Abstract: Objective To measure choline (Cho) and creatine (Cr) in cerebellum of patients with depression after first left basal ganglia infarction by magnetic resonance spectroscopy. Methods Fifty patients with first left basal ganglia infarctions admitted to the First Affiliated Hospital of Liaoning Medical University from March 2014 to September 2015 were recruited in this study, and another 25 matched healthy controls were recruited. Patients and controls underwent¹H-MRS scan locating in bilateral cerebellar white matter and the spectrum of Cho and Cr was recorded respectively at the first week after onset. Hamilton depression scale (HAMD) was also administered at the same time. According to the result of HAMD, the patients were divided into two groups: poststroke non-depressed (PSND) group (n=25) and post-stroke depression (PSD) group (n=25). The differences of Cho and Cr measured by ¹H-MRS between these groups were compared and their correlation with the HAMD score was analyzed. Results Compared with controls, Cho/Cr ratio in bilateral cerebellum of PSD patients was significantly higher right PSD: (1.33±0.42), control: (0.84±0.28), P=0.000; left PSD: (1.14±0.37), control: (0.80±0.26), P=0.001. In the right side of the cerebellum, the Cho/Cr ratio in patients with PSD increased significantly compared with PSND patients (1.33±0.42) vs (1.03±0.32), P=0.004. However, there was no significant difference in Cho/Cr ratio in left cerebellar between PSD group and PSND group (1.14±0.37) vs (0.96±0.34), P=0.063. Cho/Cr in bilateral cerebellar white matter was correlated with HAMD score in PSD patients (left: r=0.422, P=0.035; right: r=0.545, P=0.005). Conclusion Cho/Cr ratio increases in cerebellar in patients with depression after first left basal ganglia infarction.