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Esposito G, Dottori L, Pivetta G, Ligato I, Dilaghi E, Lahner E. Pernicious Anemia: The Hematological Presentation of a Multifaceted Disorder Caused by Cobalamin Deficiency. Nutrients 2022; 14:nu14081672. [PMID: 35458234 PMCID: PMC9030741 DOI: 10.3390/nu14081672] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
Pernicious anemia is still a neglected disorder in many medical contexts and is underdiagnosed in many patients. Pernicious anemia is linked to but different from autoimmune gastritis. Pernicious anemia occurs in a later stage of autoimmune atrophic gastritis when gastric intrinsic factor deficiency and consequent vitamin B12 deficiency may occur. The multifaceted nature of pernicious anemia is related to the important role of cobalamin, which, when deficient, may lead to several dysfunctions, and thus, the proteiform clinical presentations of pernicious anemia. Indeed, pernicious anemia may lead to potentially serious long-term complications related to micronutrient deficiencies and their consequences and the development of gastric cancer and type 1 gastric neuroendocrine tumors. When not recognized in a timely manner or when pernicious anemia is diagnosed with delay, these complications may be potentially life-threatening and sometimes irreversible. The current review aimed to focus on epidemiology, pathogenesis, and clinical presentations of pernicious anemia in an attempt to look beyond borders of medical specialties. It aimed to focus on micronutrient deficiencies besides the well-known vitamin B12 deficiency, the diagnostic approach for pernicious anemia, its long-term complications and optimal clinical management, and endoscopic surveillance of patients with pernicious anemia.
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Abstract
PURPOSE OF REVIEW Fatigue, a protean complaint encompassing both physical, mental exhaustion but also demotivation, has shown to effect quality of life in patients with inflammatory bowel disease (IBD). Here we present a review of the literature as it relates to IBD-associated fatigue. Moreover, we present the common causes attributed to fatigue and present an algorithmic approach to the assessment of fatigue. Finally, we report data regarding potential management strategies for IBD-associated fatigue. RECENT FINDINGS Unfortunately, owing to its multidimensional nature and multifactorial causes, patients with IBD may continue to report fatigue despite optimization of disease management, replenishment of nutritional deficiencies, or management of coexistent disorders. Management likely requires a multidisciplinary approach. SUMMARY The majority of patients with IBD report fatigue symptoms both in setting of active disease but also during the course of remission. Fatigue is a multidimensional complaints, and management likely requires a multidisciplinary approach. Herein, we present a framework for the management and assessment of fatigue in IBD.
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Tak AZA, Dayan E, Bulut HT. Evaluation of diffusion tensor imaging changes and neurocognitive effects of asymptomatic vitamin B12 deficiency. Acta Neurol Belg 2018; 118:289-296. [PMID: 29663261 DOI: 10.1007/s13760-018-0912-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 03/13/2018] [Indexed: 02/08/2023]
Abstract
Vitamin B12 plays an important role in the mechanisms which are responsible for myelinization in the central nervous system. It can particularly lead to hematological and neuropsychiatric symptoms when serum levels fall due to insufficient intake with diet or absorption problems. The purpose of this study was to show the cognitive effects in vitamin B12 deficiency cases that have not reached clinical symptom level using neuropsychological tests, and to show possible cerebral neuronal damage using diffusion tensor imaging (DTI) method. A total of 62 asymptomatic vitamin B12 deficiency patients and 40 healthy subjects were included in the study and both groups were subjected to Standardized Mini-Mental State Examination, Montreal Cognitive Assessment Test, Rey Auditory Verbal Learning Test, forward and backward digit span (WMS-R forward and backward), Visual Reproduction Subtest (WMS-III), Category Fluency Test, Trail Making (Trail A-B) (21) and Similarities (BENZ) tests. DTI examinations were performed on both groups. Patient group was determined to get lower scores in all neuropsychological tests compared to control group. In DTI examination, a significant decrease in FA values of bilateral hippocampus and a prominent increase in apparent diffusion coefficient (ADC) values were determined in the patient group compared to control group. In this study, it was determined that there was microstructural damage in the brain in the presence of vitamin B12 deficiency even in the asymptomatic period, and the patients revealed cognitive decline. In accordance with this result, early treatment of the easily diagnosed and treated vitamin B12 deficiency may prevent possible irreversible damage in the future.
