Vitamin B12 aka cobalamin: Essential for mood, nervous system

[trenace]

9 hours ago, Kittygiggles said:

Ah okay, she sounds like she's considering things in detail. Perhaps the issue lies in balancing your folate. I have no idea I guess but I would like to know more when you do, because you're right, it could help me Today I actually backed off all supplements too. I will try to do this for up to a week to see which ones seem unnecessary. 

 

Good luck!

I'll defo keep u posted. Yeh overdoing supps is no good even for a healthy person nevermind us in withdrawal lol. 

[trenace]

9 minutes ago, Songbird said:

 

Yes.  I've found that when my system is already sensitive, I'm then more sensitive to other things as well - it can be a nasty spiral.  The antibiotics could have started it, making your system more sensitive so it reacted to the b12 injections.  I've had this happen with steroid injections (for my shoulder injury) - when I was unstable I had a bad reaction to the steroid, but when I was stable the steroid injection wasn't a problem.  It's wise to be very cautious during any period of instability.

Thank you. Yh I'm defo going to lay off everything for while now. 

[NoMeaning25]

I tested my B12 and my results came back as severely deficient. My doctor wants me to take hydroxocobalamin injections every other day until my neurological symptoms improve, then 2x weekly, then weekly and then on a twice monthly dose. Its hard to say if my symptoms are withdrawal or b12 and im scared to have the injections for fear of a reaction but seems i dont have much of a choice since i do not absorb b12 from the gut at all. Maybe the reason ive been so ill for 7 years and not getting better? 

[ChessieCat]

You could ask doctor to give you a small dose to start with as a test to see how you react.

[ChessieCat]

And don't make any other changes at the same time Keep it Simple, Slow and Stable

[NoMeaning25]

Thanks ill ask my doctor. Im not tapering im off antidepressants for 7 years already

[Mariposa]

After reading repeated recommendations for b12 and magnesium on SA boards, I decided I had nothing to lose to try a b12 supplement (I already take magnesium).

 

The thing, is, I've regularly had my b12 tested because of my diet and it's always been considered in the normal range. Most recently it was at 281pg/mL and deficiency is listed by my doctor at 145 pg/mL.

 

BUT the shift for me has been dramatic- it's too soon to say (a little over a week) but it has *majorly* impacted my energy levels, my spinal/back pain, and my motivation in a positive direction. It hit me within the first 48 hrs then I felt like I was somewhat chaotically jekyl-and-hyding for the next few days. Now it's smoothed out somewhat.

 

This made me research a bit on b12 and found out two things that may be true 1) that blood tests don't reliably tell the whole story and 2) that b12 deficiency has been a culprit for mimicking pretty severe states of mental 'illness', including suicidality and 'bipolar-like' symptoms. Oh and a third was that 3) anti-convulsants are known to cause b12 deficiency (I was on Lamictal/Lamitrogine).

 

I'm just wondering what others who have done more research on b12 could add to this, because if if the bulk of my continued PAWS suffering has been a b12 deficiency all along....well, hell.  Please, any information is appreciated!

 

I also don't want to get ahead of myself, and if it's just an initial effect of redundantly dosing b12, well, I'd be interested in what others' experience has been with that too.

 

Thank you.

 

 

[Hellbutrin]

On 11/2/2011 at 5:21 PM, Altostrata said:

How to take B12

 

If you have normal B12 metabolism and get lots of B12 through eating animal proteins (there's no other way to get it), you may not need B12 supplementation.

 

If you are feeling run down, are stressed, of a certain age, or are not eating well, you may need B12.

 

B12 is stored in the liver and can get depleted by poor diet, stress, or age. If you have not yet started tapering a psychiatric drug, you might as well take some to be on the safe side. It's cheap and excess just goes out in your urine. (If you have started tapering, see below.)

 

There are three ways to take B12: Through injections, sublingual (under the tongue) tablets, or regular tablets. The shots and sublingual tablets are most effective.

 

The most common form of B12 is cyanocobalamin, which releases a tiny amount of cyanide atoms as it is metabolised. It is unknown what this does, but there are other forms of B12. To avoid the cyanide, sublingual methylcobalamin is a better form to take by mouth and hydroxocobalamin by injection.

 

The usual B12 dosage is 1000mcg per day. Of 1000mcg/day of sublingual B12, a tiny amount, perhaps 10mcg is absorbed by the mouth mucosa. This bypasses any absorption problems that might exist in the small intestine (as does an injection).

