Dosage (therapeutic): By injection: from 1000 mcg every few days up to 10,000 to 25,000 mcg/day.
Oral (including sublingual) and nasal gel: probably 500-25,000 mcg/day. Sublingual and (especially)
nasal gel products may rival B12 shots in their ability to increase blood levels. Studies like that
of Mayer et al. suggest the cyanocobalamin form of B12 typically used in supplements isn't as
clinically effective as methylcobalamin.
Cost: moderate.
Side effects, cautions, contraindications: Evidently none.
Some of the most florid psychoses in the medical literature - typically involving elderly people
gone paranoid, manic, or violent - testify to the perils of unrecognized vitamin B12 deficiency. And
that's only during the early stages. When the cause is the B12 malabsorption disease called
pernicious anemia, as the years go by and B12 levels dwindle to nothing, irreversible nerve and
brain damage and dementia insidiously ensue. This can also occur in strict vegetarians (vegans) if
they fail to obtain B12 from fortified plant foods, like meat and milk substitutes, or supplements.
A less dramatic, but more common symptom of early B12 deficiency is depression, typically of the
listless, mentally foggy kind. In the 1950s, one such woman had so convincing a case of endogenous
depression that shock therapy was vainly administered. Four years later, her slow-onset B12
deficiency was finally diagnosed. A few days and a few shots of B12 later, "she showed a dramatic
clinical improvement and came to life again," her doctor T. N. Fraser reported. Another couple of
months, and "she looked the picture of health."
Because pernicious anemia is a highly age-related disease, most doctors today are alert for it in
elderly patients with neuropsychiatric symptoms. But studies suggest any depressed person has a 10
to 30 percent chance of being B12-shy, usually without pernicious anemia as the cause. That
deficiency, according to Cees van Tiggelen et al., "has profound effects on several neurotransmitter
systems and results in significantly reduced norepinephrine levels in the brain." Norepinephrine is
one of the brain's most important good-mood neurotransmitters.
Logically, all depressives with low B12 should be replenished. In practice, many orthomolecular
psychiatrists believe any depressive should take extra B12, even to the point of trying B12 shots
(injections).
For years, B12 shots have been an unofficial treatment for fatigued, run down, or depressed
patients. (Large oral doses are very poorly absorbed, though sublingual and intranasal B12
formulations appear to give injections a run for their money.) The practice has been the butt (pun
intended) of many jokes among skeptics. Yet what research there is has supported it.
In 1973, in a double-blind trial by F. R. Ellis and S. Nasser, B12 shots boosted the energy and
lifted the moods of chronically fatigued patients significantly more than shots of water. Sixteen
years later, in a less formal single-blind study, orthomolecular psychiatrist Herbert Newbold
reported that his B12-responsive patients "invariably" were able to tell whether they had received
B12 or an injection of water. Newbold also noted that B12 is not a simple stimulant, but a
"normalizer" that helps some of his patients sleep better and even made one less manic. (Mania is a
symptom of B12 deficiency.)
Newbold's suggestion that B12 is a mood stabilizer is echoed by recent research in which oral
megadoses of methylcobalamin - the most bioactive form of B12 - has shown promise as a regulator of
disturbed sleep-wake rhythms. Methylcobalamin has been particularly well-studied in Japan as a
treatment for delayed sleep phase syndrome; that is, not being able to fall asleep until very late
at night and needing to sleep in every morning. Because sleep-wake disturbances are part and parcel
of most mood disorders, B12's apparent sleep-wake regulatory effect could help account for its mood-
stabilizing benefits. In a 1996 study by G. Mayer et al., three grams a day of methylcobalamin, but
not cyanocobalamin (the form of B12 in most supplements), managed to decrease sleep time yet improve
sleep quality and daytime alertness in a small group of healthy men and women.
There is an intriguing reason why some people with normal blood levels of B12 may need megadoses of
the vitamin. They may have a B12 deficiency that is confined to the brain.
While most doctors would never consider such a possibility, studies have documented local cerebral
deficiencies of B12 (using cerebrospinal fluid levels as a measure) in people with Alzheimer's
disease, postpartum depression, and toxic neuropsychiatric disorders, including toxic depression.
