can lead to anxiety-like behaviors induced by DSS in IBD mice

“…Exogenous CDP-choline can directly cross the blood-brain barrier, or it can be rapidly hydrolyzed to cytidine and choline, which is effectively used in the synthesis of PC and acetylcholine (41). In various animal models of CNS disorders, CDP-choline enhanced membrane repair and neuronal functions (42,43). Both PC and acetylcholine levels in the PFC of DSS mice were elevated after feeding CDP-choline, and free choline levels in the serum were signi cantly decreased, which was su cient to demonstrate the presence of choline de ciency in PFC and systemic abnormalities of choline metabolism of the DSS-induced IBD mice model.…”

Recent advances in anxiety disorders: Focus on animal models and pathological mechanisms

“…Choline is one of the substances that synthesize ACh. Plasma concentrations of choline have been negatively correlated with anxiety symptoms in a large‐scale population‐based study 71 . It has been revealed that CRS increases the expression of mAChR in the ventral hippocampus (vHPC) of mice and vHPC ACh release in mice, inducing social avoidance and anxiety‐like behaviors 72 .…”