 

If you suspect B12 deficiency, it's probably best to have a B12 shot before you start to taper a psychiatric drug, while your nervous system is still stable.

 

The MTHFR fallacy

Much has been made in recent years of poor metabolization of B12 (and other B vitamins) in people with MTHFR genetic variations. A large, incoherent field of practice has been built upon this by integrative, functional, and alternative practitioners.

 

Only a very small number of people have MTHFR genetic variations that require special treatment. The rest are normal MTHFR variations that can be "treated" by simply eating lots of fresh leafy green vegetables, which contain the appropriate type of folate and other important nutrients for our bodies (but not vitamin B12).

 

Vitamin B12 cannot be found in vegetables, it exists only in animal products and in B12 supplements. Practitioners who treat MTHFR make a big deal about those who cannot tolerate B12 supplements, they are supposed to have difficulties in "methylation" that require expensive, elaborate supplement regimes.

 

This is unnecessary. People with MTHFR variations can take sublingual methylcobalamin. See below.

 

What to do if you can't tolerate a vitamin B12 supplement?

Some people do have difficulty taking B12 supplements and other B vitamin supplements -- they find the B vitamins in this form cause surges of anxiety, palpitations, sleeplessness, etc. (symptoms of nervous system activation).

 

If you have been tapering psychiatric drugs or have withdrawal syndrome, your nervous system may well be sensitized to B vitamins. You need to be very careful about all B supplements, they may be too strong for you and trigger activation.

 

If you get a bad reaction to vitamin B12 supplements, you might want to try a very small amount of vitamin B12 sublingual methylcobalamin first, perhaps a crumb of a 1000mcg tablet. You can take a tiny crumb daily for a week, then build up to 2 crumbs and eventually to an entire tablet.

 

If you get activation symptoms, you're taking too much, take less. You may be able to tolerate only a tiny crumb for months.

 

(I suggest methylcobalamin because, being already methylized, this compensates for any MTHFR-related "methylation" difficulties. It's fine for people who don't have MTHFR variations, too.)

 

My own experience

I apparently had low B12 when I went off Paxil, and B12 (hydroxycobalamin) shots helped me a lot in the first year of severe discontinuation syndrome. I started taking them in month 10 and I wish I had found out about it earlier.

 

I had been taking Zantac for two years while I was taking Paxil, and I suspect that caused a subclinical B12 deficiency, along with my being an older person.

 

I started out with B12 shots (hydroxycobolamin). They gave me a warm, tingling, relaxing feeling all over my body and relieved, to some extent, some of my withdrawal symptoms. I gave myself a 1000mcg shot every week for many months. I was probably very low in B12.

 

A few years later, I suffered a terrible setback, lost the ability to sleep, and was advised to stop all B vitamin supplements because of potential activation in my nervous system sensitized by post-withdrawal syndrome. I stopped supplementing B12. (The rest of the story is here.)

 

A few years after that (I had recovered my sleep), blood tests showed I was low in B12 (I was an even older person). I had had tests showing I had 2 common MTHFR genetic variations, which may or may not mean difficulty processing B vitamins.

 

I tried taking a 1000mcg subllngual methylcobalamin and found it uncomfortably activating (electrical sensations). I decided to try a tiny crumb and build up from there. Over 6 months, I increased to a normal 1000mcg tablet per day. My B12 blood levels rose. Now I take a 1000mcg tablet a few times a week to keep the stores in my liver topped up.

Hi Alto,

 

Thanks for taking the time to write about your experience with taking B12. Do you feel that taking the B12 the first time around caused your set back/sleep issues or do you feel it was likely multiple factors? I know there's not a way to know definitively. My blood work shows that I'm at a 372 in B12 and the "ideal" range is between 272 and 1245. So, I'm not deficient, but it's definitely on the low side. I researched different B12 options and I decided to purchase a liquid bottle of b12 to make it easier to titrate. This is the one that I got

 

https://www.amazon.com/Trace-Minerals-Liquid-Ionic-Supplement/dp/B01MCYXPDB

 

It says that the serving size is 1ml/.2 tsp, but I've decided to start taking one small drop to see how I do with it for a while. When I was in acute I had terrible issues with insomnia for over a year, I definitely don't want to experience a set back of that magnitude. I still don't get restful sleep, so I want to make sure that I don't take anything that will effect my sleep. I'm going to take it as slow as I can to see how I do with it. 

