Hi, I am new to this and wondered if anyone could shed some light on my situation.
I am a 35 year old woman who for the last 4 years has been suffering with anxiety, this has generally been effectively treated by antidepresants. With only one episode after I abruptly come off them 2 years ago.
After going back on the AD, I had very gradually tapered down to next to nothing prior to christmas just gone. I have always been on the lowest dose of sertraline, 50mg but this still took me around 6 plus months to reduce.
It is worth mentioning that I had no previous mental health issues prior to the last 4 years.
After Christmas I began to have a bad period with the anxiety again, this resulted on me going back on the AD 50 MG a day. but this time I have not responded as well to them as I did before.
In Jan I asked my GP to test for b12 as there seemed to be no triggers for my recent dip in mental health. I was constantly tired and mentally foggy plus some other symptoms. My b12 came back as 157. I am not a vegetarian or vegan and eat meat and fish. My iron was low but in range at 119.
I began my loading doses in the beginning if feb and things got worse before they began to improve. But my anxiety just wasnt responding to the AD in the way that it had previously. Things have very slowly started to pick up and I am now able to get through a day without wishing for bed time the moment I open my eyes from a 10 hour sleep. Low mood is still present but the terrible anxiousness has subsided. I do feel sharper and less forgetful. Pins and needles also not happening.
They tested me for intrisic factor and apparently this is fine. So I dont have PA, but I do wonder why my levels have gotten low considering I eat well enough.
The GP has no plans to give me 3 monthly injections as I should now be able to maintain my levels.
Oh and just a side note, 2 years ago, following my last big bout of anxiety I had asked to be tested for b12 and iron as I had terrible memory loss and tiredness. I was was told I was in range but I recently found out that my result was actually 203. Since reading stuff on b12 I believe I should have been treated then. They didnt treat me for b12 but gave me iron tablets which in fairness seemed to help?
So I guess my questions are....
Is there anyone out there experiencing similar things to me. Could my anxiety be down to the deficency. I so wish I could find an answer to this?
After 5 weeks how should I be feeling?
Also why would I be deficient if its not PA. I have not had any stomach operations and I dont have celiacs or anything like that.
How strong is the ling between anxiety and b12 deficency?
Through reading some stuff on here you guys seem so knowledgeable about this, I dont really think my GP knows much about this and it leaves me feeling like I have no idea what im talking about when I try to make sense of it with her. Sorry for the long post.
Thank you in advance for taking the time to reply and help me.
Cheers
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Louloubalou
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The first thing to mention is the fact that you apparently tested negative for Intrinsic Factor Antibodies . This test is notoriously unreliable if you test negative ( not if you test positive ) , and your doctor should know this . Your B12 reading is low , and you have 2 symptoms of B12 deficiency namely the extreme tiredness , even after a long sleep, and the anxiety .Have you any other symptoms ?
a) as Wedgewood says - IFA isn't a very sensitive test and gives false positives 40-60% of the time depending on the exact test method. This means that a negative is a long way from showing that you don't have PA.
The BCSH guidelines on diagnosis and treatment of folate and cobalamin disorders refers to IFAB negative PA because the test is so insensitive.
b) unless the cause is dietary or treatable (eg h pylori infection) injections should be for life. These should be every 2-3 months - or every 2 months if you had neurological symptoms (the pins and needles)
You can refer your GP to these guidelines which they can access through the BNF
c) it sounds as if you may have had both iron and B12 deficiency - which would suggest an absorption problem - and PA is the most common. PA is an auto-immune disorder in which the body attacks the mechanisms in the gut that allow you to absorb B12. This can also affect absorption of other vitamins and minerals, most commonly iron and folate.
if you have any gastric issues such as heart burn this would also suggest PA as part of the problem - the symptoms of low stomach acidity are basically the same as those of high stomach acidity.
d) I had 30+ years of anxiety and depression before I found out I had a B12 absorption problems. Both got worse after I started treatment with B12 shots. This was largely because I was not getting the treatment I really need which is much more aggressive than the treatment used in the UK. Once I did manage to get my B12 levels to where I need them to be both the depression and the anxiety went - not saying that there aren't situations where I will get anxious and feel down - just that they aren't a constant state anymore.
Yes, anxiety can be caused by a B12 deficiency. And just five weeks may not be enough to remedy it. You need regular injections - every two months, let alone every three months.
low total serum cobalamin level may be further evaluated by testing for anti-IFAB. If positive, the test has a high positive predictive value (95%) for the presence of pernicious anaemia (Toh et al, 1997), with a concurrent low false positive rate (1–2%) i.e. a high specificity. It identifies those patients with a need for lifelong cobalamin replacement therapy. IFAB is positive in 40–60% of cases (Ungar et al, 1967), i.e., low sensitivity, and the finding of a negative IFAB assay does not therefore rule out pernicious anaemia (hereafter referred to as AbNegPA
Post a copy, with a covering letter, saying that you believe you require treatment according to the BNF.
absolutely anxiety can be linked to B12 deficiency as it was in my case....and it got worse on my loading doses, so be prepared. You need more regular injections. the best of luck on your healing journey. j in Ireland.
