B12 deficiency: Eight ‘sudden’ mood changes that can signal ‘markedly’ low B12 levels

Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency

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Vitamin B12 helps to keep the body ticking over smoothly. It helps to make red blood cells, keeps the nervous system healthy and supports normal psychological function. A case study published in the Primary Care Companion to the Journal of Clinical Psychiatry hints at what happens when the latter is undermined.

It documents a case of a woman experiencing full manic syndrome, with B12 deficiency as the probable cause.

According to mental health charity Mind, mania is characterised by periods of over-active and excited behaviour that significantly impacts your ability to do your usual day-to-day activities.

The case study documents a 35-year-old woman with no personal or family history of psychiatric disorders, who was admitted to the hospital in February of 2005 with a three-week history of episodes of manic symptoms of several hours’ duration.

The symptoms included:

  • Grandiosity
  • Hyperactivity
  • Sexual indiscretion
  • Excessive appetite
  • Irritable mood
  • Reckless behaviour
  • Flight of ideas
  • Overbearing manner.

“These episodes had a sudden onset and conclusion, and the patient was able to remember them. No hallucinations were reported at any time,” the case report states.

It continues: “At admission, she was oriented in all spheres, but was easily distractible.

“All these psychiatric symptoms disappeared after one hour, without any medical intervention.”

According to the report, serum vitamin B12 level was measured and was found to be “markedly diminished”.

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“After the third day of B12 replacement therapy, our patient did not experience new manic episodes,” it states.

“Within one month, neurologic symptoms had improved. One year after B12 vitamin replacement started, her mental status was still normal.”

The case study concludes: “The absence of previous psychiatric or medical disorders, coupled with her continued clinical remission while she was receiving B12 alone, argues that B12 deficiency was the most likely cause of her psychiatric disorder.”

General symptoms of B12 deficiency include:

  • Fatigue/exhaustion
  • Muscle weakness
  • Vision problems
  • Pins and needles
  • Sore tongue or mouth ulcers
  • Issues with memory.

How to top up B12

The richest sources of B12 are animal-based, including:

  • meat and liver
  • fish
  • clams
  • Milk and dairy products
  • Eggs.

Plant-based sources of vitamin B12 include yeast extract, fortified plant milks and fortified breakfast cereals.

According to Holland and Barrett, the synthetic (man-made) version of B12 is called cyanocobalamin, which you may see in supplements.

B12 deficiency – how to treat chronically low levels

The treatment for vitamin B12 or folate deficiency anaemia depends on what’s causing the condition.

Most people can be easily treated with injections or tablets to replace the missing vitamins.

Vitamin B12 deficiency anaemia (low red blood cell count) is usually treated with injections of vitamin B12, explains the NHS.

There are two types of vitamin B12 injections:

  • Hydroxocobalamin
  • Cyanocobalamin.

“Hydroxocobalamin is usually the recommended option as it stays in the body for longer,” adds the NHS.

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