Catatonic depression? Could be just a vitamin deficiency

Hindustan Times | By, New Delhi
Mar 22, 2015 06:26 PM IST

Frequent bouts of nerve-racking anxiety, catatonic depression and stuporous lethargy can be triggered by a complex interplay between unrelenting work and social pressures. Or they could simply be a result of dietary omissions.

Catatonic depression? Could be just a vitamin deficiency.


Frequent bouts of nerve-racking anxiety, catatonic depression and stuporous lethargy can be triggered by a complex interplay between unrelenting work and social pressures. Or they could simply be a result of dietary omissions.

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Most Indians are deficient in Vitamin B12, which is found in eggs, fish, meats and dairy products and is essential for the formation of red blood cells and for nerve function. If untreated, a vitamin B12 deficiency can cause anaemia and irreversible nerve and brain damage, which is most pronounced in people over 65.

This deficiency is not unique to India. A systemic review of 40 published scientific papers published in the European Journal of Clinical Nutrition last year reported that the vitamin B12 deficiency prevalence was 45% in infants, 0 to 33.3% in children and adolescents, 17 to 39% and 0-86.5% in adults, including those over 65 years. Higher deficiency was reported in vegetarians than omnivores. The study recommended that all vegetarians, regardless of their diet, should be screened for vitamin B12 deficiency.

Frequent infections from gut-bacteria such as H Pylori further lower absorption of this critical vitamin among Indians, leading to deficiency.


People with chronic vitamin B12 deficiency eventually develop pernicious anaemia, an auto-immune condition in which people cannot produce enough intrinsic factor, a compound secreted from the lining of the stomach that is needed to absorb vitamin B12 in the intestines. This leads to chronic B12 deficiency. People with pernicious anaemia may need booster injections of B12 every three to six months for the rest of their lives.

While low levels affect mood, severe deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence and loss of taste and smell, reported the New England Journal of Medicine.

The deficiency also accelerates brain decline as you age. People over 65 years with low-vitamin B12 are more likely to have memory problems, cognitive decline and shrinkage in brain volume, reported scientists in the journal Neurology 2012. MRI scans of the brains showed that seniors with four of five vitamin B12-deficiency markers are much more likely to do poorly in brain function test and have smaller total brain volumes than their counterparts with no vitamin B12 deficits.

Disorders that interfere with food absorption, such as celiac or Crohn's disease, can cause B12 trouble. People who have had weight-loss surgery or other surgeries that involve partial removal of the intestine are also likely to need supplementation, as do people using heartburn drugs, which reduce acid production in the stomach needed to absorb vitamin B12.

Another group that must get tested for vitamin B12 are diabetics who are on the commonly-prescribed medicine metformin. The blood glucose-regulating medicine is an established risk factor for vitamin B12 deficiency, but very few diabetes patients are informed about it when they are put on treatment. Those who are often forget; so it is essential for diabetics to have their vitamin B12 levels checked once a year.


Those who eat eggs, dairy, fish and meats regularly rarely have B12 deficits unless they have had a surgery or an autoimmune disorder that leads to poor absorption of the vitamin. As with most vitamin deficiencies, however, those with a deficiency develop symptoms in the initial stages, so it's recommended that everyone gets their blood tested at least once for vitamin B12 levels - the normal values are 200 to 900 picograms per millilitre (pg/mL) - and then use the reading as a baseline to follow up every few years.

In people with severe anaemia, intrinsic factor antibody levels in the blood should also be measured to determine whether a person has pernicious anaemia.

Vitamin B12 deficiency is very easy to fix and is treated using an activated form of the vitamin. Hydroxocobalamin, an active form of vitamin B12, injections given in a muscle two to three times a week boosts levels very quickly, with most people building adequate stores of the vitamin after about six shots. Dosing is typically 1000 mcg to 5000 mcg given two to three times a week for one to two months, depending on the deficiency and the person's response to the treatment.

Most people with acute deficiency notice a boost in energy and mood within days of starting treatment. For those with mild deficiency, a standard multivitamin is usually enough, but if you still feel down and out, consider testing and treating the deficiency to get your health and happiness back on track.

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    Sanchita is the health & science editor of the Hindustan Times. She has been reporting and writing on public health policy, health and nutrition for close to two decades. She is an International Reporting Project fellow from Paul H. Nitze School of Advanced International Studies at the Bloomberg School of Public Health and was part of the expert group that drafted the Press Council of India’s media guidelines on health reporting, including reporting on people living with HIV.

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