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Hussein H, Abd El Mawella S, Ahmed T. Folate, vitamin B 12, and negative symptoms in schizophrenia. EGYPTIAN JOURNAL OF PSYCHIATRY 2018; 39:89. [DOI: 10.4103/ejpsy.ejpsy_39_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Delichatsios H, Fasano A. Case 14-2016: A Woman with a Thyroid Nodule and Psychosis. N Engl J Med 2016; 375:e20. [PMID: 27579661 DOI: 10.1056/nejmc1607733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Travica N, Ried K, Bujnowski R, Sali A. Integrative health check reveals suboptimal levels in a number of vital biomarkers. ADVANCES IN INTEGRATIVE MEDICINE 2015. [DOI: 10.1016/j.aimed.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dean OM, Turner A, Malhi GS, Ng C, Cotton SM, Dodd S, Sarris J, Samuni Y, Tanious M, Dowling N, Waterdrinker A, Smith D, Berk M. Design and rationale of a 16-week adjunctive randomized placebo-controlled trial of mitochondrial agents for the treatment of bipolar depression. ACTA ACUST UNITED AC 2014; 37:3-12. [PMID: 25295681 DOI: 10.1590/1516-4446-2013-1341] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/05/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Bipolar disorder places a significant burden on individuals, caregivers and family, and the broader community. Current treatments are believed to be more effective against manic symptoms, leaving a shortfall in recovery during the depressive phase of the illness. The current study draws on recent evidence suggesting that, in addition to increased oxidative load, alterations in mitochondrial function occur in bipolar disorder. METHODS This 16-week study aims to explore the potential benefits of N-acetylcysteine (NAC) alone or in combination (CT) with selected nutraceuticals believed to enhance mitochondrial function. The study includes adults diagnosed with bipolar disorder currently experiencing an episode of depression. Participants are asked to take NAC, CT, or placebo in addition to any usual treatments. A post-discontinuation visit is conducted 4 weeks following the treatment phase. RESULTS The primary outcome of the study will be mean change on the Montgomery-Asberg Depression Rating Scale. Secondary outcomes include functioning, substance use, mania ratings, and quality of life. Blood samples will be collected at baseline and week 16 to explore biochemical alterations following treatment. CONCLUSION This study may provide a novel adjunctive treatment for bipolar depression. Analysis of biological samples may assist in understanding the therapeutic benefits and the underlying etiology of bipolar depression. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ACTRN12612000830897.
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Affiliation(s)
- Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Chee Ng
- Department of Psychiatry University of Melbourne, Melbourne, Australia
| | - Sue M Cotton
- Orygen Youth Health Research Centre, Melbourne, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | | | - Yuval Samuni
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Michelle Tanious
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nathan Dowling
- Department of Psychiatry University of Melbourne, Melbourne, Australia
| | - Astrid Waterdrinker
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Deidre Smith
- Department of Psychiatry University of Melbourne, Melbourne, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
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Cobalamin deficiency: clinical picture and radiological findings. Nutrients 2013; 5:4521-39. [PMID: 24248213 PMCID: PMC3847746 DOI: 10.3390/nu5114521] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 10/18/2013] [Accepted: 10/28/2013] [Indexed: 02/01/2023] Open
Abstract
Vitamin B12 deficiency causes a wide range of hematological, gastrointestinal, psychiatric and neurological disorders. Hematological presentation of cobalamin deficiency ranges from the incidental increase of mean corpuscular volume and neutrophil hypersegmentation to symptoms due to severe anemia, such as angor, dyspnea on exertion, fatigue or symptoms related to congestive heart failure, such as ankle edema, orthopnea and nocturia. Neuropsychiatric symptoms may precede hematologic signs and are represented by myelopathy, neuropathy, dementia and, less often, optic nerve atrophy. The spinal cord manifestation, subacute combined degeneration (SCD), is characterized by symmetric dysesthesia, disturbance of position sense and spastic paraparesis or tetraparesis. The most consistent MRI finding is a symmetrical abnormally increased T2 signal intensity confined to posterior or posterior and lateral columns in the cervical and thoracic spinal cord. Isolated peripheral neuropathy is less frequent, but likely overlooked. Vitamin B12 deficiency has been correlated negatively with cognitive functioning in healthy elderly subjects. Symptoms include slow mentation, memory impairment, attention deficits and dementia. Optic neuropathy occurs occasionally in adult patient. It is characterized by symmetric, painless and progressive visual loss. Parenteral replacement therapy should be started soon after the vitamin deficiency has been established.
