Injection advice?

Hi, total newbie here. Had a B12 deficiency 2 years ago and was given B12 and folic tablets for a year after which I was told I was fine and to stop the tablets. I've been getting treatment for depression for 20 years and the psychiatrist asked for blood tests, and it turns out my folate is again nil and my B12 apparently never recovered even after the tablets.

I've to attend nurse tomorrow for my first injection, but my query is regarding the treatment. My doc has prescribed 1000mcg/1ml one every week for four weeks then every three months. From the reading I've been doing it seems it should be every two days until things stop improving. Should I query this or just trust the doc?

I'm also going to ask for copies of my blood results to try and understand more about what's going on.

11 Replies

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  • Hi ajw1205 If you are in the UK the NICE guidelines are as follows:

    Click on the link, then on "Scenario: Management" and scroll down to "Treatment for B12 deficiency"

    google.co.uk/url?sa=t&rct=j...

    The important paragraph reads

    "Initially administer hydroxocobalamin 1 mg intramuscularly on alternate days until there is no further improvement, then administer hydroxocobalamin 1 mg intramuscularly every 2 months."

    You will also need to supplement with folic acid but leave this for a day or so after your first B12 injection. Your doctor may again prescribe this.

    You might also ask your doctor whether he/she thinks that the antidepressants you are taking may have had an adverse affect on your B12 level.

    Do you have any ideas why you are deficient in both B12 and Folate? What is your diet like?

  • Thanks for getting back so fast Clive. My diet is typical I think (although I'm overweight and eat too many crisps!), eat meat, veggies, rice, pasta, sandwiches, oat bars.

    I have no idea why I should be lacking in either B12 or Folate. I hadn't thought about the anti depressants having an effect on them. On checking the list of symptoms I feel they fit what I'm going through - depression, anxiety, fatigue, days of forgetfulness/dopiness, burning feet + legs, tinnitus, wobbly if I stand too fast, deep gasps for air sometimes. Those are the ones I remember right now, lol

  • Hi ajw, a day or two ago I read something about antidepressants potentially depleting folate. In retrospect, that makes complete sense now because at one point several years ago my psych. had to add a drug called Deplin to boost the effects of my SSRI. On recent investigation, I found out that Deplin is actually L-methylfolate (the active form of folate) Interesting to say the least.

  • That was just a sideline thought, all of the symptoms that you describe above were included in my symptoms before autoimmune gastritis/pernicious anemia was diagnosed in my case.

    I hope that you can get on a helpful schedule of B12 shots and that they are able to determine the cause of your B12 deficiency.

  • Hi there. My psych is considering T3 treatment to boost my anti-d's (currently on Sertraline). I'm just hoping B12 treatment will alleviate the depression :)

  • I hope that it will work for you as well. Is your GP planning to investigate the reason for your B12 and folate deficiencies? With B12 deficiency and Pernicious anemia, as I'm sure you've gathered, it's an uphill battle and we somehow have to advocate for ourselves.

    The best advice that I can give is as you plan to do, request all of your results. (Keep copies in a file at home to refer to or bring to whatever specialist/s your GP may refer you to).

    When you have results in hand, post a new message with your results and the ranges and a support member or admin should be able to help you out. Also keep a log of your symptoms before beginning B12 injections and during to document if and when your symptoms start to subside. Include everything- the memory issues, shortness of breath, dizziness etc.

    I wish you the best!

  • I noticed the proposed T3 treatment. Do you have a thyroid problem ? If so I am wondering if you have been tested and have some results with ranges. Low thyroid is so closely linked to low B12. I have Hashimotos and a B12 issue - happy to help 😊

  • Hi. My psychiatrist has suggested T3 augmentation therapy which apparently can increase the effects of anti-depressants. I think because I've been on various tablets over 20 years he thinks my body is resisting them. I'm hoping that the B12 will negate the need, but it will take time. I see him again at the end of this month.

    The only thyroid results I have are -

    TSH 1.50 mu/l (0.35-5.00)

    Free T4 10.5 pmol/l (9.0-21.0)

  • So your thyroid is not producing enough T4 and yet your TSH is also LOW. Was it a fasting test early in the morning. As your T4 is low then it follows that the conversion to T3 will also be Low. This is suggesting CENTRAL rather than PRIMARY hypothyroidism. Did you have tests for thyroid anti-bodies - Anti TPO & Anti -Tg ? Hashimotos is the most common thyroid condition in the world so needs to be eliminated.

    Have you caught up with Kelly Brogan - her website and her book - A Mind of My Own ?

  • It's marked as a non-fasting test, but I really don't remember when it was. That's all the figures given under the Thyroid function test section of my results. Thyroid's never even been mentioned by my GP, so guess that's another thing to learn about. I'll check out that blog, thanks.

  • So, first injection was pain free :) Seems to be the Practice's practice to prescribe injections once a week for four weeks then every three months, so back next week for my second.

    Got my blood results showing abnormalities in B12 at 182, Folate at 2.3, Est GFR at 55, Haematocrit at 0.475. Everything else is Satisfactory, including Ferritin, Thyroid and Blood Glucose. Does that all sound familiar?

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