CHOLINE PREPARATIONS IN THE TREATMENT OF ASTHENIC STATES: MODERNITY AND PERSPECTIVES (A LITERATURE REVIEW WITH A CLINICAL CASE PRESENTATION)

Purpose. To provide the reader with a detailed description of the biochemical and physiological effects of choline, which make it an indispensable component of our daily food. Then to thoroughly review all the relevant clinical data on the use of choline preparations for the treatment of asthenic and astheno-depressive conditions and cognitive impairments. Then, to present the reader with a clinical case from our own practice, illustrating the effectiveness of the use of choline alfoscerate as part of the combination therapy of a mild form of post-COVID astheno-depressive syndrome in a 19-year-old man who have refused to take antidepressants, as well as any other psychotropic drugs, but instead wanted some form of pharmacotherapy based exclusively on «natural components». Methodology. We have searched PubMed, Google Scholar, Web of Science databases for keywords such as «choline biochemistry», «choline and phospholipids», «choline and betaine», «arsenolipids», «nitrolipids», «choline and cognition», «choline and asthenia». Then we filtered the data we had found by their relevance. Then we summarized and presented the relevant data in the theoretical part of this article. Then we described in detail the clinical case of the effective use of choline alfoscerate in the complex therapy of post-COVID asthenic-depressive state which we have encountered in our own practice. Results. The results we have obtained during compilation of this review, in our opinion, may allow us to draw preliminary conclusions about the possible prospects for the use of choline preparations (and, in particular, choline alfoscerate preparations) in monotherapy or as part of combination therapy of asthenic and / or astheno-depressive states (especially if those states are accompanied by impaired memory, concentration, increased mental fatigue), including those states that were caused by a recent history of COVID-19 (that is, asthenic or astheno-depressive states developed as part of the post-covid syndrome). To be able to make any further, more firm conclusions regarding the efficacy and safety of the use of choline-containing preparations in this context, it will be necessary to organize and conduct large, multicenter, methodologically sound, double-blind, placebo-controlled, randomized clinical trials (RCTs), with clinically meaningful and relevant outcomes in the treatment of asthenia clearly defined as trial endpoints in advance (before starting the trial itself). Practical implications. We believe that the results we have presented in this review justify the need to further study the efficacy and safety of the use of choline preparations, both as monotherapy and as a part of combination therapy of asthenic and astheno-depressive conditions, preferably in the format of large, multicenter, well organized, methodologically sound, double-blind, placebo-controlled RCTs with clearly pre-defined clinically meaningful and relevant endpoints.