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Cobalamin deficiency presenting as obsessive compulsive disorder: case report. Gen Hosp Psychiatry 2012; 34:578.e7-8. [PMID: 22227032 DOI: 10.1016/j.genhosppsych.2011.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 11/21/2022]
Abstract
Cobalamin deficiency commonly presents with a wide range of neuropsychiatric manifestations ranging from myelopathy, neuropathy, optic neuritis and dementia to mood disorders, chronic fatigue and psychosis even without classical hematological abnormalities like anemia and macrocytosis. However, obsessive compulsive disorder (OCD) in relation to vitamin B12 deficiency has not been described so far. We report a case of middle-aged man presenting with OCD, low serum cobalamin and a positive family history of vitamin B12 deficiency who responded well to methylcobalamin replacement.
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Sahoo MK, Avasthi A, Singh P. Negative symptoms presenting as neuropsychiatric manifestation of vitamin B12 deficiency. Indian J Psychiatry 2011; 53:370-1. [PMID: 22303049 PMCID: PMC3267352 DOI: 10.4103/0019-5545.91914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Long lists of psychiatric illness or symptoms have been documented to be caused by vitamin B12 deficiency. We describe an atypical case of a young adult who presented with predominant negative symptoms followed by neurological symptoms consistent with vitamin B12 deficiency. The symptoms showed complete remission after vitamin B12 supplementation. The uniqueness of this case is that vitamin B12 deficiency presented with predominant negative symptoms without other psychotic and manic symptoms, which has not been reported previously.
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Affiliation(s)
- Manoj Kumar Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kuo SC, Yeh CB, Yeh YW, Tzeng NS. Schizophrenia-like psychotic episode precipitated by cobalamin deficiency. Gen Hosp Psychiatry 2009; 31:586-8. [PMID: 19892219 DOI: 10.1016/j.genhosppsych.2009.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 02/12/2009] [Accepted: 02/17/2009] [Indexed: 10/21/2022]
Abstract
Although cobalamin deficiency is widely known and usually presents with hematologic and neuropsychiatric manifestations, the psychiatric symptoms are not usually the predominant manifestation. We describe a young single male vegetarian who developed a cobalamin-induced psychotic episode without preceding neurologic manifestations and without any hematologic symptoms. He recovered after a short course of antipsychotics and oral cobalamin supplementation and remained asymptomatic and functionally independent at 1 year of follow-up.
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Affiliation(s)
- Shin-Chang Kuo
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Malignant catatonia in a patient with bipolar disorder, B12 deficiency, and neuroleptic malignant syndrome: one cause or three? J Psychiatr Pract 2009; 15:415-22. [PMID: 19820558 DOI: 10.1097/01.pra.0000361282.95962.9f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A Case is presented of a 23-year-old woman with progressive onset of paranoid psychosis and catatonia, who was ultimately found to have both vitamin B12 deficiency and a family history of bipolar disorder. The patient was initially diagnosed with schizophrenia and treated with the antipsychotic medication ziprasidone. Her condition rapidly worsened to a state consistent with either neuroleptic malignant syndrome or malignant catatonia. Work-up then revealed vitamin B12 deficiency and a family history of bipolar disorder. Her symptoms improved rapidly but partially with benzodiazepines and electrocon-vulsive therapy, and completely with addition of valproic acid, vitamin B12 replacement, and re-introduction of antipsychotic medication in the form of olanzapine. The authors discuss the differential diagnosis of catatonia as reflecting a high likelihood of underlying mood disorder; the evaluation and management of malignant catatonia and malignant neuroleptic syndrome; and the role of vitamin B12 deficiency in precipitating psychotic symptoms. The case also illustrates the problems of diagnosing and managing a multifactorial disorder with psychiatric, general medical, and perhaps iatrogenic components.
