How to manage severe symptoms of B12 deficiency?

[Hamayeshguy]

My psychiatrist prescribed me mirtazapine 30 mg half every night and resperidone 1 mg. But since I take painkillers I didn't take resperidone because it's SSRIs ( selective serotonin reuptake inhibitor) and it has severe interaction with NSIAD painkillers like naproxen and ibuprofen and causes gut bleeding in 75 % of people and lead to bigger problems. And mirtazapine also causes constipation and dry mouth and since I take iron pills it causes severe constipation. Already deficiency caused umbilical hernia and I have to be careful. Dies anyone taking any mental supportive medication which doesn't have much side affects like withdrawal effects. As resperidone and mirtazapine have severe withdrawal side effects. Is there any mental support medication for B12 deficiency and pa with extensive neuropathy? It takes long time symptoms get improved and it needs to have good mental support medication. Any comments?

[Gambit62 Administrator]

I'm not sure where you get the figure of 75% from for gut bleeding where using both NSAIDs and SSRIsThis study - admittedly small numbers and quite old (2003) does show that the combination of NSAIDs and SSRIs increased the use of drugs used to treat peptic ulcers but here the figures are still less than 75% and that is the use of the drugs which is somewhat different from saying that people did actually have peptic ulcers or gastric bleeding - just that they had gastric symptoms

ncbi.nlm.nih.gov/pmc/articl...

This somewhat later literature review also highlights the risk (probability of developing internal bleeding). Please note that increasing probability is different from saying that the combination causes internal bleeding - though it is a good reason for avoiding the combination.

pubmed.ncbi.nlm.nih.gov/247...

SSRIs are generally preferred for treatment of anxiety and depression as the incidence of side effect tends to be lower, though bleeding in the gut when combined with antidepressants is statistically more likely than when using other types of anti-depressants.

I'm not a medic and this forum is not intended to be a substitute for professional medical advice. In this instance I would suggest that you discuss your medications with a pharmacist, who is likely to be in a better position to advise on interactions and suitable alternatives. It may be that occasional use of NSAIDs may not be a significant issue but they may also be able to recommend alternative drugs to the NSAIDs you are using that aren't associated with the risk factors, ie it may be better to look at alternatives for treating symptoms that you are currently using NSAIDs for and this may be a better route to go down given that there tend to be higher rates of side effects that patients struggle to tolerate on non-RI antidepressants.

To be honest the use of NSAIDs generally isn't recommended in patients with PA anyway but...

[Gen89 in reply to Gambit62]

Can I ask you why use of naproxen isn’t advised with PA?

[Hamayeshguy in reply to Gen89]

I don't know the exact mechanism but there are sources claim NSAIDs and SSRIs together cause gut bleeding.

[Gen89 in reply to Hamayeshguy]

Ok thanks. But I was wondering why naproxen isn’t recommended if you have PA ?

[Gambit62 Administrator in reply to Gen89]

Gen89 - just a reminder to include the person you are addressing if you aren't responding to the poster - just makes it easier for the poster to follow.

Naproxen is a drug that they are very careful about checking if you have stomach issues.

I don't think it's naproxen specifically - more NSAIDs in general and probably to do with potential effects on the gut given that there are already auto-immune responses going on in the gut. To be honest I'm on a course of naproxen at the moment for a knee issue ... and in the past when I was given it for a trapped nerve in the back I found it acted as a really good preventative for migraine but.

[Gen89 in reply to Gambit62]

Ok thanks for the info.

[Hamayeshguy]

Is that true Pregabalin which is seizure medication prescribed for neuropathy pain relief?

[Gambit62 Administrator in reply to Hamayeshguy]

yes, pregabalin can be prescribed for neurological oroblems. Many medications have multiple uses

[Polaris]

Hi Hamayeshguy. Having provided our close relative's doctors and psychiatrists with clear research evidence on the neurological/psychiatric effects of extreme B12 deficiency, our family still met with a brick wall, with drugs continued to be prescribed instead of extra parenteral vitamin B12.......

Although recommended principally for women, I'd recommend highly qualified and knowledgeable psychiatrist, Dr Kelly Brogan's, book, "A Mind of your Own", the only psychiatrist I've personally come across who has researched B12 and knows the effect that thyroid disease and extreme B12 deficiency has on the brain and psyche: schizophrenia, hallucinations, paranoia, wanting to be alone, etc.

