A meta-analysis published in Molecular Psychiatry pooled 1H-MRS data across 25 prior studies involving 370 individuals with anxiety disorders and 342 controls, revealing an 8% choline reduction concentrated in the prefrontal cortex. This noninvasive spectroscopy technique quantifies neurometabolites without surgery, yet carries limitations including lower spatial resolution and potential influence from medication status or comorbid depression. The pattern aligns with heightened norepinephrine demand during chronic stress, which may accelerate choline turnover for phospholipid synthesis and acetylcholine production. Earlier work, such as a 2019 randomized trial in the American Journal of Clinical Nutrition on choline supplementation improving executive function in stressed adults, and a 2022 Nutrients review linking low dietary choline to elevated inflammatory markers in mood disorders, suggest the deficit is modifiable rather than merely correlative. Mainstream coverage rarely connects these dots to population-level intake shortfalls—most adults fall below the 550 mg daily adequate intake—favoring instead SSRI narratives despite modest remission rates. If confirmed in prospective trials, targeted repletion could complement exposure therapy by stabilizing membrane integrity and dampening amygdala hyperactivity, though causation remains unproven and individual genetic variations in PEMT enzyme activity warrant stratification.