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Abstract
OBJECTIVE To study unusual psychiatric manifestation of vitamin B12 deficiency and related issues. METHOD A case study of 52-year-old female and review of relevant literature. RESULTS Complete remission of psychiatric symptoms without recurrence for the next 4 years with vitamin B12 as the only specific therapy instituted. CONCLUSION Importance of B12 estimation and replacement in patients with varied psychiatric manifestations.
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Affiliation(s)
- N Berry
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Nutritional deficiencies are commonplace in patients with human immunodeficiency virus type 1 (HIV-1) infection, and recent research has indicated that nutritional factors may play an important role in the pathogenesis of HIV-1 disease. Although nutritional deficiencies are unlikely to be the primary causative factor in disease progression, they may contribute to cognitive dysfunction, neurologic abnormalities, mood disturbance, and immune dysregulation associated with HIV-1 infection. Furthermore, deficiencies of specific micronutrients have been associated with increased risk of HIV-1-associated mortality. This article will briefly summarize the role of macronutrient deficiency, the interactions of specific micronutrient deficiencies with neuropsychiatric functioning, and the role of these factors in HIV-1 disease progression. Since recent research has shown that normalization of many nutritional deficits and supplementation beyond normal levels are associated with improvements in neuropsychiatric functioning, potential treatment implications will also be discussed.
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Baldewicz TT, Goodkin K, Blaney NT, Shor-Posner G, Kumar M, Wilkie FL, Baum MK, Eisdorfer C. Cobalamin level is related to self-reported and clinically rated mood and to syndromal depression in bereaved HIV-1(+) and HIV-1(-) homosexual men. J Psychosom Res 2000; 48:177-85. [PMID: 10719135 DOI: 10.1016/s0022-3999(99)00108-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An examination of the relationship of plasma cobalamin (vitamin B(12)) level to overall psychological distress, specific mood states, and major depressive disorder was conducted in 159 bereaved men (90 HIV-1(+) and 69 HIV-1(-)). METHODS The relationship of a continuous measure of cobalamin level to psychological distress was examined, while controlling for HIV-1 serostatus, life stressors, social support, and coping styles. RESULTS Of this sample, 23.9% were either overtly or marginally cobalamin deficient; however, the deficiency rate was not significantly different by HIV-1 serostatus. Cobalamin level was inversely related to self-reported overall distress level and specifically to depression, anxiety, and confusion subscale scores, as well as to clinically rated depressed and anxious mood. Lower plasma cobalamin levels also were associated with the presence of symptoms consistent with major depressive disorder. CONCLUSION These findings suggest that cobalamin level may be physiologically related to depressed and anxious mood level, as well as to syndromal depression.
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Affiliation(s)
- T T Baldewicz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, PO Box 3119, Durham, NC 27710, USA.
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Catalano G, Catalano MC, Rosenberg EI, Embi PJ, Embi CS. Catatonia. Another neuropsychiatric presentation of vitamin B12 deficiency? PSYCHOSOMATICS 1998; 39:456-60. [PMID: 9775705 DOI: 10.1016/s0033-3182(98)71307-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- G Catalano
- Department of Psychiatry and Behavioral Medicine, University of South Florida College of Medicine, Tampa, USA
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Saracaceanu E, Tramoni AV, Henry JM. An association between subcortical dementia and pernicious anemia--a psychiatric mask. Compr Psychiatry 1997; 38:349-51. [PMID: 9406742 DOI: 10.1016/s0010-440x(97)90932-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A case report from our psychiatric ward demonstrates the emergence of two different organic pathologies, a subcortical dementia and a pernicious anemia, preceded by a psychiatric presentation mimicking a dementia of depression. We emphasize that the psychiatric mask and the lack of other clinical and paraclinical cobalamin deficiency signs were the chief obstacles to early diagnosis. Only a complete and thorough assessment allowed the real diagnosis. We describe a subcortical dementia, and after a review of the literature, we support the causalty of B12 hypovitaminosis (pernicious anemia) in the genesis of this dementia, in the absence of other organic causes of mental syndromes and in the presence of a positive and well-maintained response to vitamin B12 administration.