Having discovered that conventional psychiatric drugs only made matters worse, Dr Kelly only treats patients who will follow strict dietary advice, nutritional and lifestyle support, "to heal their bodies and feel like themselves".

Best wishes for better health soon.

[th3joker]

I’ve been using St Johns Wort for years and found it far, far more effective than SSRI’s. Mirtazapine made me fat as did Amitryptiline and pregabalin. Gabapentin was ok. Just make sure to use suncream as St Johns Wort tends to make me sensitive to UV.

[USmedsyssucks]

To be completely honest, my typical approach is to avoid trying to cover up symptoms and instead focus on finding/treating the primary issue. With mental health in the mix, that can be tricky, and there are certainly circumstances when symptomatic relief may be necessary, even as you work on the underlying B12 issue. So please don't think I'm telling you not to seek help if you need it - your welfare should be your top priority.

That being said, in over 11 years of chronic illness, I've been prescribed too many medications to count yet only found one that has proven mildly beneficial with somewhat tolerable side effects if taken very sparingly. I don't currently know of any mental health drugs without significant side effects. I may be an outlier, since I seem to be deficient in many drug metabolism pathways, but I'm always healthier when not taking prescription pills. I've seen others fall down the prescription pill rabbit hole as well - you start taking one prescription, which leads to side effects, then get another prescription to cover up those side effects, bringing with it new side effects, and the cycle continues. My advice would be to avoid unnecessary drugs, always try new medications one at a time so you can see how you react without confounding factors (yes, this is a direct contradiction to the many doctors who will throw a handful of pills in your face at day one), and always prioritize treating the source of the issue over masking symptoms.

This might sound unhelpful depending on your life circumstances (I understand, from firsthand experience), but have you pursued any additional avenues for improving your mental health? Perhaps lifestyle changes, finding a hobby you enjoy, joining a support group, etc. could do as much for you as prescriptions could, but without the risk of side effects. I also hope you have a doctor who is taking your B12 deficiency seriously and prescribing enough injections to actually correct the problem, because that will make or break your recovery. If you don't have a willing or knowledgeable physician, you may want to explore the option of ordering your own B12 and self-injecting. Some people need a once monthly injection, others weekly, and some, like me, need daily injections to keep healthy. We're all individuals, but unfortunately most MDs don't see things this way.

Best of luck to you, and I hope you find better days ahead.

[Hamayeshguy in reply to USmedsyssucks]

I do self administer but recently I noticed my neuropathy is so extensive and requires along term care, actually its my guess. Then I tried to find away to manage this problem bin long term then I sought psychiatrist help but after I did study some of the side effects of prescribed medications really it scared me too take them so nice psychology is young science and takes longer time to get matured and be comparable to other branches of other medical science. I think some over the counter mental support medication like CBD oil and St. John wort has less side effects or even to some point they are beneficial since for approval they have passed mire barrier to reach otc medication shelves.

[USmedsyssucks in reply to Hamayeshguy]

I've had quite a few friends have excellent luck with CBD and even medicinal marijuana where legal. I tried CBD oil a few years ago for chronic pain and noticed it made me tired, which wasn't the effect I was hoping for at the time. But if you have insomnia, it's great. Some people don't get tired and just finds it helps anxiety. One friend with chronic pain did say St. John's wort helped. You are correct that psychology isn't exactly a refined science at this point, and many medications come with significant side effects, so trying the natural route seems very logical to me. Best of luck!

[MoKayD]

If anxiety is an issue, I've found that a combination of magnesium, calcium, and potassium help with anxiety related sleep issues. A lack of sleep causes me to feel anxious. If you are physically up to it, walking outside in nature is very calming.

During the early, dark days of my B12 treatment it seemed that my mind would get caught up in a loop of anxious thoughts that was very hard to get out of, especially at night. I've recently started doing something called "tapping therapy" and as strange as it is, it seems to help me with my late night rumination issues. You might want to give it a try. It can't hurt you. I have an app on my phone but you can go to Youtube and find a lot of videos that walk you through it.

[SigNi]

I take escitalipram drops, mostly for the related anxiety. I can adjust the dosage easily and it also can help with depression. I took bupropion along with it for awhile and then tapered off. Both take a while for the effect to be felt. I am experimenting with powdered GABA, but not long enough to say it‘s effective or not for me. Good luck.