KIRA STEIN, MD, APC

ADULT PSYCHIATRY - BOARD CERTIFIED ABPN


Vitamin B12

 

 

TO TREAT OR NOT TO TREAT: THE PROBLEM WITH VITAMIN B12 LEVELS

A large percent of patients who come in for an evaluation at West Coast Life Center here in Los Angeles, suffer from depression, fatigue, mental fog, andmemory problems, and often end up having either low or low-normal Vitamin B12 blood levels. Many doctors opt not to treat low-normal levels, but as integrative psychiatrists here at the West Coast Life Center, we usually find that the benefits of early treatment of vitamin B12 insufficiency outweighs the risks, and that early intervention with Vitamin B12 supplementation can dramatically turn around a person’s health and wellbeing. In fact, treatment with Vitamin B12 in someone complaining of depression often results in more rapid relief than with antidepressant medications alone.

WHY IS VITAMIN B12 SO IMPORTANT?

Vitamin B12 is a natural nutrient that is necessary and balances the body’s blood, genetic material (DNA), and nervous system. Vitamin B12 needs to be ingested in sufficient amount in order to stave off depression and other psychiatric and neurological problems.

2In healthy balanced diets, Vitamin B12 can be found in foods such as beef and chicken (especially liver), shellfish, mackerel and haddock, a various dairy products such as milk, yogurt and swiss cheese.

THE PROBLEM WITH INADEQUATE TREATMENT OF LOW VITAMIN B12 LEVELS

In the general medical world today, Vitamin B12 insufficiency is often left untreated despite psychiatric and cognitive warning signs that levels are getting dangerously low. Depression, cognitive decline, apathy, irritability, tremor, incoordination, angular chelitis (inflammation at the corners of the mouth), and delirium, are often the first signs of decreasing Vitamin B12 levels, even before they reach the currently designated threshold considered to be deficient by the general medical community. Problems with peripheral nerves, brain shrinkage (or “atrophy”), hallucinations, dementia, heart conditions and anemia are seen with more severe drops in Vitamin B12 levels, and these often can be avoided, too, if only the signs are heeded and taken seriously soon enough.

WHO IS AT RISK OF VITAMIN B12 DEFICIENCY?

Vegetarians, and especially vegans, as well as alcoholics who tend to have poorly balanced diets, and heavy coffee drinkers, are susceptible to Vitamin B12 deficiency. Others at risk for vitamin B12 deficiency are those who can’t absorb a normal diet rich in Vitamin B12, such as people who regularly take acid reducers or the diabetic medication metformin, or have weakened or inflamed stomach linings, or a history of gastric bypass, or who have an autoimmune problem in which the body’s immune system attacks intrinsic factor, the protein responsible for Vitamin B12 absorption. Furthermore, the elderly – particularly women – are at most risk of developing Vitamin B12 deficiency.

HOW TO TREAT LOW VITAMIN B12

Psychiatrists regularly see patients suffering from depression, mood and anxiety disorders, cognitive problems and irritability, and patients who have other risk factors for vitamin B12 deficiency, so Vitamin B12 levels may be requested. If patients are suffering from such symptoms and demonstrate a low Vitamin B12 level,  Vitamin B12 shots every 3-4 weeks may be recommended. If levels are normal, but on the low end, and symptoms are not severe, Vitamin B12 lozenges or melts may be recommended, since swallowed pills are rarely sufficiently absorbed. Levels may be rechecked after a few of months to help decide if more aggressive treatment is needed.

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