 

When you started taking B12 initially and had issues with your sleep how much were you taking? 

[Altostrata]

All of your questions have been answered in the text you quoted.

[Hellbutrin]

20 hours ago, Altostrata said:

All of your questions have been answered in the text you quoted.

Do you think that the B12 you were taking caused your set back? Did you see improvement with your sleep after you stopped taking them?

[Altostrata]

No to both questions.

[Hellbutrin]

On 2/24/2020 at 1:07 PM, Mariposa said:

After reading repeated recommendations for b12 and magnesium on SA boards, I decided I had nothing to lose to try a b12 supplement (I already take magnesium).

 

The thing, is, I've regularly had my b12 tested because of my diet and it's always been considered in the normal range. Most recently it was at 281pg/mL and deficiency is listed by my doctor at 145 pg/mL.

 

BUT the shift for me has been dramatic- it's too soon to say (a little over a week) but it has *majorly* impacted my energy levels, my spinal/back pain, and my motivation in a positive direction. It hit me within the first 48 hrs then I felt like I was somewhat chaotically jekyl-and-hyding for the next few days. Now it's smoothed out somewhat.

 

This made me research a bit on b12 and found out two things that may be true 1) that blood tests don't reliably tell the whole story and 2) that b12 deficiency has been a culprit for mimicking pretty severe states of mental 'illness', including suicidality and 'bipolar-like' symptoms. Oh and a third was that 3) anti-convulsants are known to cause b12 deficiency (I was on Lamictal/Lamitrogine).

 

I'm just wondering what others who have done more research on b12 could add to this, because if if the bulk of my continued PAWS suffering has been a b12 deficiency all along....well, hell.  Please, any information is appreciated!

 

I also don't want to get ahead of myself, and if it's just an initial effect of redundantly dosing b12, well, I'd be interested in what others' experience has been with that too.

 

Thank you.

 

 

Following

[Altostrata]

All of Mariposa's points have been covered earlier in this topic.

[Repent]

Anybody knows how long its safe to take b12/Folat by themself and not in any complex? I mean, does it cause some imbalance to the other b-vitamins in the body over time that aint good? I thought i read something about it but im not sure. 

[Altostrata]

Excess vitamin B12 and folate is excreted in the urine. Still, not a good idea to deliberately take excessive amounts.

[saimshah]

on 6th Feb I started to take vitamin b12 and hit by a several wd. now i cant even stand if i stand cartisol started to surge and i got exhausted. before i took vit b12 i was able to walk 3 to 4 km everyday. also i m not able to sleep more then 1 to 2 hours from last 10 days. please i need reassurance i will be alright and its just a wave.

[Altostrata]

@saimshah Read this topic. Some people react badly to B vitamins. We always advise starting with a very low dose to avoid significant bad reactions.

[saimshah]

what should i do now . i m totally burning . can i start ad with very small dose again and slow taper. please advise i m thinking i will die i could not sleep due to extreme burning tonight

[saimshah]

do people die due to these symptoms . do u know anyone who died due to wd .  i m very upset and scared please anyone answer me i need help.

[ChessieCat]

47 minutes ago, saimshah said:

do people die due to these symptoms . do u know anyone who died due to wd .  i m very upset and scared please anyone answer me i need help.

 

 

Check out the success stories

 

success-stories-recovery-from-withdrawal

[saimshah]

can u reassure what i m facing is only withdrawal or something else. i took vit b12 10 days ago for 3 days and then it started. is it some sort of reaction and i should go to doc or hold on for betterment.

[ChessieCat]

5 hours ago, Altostrata said:

@saimshah Read this topic. Some people react badly to B vitamins. We always advise starting with a very low dose to avoid significant bad reactions.

 

Altostrata has already provided an answer.  Alto is this website's owner.

[saimshah]

now i have taken it and in reaction.what i should do now. wait or some way to reduce symtoms.

[ChessieCat]

You will just have to wait it out  There are no magic fixes.  It is generally better not to try taking anything to fix it because it will probably only make things worse.

 

SA strongly encourages members to learn and use

 

Non-drug techniques to cope

 

 

[saimshah]

can i start my ad on low dose and taper it slowly. will it work ? 

