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Neuropsychiatric symptoms of B12 deficiency:

Not just in the elderly and often without anaemia Vitamin B12 is an essential nutrient, needed for the function of many systems in the body. As a result of a B12 deficiency haematological, neurological, gastro-intestinal and psychiatric problems can develop.

The psychiatric symptoms can precede the other symptoms, among which the well known anaemia, in some cases even with years. These psychiatric symptoms include: irritability, mood changes, depression, disorientation, confusion, memory problems, concentration problems, sleep disorders, hallucinations, paranoia and apathy. Psychiatric disorders that are diagnosed in B12 deficient patients are, among others: dementia, depression, delirium, bipolar disorder, panic disorder, psychosis and phobias.
The fact that many symptoms can precede the development of anaemia, and even cause permanent damage before anaemia develops, has been known for over a century, attested by many scientific articles.
A summary of some of those articles:

Stichting Tekort

Testing B12 during treatment

During treatment with vitamin B12 injections, serum B12 is often tested to ascertain the frequency of injections, to see if the value rises, or to base maintenance treatment on.

However, this value says nothing about the effect of the treatment. The patient's symptoms should be the only guideline for basing treatment. After a loading dose of 10 injections in 5 to 10 weeks, a maintenance dose can be determined based on the symptoms. 

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Everything you need to know about vitamin B-12

Last updated Tue 28 November 2017 By Christian Nordqvist. Reviewed by Alan Carter, PharmD
  1. What is vitamin B-12?
  2. Foods
  3. Benefits
  4. Deficiency symptoms
  5. Supplements
  6. Side effects
Vitamin B-12 is a crucial B vitamin. It is needed for nerve tissue health, brain function, and the production of red blood cells. Cobalamin is another name for vitamin B-12.

Deficiency can result when levels of vitamin B-12 are too low. This can lead to irreversible neurological symptoms. In the United States (U.S.), between 1.5 and 15 percent of the population are currently diagnosed with vitamin B-12 deficiency.

This article will explore the functions of vitamin B-12, how a person would know they are not consuming enough vitamin B-12, and where to source more.


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B12 og migrene

LAST NED Migrene.pdf

Vitamin B12 deficiency
The right clinical information, right where it's needed.

  • Classically presents with megaloblastic anemia, but can also present with peripheral neuropathy and neuropsychiatric complaints.

  • ◊ Older people, patients with chronic malabsorption, patients with a history of gastric resection or bypass, and those taking certain medications (metformin, proton-pump inhibitors) are at risk.

  • ◊ Early diagnosis is critical in preventing and halting the progression of neurologic disorders such as peripheral neuropathy and dementia.

  • ◊ Methylmalonic acid and homocysteine levels may help to diagnose vitamin B12 deficiencyatan early, asymptomatic state.

  • ◊ Cause of vitamin B12 deficiency should be searched for on ceadiagnosis is  confirmed.

  • ◊ Treatment with high-dose or a vitamin B12 therapy may be as effective as intramuscular vitamin B12 therapy.

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Läkartidningen.

Vitamin B12/B9 - möjlig behandling vid mental trötthet 

Redan 1973 visade en placebokontrollerad studie att patienter med oförklarad trötthet blev signifikant bättre när 5 mg hydroxokobalamin (vitamin B12) injicerades intramuskulärt två gånger i veckan [1]. I dag skulle de troligen få diagnos myalgisk encefalomyelit (ME), men då fanns inga definierade kriterier. En liknande kontrollerad studie vid ME har ännu inte blivit möjlig, emedan anlitad farmakologisk expertis inte kunnat finna något i dag godkänt placebopreparat som är rödfärgat och ger rödfärgad urin

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og her


Guidelines for the diagnosis and treatment of cobalamin and folate disorders

Vinod Devalia Malcolm S. Hamilton Anne M. Molloy on behalf ofthe British Committee for Standards in Haematology

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Vitamin B12 deficiency: what is it and what are the symptoms?

Our bodies are remarkably adept at absorbing, storing and using vitamins and minerals. But sometimes our diet and lifestyle can make it more difficult to get enough of certain nutrients - which is where deficiency comes in.

https://www.telegraph.co.uk/health-fitness/body/vitamin-b12-symptoms-deficiency/