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Affiliation(s)
- E Saracaceanu
- Department of Psychiatry, Timone Hospital, Marseille, France
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Abstract
Cobalamin (vitamin B12) is an essential nutrient derived exclusively from bacterial sources. It is an essential cofactor for three known enzymatic reactions. Untreated deficiency, caused by either the autoimmune disease pernicious anemia or nutritional lack, results in a macrocytic anemia and/or subacute combined degeneration of the spinal cord and is eventually fatal. Cobalamin in serum is bound to two proteins, transcobalamin and haptocorrin. The former is responsible for the essential delivery of cobalamin to most tissues. Inadequate tissue availability of cobalamin results in increased concentration of methylmalonic acid and homocyst(e)ine due to inhibition of methylmalonyl-CoA mutase and methionine synthase, respectively. Strict vegetarians have long been known to be at risk of cobalamin deficiency, which develops insidiously over many years. It is now clear that a significant number of the elderly and HIV-positive individuals are also at increased risk of deficiency. Any individual with reduced ability to split cobalamin from food-protein may also become deficient even though intrinsic factor is present. Diagnosis of cobalamin deficiency has frequently relied on total serum cobalamin and the Schilling test. Newer approaches such as analysis of methylmalonic acid, homocyst(e)ine, holotranscobalamin, anti-intrinsic factor antibodies, and serum gastrin may provide more cost-effective testing, as well as identify those with a covert deficiency.
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Affiliation(s)
- H V Markle
- Centenary Health Centre, Scarborough, Ontario, Canada
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Hatta S, Watanabe M, Ikeda H, Kamada H, Saito T, Ohshika H. Impairment of adenylyl cyclase signal transduction in mecobalamin-deficient rats. Eur J Pharmacol 1995; 291:351-8. [PMID: 8719420 DOI: 10.1016/0922-4106(95)90076-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study examined alterations in the beta-adrenoceptor-G5-adenylyl cyclase system in cerebral cortex membranes from vitamin B12-deficient rats fed a diet lacking vitamin B12 (mecobalamin) for 15 weeks. Basal, 5(7)-guanylylimidodiphosphate (GppNHp)-, isoproterenol-, and forskolin-stimulated adenylyl cyclase activities were significantly reduced in mecobalamin-deficient rats compared with those in control rats. However, no significant differences were observed in the amount and function of G5- estimated by immunoblotting and guanine nucleotide photoaffinity labeling, respectively, or in the densities and the dissociation constants of beta-adrenoceptors, estimated by [125I] pindolol binding, between control and the deficient rats. These results indicate that vitamin B12 deficiency results in the impairment of the coupling among the beta-adrenoceptor, G5- and the catalytic subunit of adenylyl cyclase, and in dysfunction of the catalytic subunit of the enzyme, suggesting that vitamin B12 participates in the regulation of neuronal adenylyl cyclase signal transduction.
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Affiliation(s)
- S Hatta
- Department of Pharmacology, School of Medicine, Sapporo Medical University, Japan
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Oren DA, Teicher MH, Schwartz PJ, Glod C, Turner EH, Ito YN, Sedway J, Rosenthal NE, Wehr TA. A controlled trial of cyanocobalamin (vitamin B12) in the treatment of winter seasonal affective disorder. J Affect Disord 1994; 32:197-200. [PMID: 7852661 DOI: 10.1016/0165-0327(94)90018-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To test the hypothesis that cyanocobalamin (vitamin B12) is an effective treatment for winter seasonal affective disorder (SAD). 2 weeks of double-blind placebo washout, followed by random assignment to parallel treatments for 2 weeks with cyanocobalamin vs. placebo. Observations were made during weekly outpatient visits. All subjects met criteria for SAD. 27 patients were studied. After the washout period, 14 were randomly assigned to 1.5 mg cyanocobalamin (3 x/day) and 13 remained on placebo on the same schedule. 29 item SIGH-SAD scores were used to determine antidepressant efficacy. No significant differences were found in the responses between the two groups. Cyanocobalamin does not appear to be an effective short-term treatment for depression in SAD patients. The usefulness as a treatment for SAD of the methylated form of Vitamin B12, which has been used extensively in related studies, remains to be explored.
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Affiliation(s)
- D A Oren
- National Institute of Mental Health, Bethesda, MD 20892-0010
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Abstract
Attention has been focused recently on the association between vitamin B12 metabolism and the pathogenesis of multiple sclerosis (MS). Several recent reports have documented vitamin B12 deficiency in patients with MS. The etiology of this deficiency in MS is unknown. The majority of these patients do not have pernicious anemia and serum levels of the vitamin are unrelated to the course or chronicity of the disease. Moreover, vitamin B12 does not reverse the associated macrocytic anemia nor are the neurological deficits of MS improved following supplementation with vitamin B12. It has been suggested that vitamin B12 deficiency may render the patient more vulnerable to the putative viral and/or immunologic mechanisms widely suspected in MS. In the present communication, we report that serum vitamin B12 levels in MS patients are related to the age of onset of the disease. Specifically, we found in 45 MS patients that vitamin B12 levels were significantly lower in those who experienced the onset of first neurological symptoms prior to age 18 years (N = 10) compared to patients in whom the disease first manifested after age 18 (N = 35). In contrast, serum folate levels were unrelated to age of onset of the disease. As vitamin B12 levels were statistically unrelated to chronicity of illness, these findings suggest a specific association between the timing of onset of first neurological symptoms of MS and vitamin B12 metabolism. In addition, since vitamin B12 is required for the formation of myelin and for immune mechanisms, we propose that its deficiency in MS is of critical pathogenetic significance.
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Affiliation(s)
- R Sandyk
- NeuroCommunication Research Laboratories, Danbury, CT 06811
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Sandyk R, Awerbuch GI. Nocturnal melatonin secretion in multiple sclerosis patients with affective disorders. Int J Neurosci 1993; 68:227-40. [PMID: 8063528 DOI: 10.3109/00207459308994278] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The pineal gland has been implicated recently in the pathogenesis of multiple sclerosis (MS), a chronic demyelinating disease of CNS. Since nocturnal melatonin secretion is low in some groups of patients with mental depression, we predicted lower melatonin secretion in MS patients with history of affective illness compared to those without psychiatric disorders. To test this hypothesis, we studied single nocturnal plasma melatonin levels and the incidence of pineal calcification (PC) on CT scan in a cohort of 25 MS patients (4 men, 21 women; mean age = 39.4 years, SD = 9.3), 15 of whom had a history of coexisting psychiatric disorders with predominant affective symptomatology. Other factors that may be related to depression such as vitamin B12, folic acid, zinc, magnesium, and homocysteine, were also included in the analysis. Neither any of the metabolic factors surveyed nor the incidence of PC distinguished the psychiatric from the control group. However, the mean melatonin level in the psychiatric patients was significantly lower than in the control group. Since low melatonin secretion in patients with depression may be related to a phase-advance of the circadian oscillator regulating the offset of melatonin secretion, we propose that the depression of MS likewise may reflect the presence of dampened circadian oscillators. Furthermore, since exacerbation of motor symptoms in MS patients may be temporally related to worsening of depression, we propose that circadian phase lability may also underlie the relapsing-remitting course of the disease. Consequently, pharmacological agents such as lithium or bright light therapy, which have been shown to phase-delay circadian rhythms, might be effective in the treatment of affective symptoms in MS as well as preventing motor exacerbation and hastening a remission from an acute attack.
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Affiliation(s)
- R Sandyk
- NeuroCommunication Research Laboratories, Danbury, CT 06811
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Affiliation(s)
- D Benton
- Department of Psychology, University College, Swansea
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