[ChessieCat]

@saimshah

 

Please post questions specific to your own situation in your Introduction topic.  This way your history will all be in one place.

 

Also because the site is very busy with lots of members, the moderators do not always see posts made in other forums.  Whereas they regularly check the new posts that members make in the Introduction forum.

 

Your topic is here:

 

saimshah-citanew-or-xanax

 

 

[Sicksagittarius]

@Altostratamy b12 was checked in blood work and it was 161 when it was 322 in february. I know thats not the most reliable way to check it, what would be? I believe its due to using omeprazole for a year, 2 months after starting to taper lexapro. I'll be done with my omeprazole taper in a week.

 

Also, could low b12 cause an increase in WD symptoms, specifically unfocused vision 24/7? Due to this instability with the vision, should I wait awhile before trying tiny doses of b12? Does it take a few months to see if coming off of it and eating more animal protein will help raise b12 before trying b12 supplements?

 

I saw b12 deficiency can cause cause permanent nervous system damage in WD. Did you experience any of this with your deficiency or did you recover without permanent damage? If I've only been deficient for about a year in b12, do you think I could gain permanent damage to my CNS since being vegetarian previously before tapering lexapro?

 

Should I check for MTHFR genetic variations asap just to get on top of this and not cause further damage? What's the name of the test? 

 

I read that vitamin B12 deficiency weakens the nervous system and greatly exacerbated antidepressant withdrawal syndrome. What WD symptoms do b12 deficiencies cause? I read fatigue, shakiness, unsteady gait, low BP, depression, cognitive probs like memory. Are there others I should try to look out for?

[Altostrata]

@Sicksagittarius Please stop tagging me for questions unrelated to tapering or withdrawal.

 

Use site search to answer your questions.

[Sicksagittarius]

can b12 in food like fish be as stimulating as a b12 supplement? Or is it only the synthetic supplements that cause this?

[Estman]

On 11/3/2011 at 12:34 AM, Altostrata said:

Folate and B12

 

Ordinarily, folic acid (folate) works with vitamin B12 and they should be taken together. Deficiencies of either can lead to anemia or neurological symptoms, even dementia.

 

Folic acid can mask a B12 deficiency and vice versa, so it's wise to take them together and cover both bases.

 

However, folic acid can be stimulating for people with hypersensitive alerting systems, i.e. people with withdrawal syndrome.

 

If your nervous system can tolerate it, you might as well get your folate in a multivitamin supplement PLUS take additional B12. Multivitamins usually contain an insignificant amount of B12.

 

Low folate is also implicated in anemia and heart disease.

 

An integrative doctor recommended that I take a special type of folate, because she said I wasn't absorbing folate properly. I apparently inherited a genetic mutation (MTHF) that predisposes towards heart disease -- folate and B12 are important to maintain a healthy heart (and brain!!!) -- and faulty folate metabolism is part of that.

 

Metafolin, Deplin, or Metagenics FolaPro (l-5-methyl tetrahydrofolate or MTHF) are folate alternatives for people to take who cannot metabolize the usual form of folic acid in supplements. There is no reason to take a folate alternative if you don't have the MTHF mutation.

 

These folate alternatives are quite expensive, while ordinary B12 and folate supplements are very inexpensive.

My blood test showed that the folate is 7.3 nmol / l
It must be in the range of 7-46 nmol / l
Vitamin B12 levels also appear to be low, as is vitamin D.
There has been a lot of fatigue and weakness in the last month
However, it is as if fatigue causes depression.
I started taking folate and vitamin B12 the day before yesterday
I hope I can stand them

[Sofa]

My GP wants me to take B12-supplements or injections because my levels are apparently really low.

 

Is it safe to take B12 supplements, or can that make things worse?

 

I dont want my cognition, loss of emotions and sexual symptoms to get worse.

 

Anyone have any experience?

 

I have heard one should not take any supplements the first year after PSSD, to maximize chances of faster recovery. 
 

Will taking B12 make my chances of recovery worse? 
 

Can it cause permanent worsening of symptoms? 
 

I have already screwed up taking benzo and zopiclone and ginger after, so i really dont want to anything worse now.

[Sofa]

Is it normal to Feel worse right after starting treatment with B12?

 

I Feel more flat emotionally, like totally empty and dead inside. 

 

I also Feel nausiated and have cramps in my stomach.
 