Cees van Tiggelen and associates suspect this cryptic condition may also commonly afflict people
with histories of nitrous oxide or Agent Orange intoxication, alcoholics (including those with alcohol-
related dementia), long-term users of dilantin, and people with brain atrophy.
B12 has its mainstream advocates too. In 1975, psychiatrists K. Geagea and Jambur Ananth, then at
McGill University, remarked that "astonishing results can be obtained in some cases with B12
therapy, even if B12 levels are within normal range." They had just described one such case. Their
young patient's two year depression had landed him in Montreal's Jewish General Hospital after a
suicide attempt. Because the man had had a total gastrectomy nine years earlier - a risk factor for
B12 deficiency - and because his treatment-resistant symptoms had become progressively more
psychotic and neurologic in quality, Geagea and Ananth took a leap of faith. The man's B12 levels
were normal, but they gave him B12 shots anyway.
"The response to this therapeutic trial," they wrote, "was dramatic. The patient was discharged
eight days later with complete remission." He was still well three years later.
In 1999, in their book Stop Depression Now, Columbia University psychiatrist Richard Brown and
Baylor University neuropharmacologist Teodoro Bottiglieri (a leader in vitamin/depression research)
recommend that all psychiatric patients take a daily megadose of 1 mg of oral B12. In The Way Up
From Down, UCLA psychiatrist Priscilla Slagle suggests: "If you are over fifty-five, vegetarian or
alcoholic, have extreme fatigue, poor memory, low thyroid or weight loss, I recommend you take 1000
to 2000 mcg of the sublingual form [of B12] every morning."
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A B12-supplement-chewing vegan, Syd Baumel is a writer and Editor of The Aquarian in Winnipeg,
Canada. Home_|_Dealing with Depression Naturally
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While every vitamin likely contributes to mood stability, some vitamins seem to contribute more than
others - even to play a medicinal role as natural antidepressants. Take vitamin B12 (please! if
you're a vegan). Depression and Stress linked to deficiency in B12 Vitamins
The natural institute of mental health recently confirmed depression, fatigue, anxiety and mood
swings can be traced to low levels of B vitamins, including vitamin B12, B6 and folic acid. Over
twenty million North Americans suffer from depression. Compounding the problems associated with
depression include difficult, even devastating side effects from prescriptive anti-anxiety drugs.
Can B12 vitamins really offer you relief from depression, stress and fatigue? Due to extensive
testimony, we believe B12 vitamin supplements can and do offer significant relief. Known benefits of
Vitamin B12 include: relief from depression increase energy aid in stress relief reduce risk of
heart disease, stroke and Alzheimer's, support a restful sleep NUTRITION ALERT ARTICLE:
B12 and Depression
For more information, read Food & Mood.
Researchers at the National Institute on Aging in Bethesda investigated the link between vitamin B12
deficiency and depression in 700 women 65-years-old and older. Blood levels of vitamin B12 were
measured and compared to depressive symptoms obtained from the Geriatric Depression Scale. Results
showed that women with depression, especially severe depression, had significantly low blood vitamin
B12 levels. Women with low vitamin B12 levels were more than twice as likely to develop depression
as women with normal vitamin B12 status. In a case study, vitamin B12 deficiency was linked to
psychosis in a woman. The condition responded favorably to vitamin B12 injections. Bibliography:
American Journal of Psychiatry 2000;157:660-661/ 715-721. Annual Reviews in Medicine 2000;51:357-
375. Subject: b12 and depression/anxiety Date: November 16, 2002 at 7:48 pm PST
I wanted to share this as it has certainly helped me! Low b12 has been linked to
depression,anxiety and other nuero issues, even dementia! You can have low b12 for various
reasons, ie diet, other disorders, asoprtion etc. I am lacto-ova veg and even tho i eat fortified
foods my b12 was very very low.
You can get your b12 checked with a simple blood test at the Dr, and ask what your level is. Not
every GP is aware of the b12 issue so they may think a lower level is no biggie. I disagree. If your
level is below 400 it seems to be a concern. You can read more here: