Pernicious Anaemia Society
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Depressed without B12 being too low?

Hi, I'm a 19 year old girl who has been suffering from anxiety for 8 months, and the last weeks also from depression.

I have a life with a good boyfriend and friends so it doens't make sense.

In July my B12 was 150, and my GP didn't do anything about it, but last month it was 210, which is in the normal rate. (I didn't take any supplements before the test). Should I ask my GP give me injections nevertheless?

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Do you have any other symptoms?

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Yes, so anxiety/depression/suicidal thoughts/pins and needles/LOTS of hair loss/saying one word When I meant to say another/racing heartbeat at random times/really tired/problems with my tongue and in my mouth/dizzyness/headache/I lost 8 kilo's in the last 8 months,..

That's about it I think.


Hi Laura221 I'm somewhat surprised that your doctor having tested your B12 twice within six months hasn't picked up that you are "bumping along the bottom" and not done anything about it given that you have told him/her about your symptoms.

Do you have any idea why you may be B12 deficient? Did your doctor check your Folate or vitamin D levels?

Anyone at any age, can become B12 deficient. However, certain people are at an elevated risk. They include the following:

Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

Do you see yourself as one of the above "people"?

I am not a medically qualified person but there are others on here who will be able to give you good advice.


Absolutely. Low is low.

Here in the USA, some labs add a caveat to blood test results when under 400 pg/ml that 10% of the population exhibits neurological symptoms. This is called an occult (or hidden) deficiency.

The anxiety and depression are psychological symptoms that are caused by the neurological damage.

The mind is trying to function on a damaged brain and having a tough time of it.

Start a logbook of all your symptoms and start to gather data that your GP will need to help justify frequent injections. Assess a daily score for each symptom. Anxiety and depression are symptoms as well.

You may also need folic acid so ask for your folate to be tested. Get the B12 sorted first and then the folic acid.


I'd suggest contacting the PAS (Pernicious Anaemia Society) soon.


PAS tel no +44 (0)1656 769 717

Office open 8am till 2pm every day except Sundays.

Stories on young people with PA/B12 deficiency on Martyn Hooper's blog plus recent post about mental health issues and B12 deficiency.

It's possible to have severe B12 deficiency with a b12 result that is within normal range. untreated or inadequately treated B12 deficiency cna lead to permanent neurological damage.

Other b12 deficiency information

1) B12 deficiency info website


3) Pinned posts on this forum

4) book "What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

5) Book "Could it Be B12" by Sally Pacholok and JJ. Stuart

6) BMJ b12 article

7) BSH Cobalamin and Folate Guidelines

Uk b12 document that has recommendations for diagnosis and treatment of B12 deficiency and folate deficiency click on box that says "Diagnosis of B12 and Folate Deficiency" shoudl be on page 3 of listed guidelines.

This flowchart below is from BSH Cobalamin guidelines. Makes it clear that people who are symptomatic for b12 deficiency should be treated and that they should have an IFA(intrinsic factor antibody) test.

I am not a medic just a person who has struggled to get a diagnosis.

Do you have someone supportive to take with you to appts? sadly there is sometimes a lack of knowledge about B12 deficiency amongst some Gps.

Do you get copie sof all blood tesst eg B12, folate, ferritin, full blood count?

have you had tests for thyroid disease? Coeliac disease?

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Hi everyone. I don't have anemia or something, but Some months ago I have been taking Some meds against stomach acid. My symptoms are: depression/anxiety, loss of a LOT of hair, lightheadness out of nowhere, always a racing heart, I've lost 8 kilos in the last 8 months (so I'm just not underweight at the moment), I'm very irritable..

I'm aware that these can also be symptoms of depression, but I'm seeing a counselor since 8 months and that hasn't helped much. I took Escitalopram (and anti-depressant) yesterday, but I had to stop it after 1 day because it made me feel much worse..


The meds you are taking for the stomach acid are called PPI's and known to reduce the uptake of B12 in the stomach - also other vitamins. They are designed to be a short course of 8 weeks or less in certain circumstances. I would think you have LOW acid - symptoms are similar. There are natural ways of soothing the stomach .... hope you soon have some answers and the treatment you deserve :-)

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Yes insist on injections. Print out the guidelines listed in posts below and take to gp with relevant sections highlighted. Take a list of symptoms. Insist he/ she gives you the B12 injections! The depression and anxiety could be caused by low B12. The stomach medications could be a cause of low B12 but that may have just unmasked a looming deficiency that was there anyway.


Likely that you have an absorption problem.

Have you been tested to ensure that the symptoms that you have really are high stomach acidity and not low stomach acidity? - the symptoms are pretty much the same.

You mentioned that the escitalopram made things worse - may be worth asking and looking at your folate levels - its an SSRI and can have a negative impact on folate levels for some people. You need folate to be able to absorb and use B12.

Your B12 levels are, as others say - on the low side - the serum B12 test is highly problematic and the normal range will result in about 25% of people who are deficient being missed - which is why it needs to be evaluated in a context that includes other symptoms - macrocytosis (larger rounder red blood cells) is one of these symptoms but it isn't a defining characteristic and 30% of people with deficiency present with neurological and other symptoms long before they present with haematological symptoms. Your GP is unlikely to be aware of these facts.


Thank you all very much for your answers! I'll contact my GP. My folate is fine, it's even quite high, it's just my B12..


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