I also Feel really restless. I dont normally have restless legs with akathisia, but now i cant sleep because my legs always have to keep moving. I can also Feel the restlessness in my arms, back and neck! It is so bad. I have not slept in three days. 

Is it normal to become worse at first?

[ChessieCat]

42 minutes ago, Sofa said:

Is it normal to Feel worse right after starting treatment with B12?

 

I have responded in your topic.

 

For the information of other members, Sofa was advised twice (14th April 2022 and just 5 days ago) by Altostrata about starting with a small amount.  See:

 

[ThatOneGirlStitch]

If you are sensitive to small crumbs of b12 does that mean you should take no b12? Does that mean injections would also not be safe?

 

[savinggrace]

I had no choice about supplementing B12.  I let it go for way too long.  2 years ago my serum B12 was 112.  (before supplementing)  More alarming than that, especially to my doctors, was that my methylmalonic acid and homocysteine were two and half times the upper range, which set me up for heart attacks, stroke and paralysis.  I already have severe spinal cord damage.

 

I messed around with tiny doses of sublingual methycobalamin and other methods of supplementing.  I went to a functional medicine doctor who injected me with just 30 mcg. of methylcobalamin and it stimulated me badly.  I spent the better part of a year trying to research the various forms of B12 and then trying to find a doctor to prescribe what I need.

 

I suspected that I wasn't absorbing it for a very long time because more than 12 years previous my  serum B12 was sky high.  Upon more testing at SpectraCell lab, I found out that my blood serum level was high because the B12 wasn't getting into my cells...which over time eventually resulted in low serum B12 and high MMA and homocysteine.

 

Despite my constant withdrawal problems, and other chronic illness, push had come to shove.  With a ton of research and going to multiple doctors, I found one who would prescribe self-injections of hydroxycobalamin for me.  I just needed the prescription.  I knew if I was in charge I could micro-dose the B12 however I wanted with the frequency I could tolerate.

 

Once I got the script (standard script is for mg/ml of hydroxy, methy, etc) I found a compounding pharmacy to make up the injections for me.  They are not very expensive, and I did waste some of it, because each syringe had 1000 mcg. (1 mg.) serum in it.  This pharmacy made the doses up individually in syringes.  Some pharmacies distribuate vials of 30 ml.  I liked getting the individual syringes, even though I was wasting a lot of it.  It was worth the learning curve.

 

I started out injecting less than 100 mcg.  For the first few months, I found the injections increased my insomnia.  I was injecting this little bit every 4-6 weeks.  I am happy to report that within just a few injections my MMA was normal and my homocysteine was almost normal range. This is classic functional B12 deficiency.  (I eat meat every day)   I have kept it up.  I inject about 400-500 mcg. hydroxycobalamin about every 3 weeks.  So far, symptomatically I do not feel much better, BUT, the stimulation has gone away, in fact, if anything, I feel a bit more fatigued.  I have been experiencing air hunger quite a bit and I am not sure, but I think (fingers crossed) that this was due to my functional B12 deficiency.  I think the shots may be helping that.  Stay tuned!

 

Testing serum B12 while supplementing, or even within months of supplementing will not give an accurate picture of B12 status and is a waste of time and money, though doctors know very little about any of this.  However, MMA and homocysteine measurements will.

 

I have malabsorptiion problems so self-injecting was the only way to go.  I experienced the same thing with vitamin D.  No oral, transdermal, sublingual dose was tolerated or raised my vitamin D.  I am using the sun right now to raise it but not very effectively.  I suspect I will have to have injections/infusion but if I do, I will not allow massive doses...they usually start with 50,000 IU's.

 

The point of all this is...I never thought I would tolerate B12 injections...and I waited too long so some irreversible nervous system damage has likely occured, but with time, courage and patience, my very stubborn body/brain have made room for B12.  I plan to increase the dose over time as I seem to use it up quickly and I am taking half the standard dose.  Excess B12 is excreted in the urine so it is very hard to over-dose.  I am just now starting to supplement folate when i do an injection.  Previously I found any form of folate to be too stimulating but I am now taking folinic acid sub-lingual drops, small dose, with each injection.  I probably need more but am trying to get folate from food more mindfully.

 

Again, I don't know if I feel better but I guess I am not a walking heart attack and stroke, or a candidate for paralysis any more.

