What is the cause of a panic attack and derealization the day after a Vitamin B12 (B12) injection?

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Last updated: March 14, 2025View editorial policy

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From the Research

A vitamin B12 injection is unlikely to be the primary cause of panic attacks and derealization the next day, as there is no high-quality evidence to support a direct link between vitamin B12 supplementation and these symptoms. However, it is possible that the injection may trigger anxiety symptoms in sensitive individuals due to its stimulatory effect on the central nervous system 1. Additionally, vitamin B12 plays a role in neurotransmitter synthesis, including those that regulate mood and anxiety like serotonin and dopamine, and a sudden increase in these neurotransmitters could disrupt the normal balance and trigger anxiety symptoms 2.

Some patients may also experience a paradoxical reaction to B12, where instead of feeling better, they experience increased anxiety, which is more likely in patients with pre-existing anxiety disorders or those sensitive to stimulants 1. The injection method itself delivers B12 rapidly into the bloodstream, which might cause a more pronounced effect compared to oral supplements 3.

If you've experienced this reaction, it is essential to consult with your healthcare provider before receiving further B12 injections. They might recommend a lower dose, switching to oral supplements, or addressing any underlying anxiety conditions first 4. It is also crucial to note that patient-centered care and treating patients with dignity and respect is a policy priority to reduce unsafe health behaviors, such as self-medication via injection 4.

Key considerations for healthcare providers include:

  • Being aware of the potential for anxiety symptoms in sensitive individuals
  • Monitoring patients for adverse reactions to vitamin B12 injections
  • Considering alternative treatment options, such as oral supplements, for patients who experience anxiety symptoms
  • Providing patient-centered care and addressing underlying anxiety conditions to reduce unsafe health behaviors.

References

Research

Vitamin B12 Supplementation in Psychiatric Practice.

Current psychiatry reports, 2024

Research

Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency.

The Cochrane database of systematic reviews, 2018

Research

Patient safety, self-injection, and B12 deficiency: a UK cross-sectional survey.

The British journal of general practice : the journal of the Royal College of General Practitioners, 2022

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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