Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Suite C8-193, Los Angeles, CA, 90024, USA.
Private Practice, Berkeley, CA, USA.
Curr Psychiatry Rep. 2024 Jun;26(6):265-272. doi: 10.1007/s11920-024-01505-4. Epub 2024 May 2.
Vitamin B (B12, cobalamin) deficiency has been associated with neuropsychiatric symptoms, suggesting a role for B12 supplementation both as a treatment for psychiatric symptoms due to B12 deficiency and as an augmentation strategy for pharmacological treatments of psychiatric disorders. This critical review discusses the major causes of B12 deficiency, the range of psychiatric and non-psychiatric manifestations of B12 deficiency, the indications for testing B12 levels, and the evidence for B12 supplementation for major psychiatric disorders.
We find that high-quality evidence shows no benefit to routine B12 supplementation for mild depressive symptoms or to prevent depression. There is very limited evidence on the role of B12 supplementation to augment antidepressants. No high-quality evidence to date suggests a role for routine B12 supplementation in any other major psychiatric disorder. No formal guidelines indicate when clinicians should test B12 levels for common psychiatric symptoms, in the absence of major risk factors for deficiency or cardinal symptoms of deficiency. No robust evidence currently supports routine B12 supplementation for major psychiatric disorders. However, psychiatrists should be aware of the important risk factors for B12 deficiency and should be able to identify symptoms of B12 deficiency, which requires prompt testing, medical workup, and treatment. Testing for B12 deficiency should be considered for atypical or severe psychiatric presentations.
维生素 B（B12、钴胺素）缺乏与神经精神症状有关，这表明 B12 补充剂既可以作为治疗因 B12 缺乏引起的精神症状的一种方法，也可以作为精神障碍药物治疗的一种增效策略。这篇批判性综述讨论了 B12 缺乏的主要原因、B12 缺乏的各种精神和非精神表现、检测 B12 水平的指征以及 B12 补充剂治疗主要精神障碍的证据。
我们发现，高质量证据表明，常规补充 B12 对轻度抑郁症状或预防抑郁没有益处。B12 补充剂辅助抗抑郁药的作用的证据非常有限。迄今为止，没有高质量的证据表明常规补充 B12 对任何其他主要精神障碍有作用。目前没有正式的指南表明，在没有缺乏的主要危险因素或缺乏的典型症状的情况下，临床医生应何时因常见精神症状而检测 B12 水平。目前尚无强有力的证据支持常规补充 B12 治疗主要精神障碍。然而，精神科医生应该了解 B12 缺乏的重要危险因素，并能够识别 B12 缺乏的症状，这需要及时进行检测、医学检查和治疗。对于非典型或严重的精神表现，应考虑检测 B12 缺乏症。