 

Start low and go slow.  I feel fairly confident in saying if I can do this, almost anyone can.  Healing or improvement with B12 supplementation is not linear and sometimes things get worse before they get better.  Sound familiar?

 

Grace

[cathnz]

On 7/17/2022 at 9:43 AM, savinggrace said:

I had no choice about supplementing B12.  I let it go for way too long.  2 years ago my serum B12 was 112.  (before supplementing)  More alarming than that, especially to my doctors, was that my methylmalonic acid and homocysteine were two and half times the upper range, which set me up for heart attacks, stroke and paralysis.  I already have severe spinal cord damage.

 

I messed around with tiny doses of sublingual methycobalamin and other methods of supplementing.  I went to a functional medicine doctor who injected me with just 30 mcg. of methylcobalamin and it stimulated me badly.  I spent the better part of a year trying to research the various forms of B12 and then trying to find a doctor to prescribe what I need.

 

I suspected that I wasn't absorbing it for a very long time because more than 12 years previous my  serum B12 was sky high.  Upon more testing at SpectraCell lab, I found out that my blood serum level was high because the B12 wasn't getting into my cells...which over time eventually resulted in low serum B12 and high MMA and homocysteine.

 

Despite my constant withdrawal problems, and other chronic illness, push had come to shove.  With a ton of research and going to multiple doctors, I found one who would prescribe self-injections of hydroxycobalamin for me.  I just needed the prescription.  I knew if I was in charge I could micro-dose the B12 however I wanted with the frequency I could tolerate.

 

Once I got the script (standard script is for mg/ml of hydroxy, methy, etc) I found a compounding pharmacy to make up the injections for me.  They are not very expensive, and I did waste some of it, because each syringe had 1000 mcg. (1 mg.) serum in it.  This pharmacy made the doses up individually in syringes.  Some pharmacies distribuate vials of 30 ml.  I liked getting the individual syringes, even though I was wasting a lot of it.  It was worth the learning curve.

 

I started out injecting less than 100 mcg.  For the first few months, I found the injections increased my insomnia.  I was injecting this little bit every 4-6 weeks.  I am happy to report that within just a few injections my MMA was normal and my homocysteine was almost normal range. This is classic functional B12 deficiency.  (I eat meat every day)   I have kept it up.  I inject about 400-500 mcg. hydroxycobalamin about every 3 weeks.  So far, symptomatically I do not feel much better, BUT, the stimulation has gone away, in fact, if anything, I feel a bit more fatigued.  I have been experiencing air hunger quite a bit and I am not sure, but I think (fingers crossed) that this was due to my functional B12 deficiency.  I think the shots may be helping that.  Stay tuned!

 

Testing serum B12 while supplementing, or even within months of supplementing will not give an accurate picture of B12 status and is a waste of time and money, though doctors know very little about any of this.  However, MMA and homocysteine measurements will.

 

I have malabsorptiion problems so self-injecting was the only way to go.  I experienced the same thing with vitamin D.  No oral, transdermal, sublingual dose was tolerated or raised my vitamin D.  I am using the sun right now to raise it but not very effectively.  I suspect I will have to have injections/infusion but if I do, I will not allow massive doses...they usually start with 50,000 IU's.

 

The point of all this is...I never thought I would tolerate B12 injections...and I waited too long so some irreversible nervous system damage has likely occured, but with time, courage and patience, my very stubborn body/brain have made room for B12.  I plan to increase the dose over time as I seem to use it up quickly and I am taking half the standard dose.  Excess B12 is excreted in the urine so it is very hard to over-dose.  I am just now starting to supplement folate when i do an injection.  Previously I found any form of folate to be too stimulating but I am now taking folinic acid sub-lingual drops, small dose, with each injection.  I probably need more but am trying to get folate from food more mindfully.

 

Again, I don't know if I feel better but I guess I am not a walking heart attack and stroke, or a candidate for paralysis any more.

 

Start low and go slow.  I feel fairly confident in saying if I can do this, almost anyone can.  Healing or improvement with B12 supplementation is not linear and sometimes things get worse before they get better.  Sound familiar?

 

Grace

@savinggraceyour story could be mine. I've put off treating a b12 deficiency (extremely high mna detected 2 years ago) because of fear it would destabilise me and make my akathisia worse. But my levels are getting worse and nuero symptoms worse so I have to take action.I'm going to start self injecting.