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Depression

Depression and B12 Deficiency

11/17/2008

Question:

I have had depressive symptoms for a year after a major move and job change. At 58, I thought it would go away after I adjusted to the changes. Instead it progressively got worse and affected my work and personal life. Besides isolating myself and missing a lot of work, I had great difficulty learning the procedures in my new work place. I have not changed careers, but changed places of employment. I worried that I had early dementia problems. After 6 months, I found myself with thoughts of death and became frightened enough that I sought help. I was diagnosed with MDD and panic attacks. The psychiatrist has had a difficult time finding a combination of drugs to manage my mood. I`m currently on Wellbutrin, Luvox, and clonazepam. We've tried many combinations and I have pulled out of the depths of the depression but I`m not myself yet. I recently had a full physical and found that I have B12 levels at 172 and TSH at 6.49. Further investigation of the thyroid is being done (more blood work and an ultrasound) before a treatment plan is put in place. I began immediately a 6-week course of B12 injections and daily sub-lingual B12. The rest of the results from the physical are normal. No anemia, no diabetes, normal red blood cells, good cholesterol and blood pressure and so on. My family doctor was upbeat and thought that treating these deficiencies would help the depression. The psychiatrist was not so positive about B12 and said there is little research evidence to suggest that B12 supplements would correct the depression. Of course I`ve been searching the Internet and understand what he means. I`ve been surprised by how closely my symptoms fit most of those attributed to MDD and B12 deficiencies. I`m concerned that neurological damage may have occurred and may mean that some of my symptoms, confusion, difficulty learning new things, stumbling, etc, may not go away. At 58 can the brain repair itself or retrain itself to remedy these problems? Will the symptoms go away if we can get control of the depression by adding the B12 and thyroid supplements to my anti-depressants? Is this something I`ll struggle with for years? I've had a very successful career and was not planning on early retirement. I am very grateful to have an understanding employer right now. What has happened to me is not normal and I worry about the future.

Answer:

You pose many questions that I will try and answer given the availability of the information presented. Certainly both lower levels of B-12 and thyroid ARE associated with an increased risk of depressive symptoms. Folic acid supplementation can also be helpful for mood. Depending upon other factors including the number of depressive episode, quality of the symptoms, etc. all are factors in outcome. With what appears to be the severity of your mood symptoms, I would speculate that the treatments mentioned would be adjunctive to your antidepressant regimen. The further thyroid evaluation that is being evaluated is warranted. You mentioned no evidence of significant neurological symptoms so your concerns in this domain may be premature at this time. It appears that the evaluation that you are going through is appropriate. Alternative treatments for depression also exist alone and in combination if that is required, so continue to work with your family physician and psychiatrist to get your symptoms under control.

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Response by:

Nicholas A Votolato, RPh BCPP Nicholas A Votolato, RPh BCPP
Formerly:
Introductory Clinicxal Psychopharamcology
Advanced Clinical Psychopharmacology
Clinical Pharmacokinetics
Clinical Therapetics
College of Medicine
The Ohio State University