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Laboratory findings of markedly elevated B12 levels discovered incidentally should prompt GP review, particularly if you are not taking supplements

91 Evidence in patients with depression without concomitant other psychiatric disorders is limited, but NAC appears to improve depressive symptoms associated with other disorders, including BD, trichotillomania, tobacco addiction and PTSD

These patients need individualized copper and liver monitoring with shorter follow-up intervals

We recommend storing serum for further analysis including MMA, or holotranscobalamin and intrinsic factor antibody analysis, and treating the patient immediately with parenteral B12 treatment