INS and depressive disorder: Therefore, the alleviation of depressive symptoms by choline alphoscerate is likely to attenuate excessive cortisol associated with depressive symptoms and subsequent metabolic disruptions; however, the improvement in depression was not statistically different between the choline alphoscerate and placebo groups, likely due to the placebo effect, implying that the amelioration of depressive mood itself cannot fully explain the benefit of choline alphoscerate on insulin resistance.