From the Guidelines
Vitamin B12 injections can precipitate panic attacks and derealization in patients with genetic variations in MTHFR and COMT due to the potential overstimulation of the nervous system and temporary imbalance in neurotransmitters, particularly serotonin and dopamine. The mechanism behind this reaction is complex and involves the interplay between vitamin B12, folate, and the body's methylation cycles. According to the British Obesity and Metabolic Surgery Society guidelines 1, vitamin B12 deficiency should be treated immediately, and the recommended treatment involves hydroxocobalamin injections. However, in patients with genetic variations in MTHFR and COMT, this rapid increase in B12 levels may disrupt the delicate balance of neurotransmitters, leading to adverse reactions such as anxiety, panic, and derealization.
Some key points to consider in this context include:
- The importance of excluding vitamin B12 deficiency before treating folic acid deficiency 1
- The potential for folic acid supplementation to mask severe vitamin B12 depletion 1
- The need for urgent specialist advice from a neurologist and haematologist in cases of vitamin B12 deficiency with possible neurological involvement 1
- The recommended treatment regimen for vitamin B12 deficiency, which involves hydroxocobalamin injections 1
In patients with genetic variations in MTHFR and COMT, it may be necessary to adjust the treatment approach to minimize the risk of adverse reactions. This could involve:
- Starting with lower doses of vitamin B12 and gradually increasing as needed
- Using oral supplements instead of injections
- Supporting the methylation pathway with appropriate cofactors like folate
- Monitoring the patient's response to treatment and adjusting the approach as needed to minimize adverse reactions.
From the Research
Mechanism of Vitamin B12 Injections and Panic Attacks
- The exact mechanism by which vitamin B12 injections may precipitate panic attacks and derealization in patients with genetic variations in Methylenetetrahydrofolate Reductase (MTHFR) and Catechol-O-Methyltransferase (COMT) is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, it is known that vitamin B12 plays a crucial role in the synthesis of neurotransmitters, such as serotonin and dopamine, which are involved in mood regulation 4.
- Genetic variations in MTHFR and COMT may affect the metabolism of these neurotransmitters, potentially leading to an increased risk of panic attacks and derealization 4.
- Additionally, vitamin B12 deficiency has been associated with psychiatric symptoms, including depression, mania, and psychosis, which may be related to the development of panic attacks and derealization 2, 4.
Potential Side Effects of Vitamin B12 Injections
- Vitamin B12 injections can cause side effects, including anaphylactic reactions, which may be related to the development of panic attacks and derealization 5.
- However, the provided studies do not specifically address the relationship between vitamin B12 injections and panic attacks or derealization in patients with genetic variations in MTHFR and COMT.
Diagnosis and Treatment of Vitamin B12 Deficiency
- Vitamin B12 deficiency can be diagnosed through blood tests, including measurements of serum cobalamin, methylmalonic acid, and homocysteine 2, 3, 6.
- Treatment of vitamin B12 deficiency typically involves supplementation with vitamin B12, either through oral or intramuscular injections 2, 3, 6.
- However, the provided studies do not address the specific treatment of panic attacks and derealization in patients with genetic variations in MTHFR and COMT.