Thank you all for your responses. It is comforting to know that there are people out there who actually know what is going on, can offer info and have their own experiences with all of this. This has helped no end. Thank you all so much. X
It can feel like a lonely place when those around you dont understand what is happening with you.
My Dr looked at me stupud when I said I think the anxiety maybe linked. It made me feel at a loss all over again.
Anyway am back up the GP's on friday and will be armed with a little more info and insight this time.
Wedgewood my symptoms were as follows
Triedness.
Headaches.
Short term memory loss, forgetting what I had for breakfast.
Foggy.
Anxiety.
Low mood, just cant be bothered.
Back pain that started around 2 years ago-only when im sleeping.
Dry skin.
Weak and splitting nails.
Feeling jittery.
Dizzy.
Very occasional numbness in my right thigh.
When on the loading doses some of these became more pronounced and I noticed I was a little off balance at times, something that I dont think was there before hand.
To be fair I didnt report all the symptoms to the GP as I some of these things ive had for so long I just assumed it was normal and just because I was getting older and maybe that is the case with some of these things. Like the headache, bad back.
Thanks..... any more advice, info and anything in between will be welcome.
Hi, good to get the advice on this group isn’t it. I too have a similar experience. Currently on same dose as you of sertraline and tried to come off over time but felt so low I went back on not sure I have felt back to where I was before after 3 months of reintroduction . I am also on HRT as I thought symptoms were peri menopause. I have also just had normal bloods report so too wondering if I don’t actually have PA. argh it is difficult. I had last loading dose of b12 yesterday and awaiting improvement. Apart from the b12 I now have no idea whether I need the HRT or Sertraline at all now. As I kind of feel a bit better I want to keep them all as worried about tipping the balance but don’t want to stay on anything I don’t need! Feeling very confused
I can relate to this, I feel confused and bewildered by all of what is going on.. feels like my body has not been my own for a long time.. if that makes sense.
Yes those other symptoms you mention are all B12 deficiency/ Pernicious Anaemia symptoms . When you start treatment , it’s quite common to get worse before you get better . There are no end of symptoms for. B12 deficiency, but exhaustion , brain fog , short -term memory problems , dizzyness ,anxiety are common to most patients . I had awful foot numbness .as well . You can read all about the other possible symptoms by consulting Mr.Google . But you don’t get them all -just a nice selection of 5 or 6!
B12 is needed to form the myelin sheath around our nerves . Deficiency depletes that sheath , resulting in a myriad of symptoms . You need plenty of folate / folic acid to act with the B12 . I take a 400 mcg tablet daily , and also eat folate -rich vegs and fruit .
After loading doses ( 6 over 2 weeks ) you need injections as often as required to keep symptoms at bay . This will vary from person to person , but the doctors do not acknowledge this . But under the new advice you should at least get an injection every 2 months . If this proves inadequate , it will be difficult to get more . It was for me , and that’s when I turned to self-injection . But I hope you get the treatment you need and deserve . If you don’t , come back here for further advice . Best wishes .
There are some great responses on here with some good info, so I'll keep mine short. Yes, B12 and anxiety are linked. And no, sadly, most GPs don't know this.
Welcome to this lovely site - there are lots of people who are knowledgeable and helpful.
I did have vit d checked as well as a whole host of other stuff... apparently all normal.. but I guess I learned the hard way that 'within range' should be questioned.
My advice is to always get the print out of your blood tests and check them yourself. You don’t have to be an expert as the results flag themselves and give the ranges. This way if your also close to a boundary you can look into it in more detail. Effectively I have had a b12 deficiency that could have been picked up circa 15 years ago when I was 16 but always told my levels were normal.
Get your paper work from your tests and check yourself and also good for your own records.
I specifically mentioned vitamin d as it is pretty common for people to be deficient (part of the world depending) and can cause anxiety etc. Are you in the UK? If so by Dec/Jan time your body would have been using up your stores of vit d as you wouldn’t have been producing vit d from the sun since October. Worth double checking and supplementing in case as cheap and readily available. However don’t let any of this distract you from your issues with b12 but everything can play a part and layer up.
For me it started in October last year as unexplained sudden anxiety amongst other symptoms. In other words it would just wash over me even if I wasn't thinking about anything negative.
It got better after 6 loading doses but 3 weeks later it came back. GP wouldn't give any more so I paid a private GP for another 10 alternate day injections and after those it got much better. It's now over a month later and unexplained anxiety hasnt been back. That's 3 months in total after B12 treatment started. My level was 145.
I was diagnosed as B12 deficient 2 years ago after going to see the doctor believing i was in early stage of dementia ..... I had terrible short term memory and was constantly tired.
This tiredness and short term memory caused me a lot of anxiety and it was also stressing my wife out.
I had a blood test and my B12 level was only 80 ..... this was way to low.
Since then I have been on B12 injections every 12 week, reduced to every 10 weeks back in October.
i have since found out from the PA website that NICE have recommended injections should be given every 2-3 months.
I am fighting hard to get injections every 8 weeks but at present this is being blocked by my doctors.
Bottom line is .... from day of injection I feel fine for about 6 weeks, then start to feel more tired until week 8 when I basically run out of steam and I cannot function properly both physically and mentally.
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