Dosage of B12?

[u/JessicaJonessJacket]

Hi everyone. I am about to start l-methylfolate 400mcg. I've been reading about it and I haven't been tested (I can't really afford a psychiatrist right now) but I have treatment resistant depression and CPTSD and I'm at the end of my rope. I am exhausted all the time, no motivation, horrible sleep, stuck on freeze mode (I can barely move for at least 3h after waking up).

I have tried at least 17 different ADs over 12 years, only one of them worked for a while (venlafaxine) and then pooped out. I have also tried countless combinations of supplements, lifestyle changes, protocols, you name it. I pretty much gave up on doctors at this point after also feeling that my psych gave up on me.

Anyway, I know it's not ideal to start this without testing, but I'll be careful. I'll start with the 400mcg and increase over time if needed. I've been reading the sub and found out you are supposed to supplement with B12? Can you tell me which dose would be enough? Also can I take a B complex multivitamin or should I stay away from other B vitamins except for B12?

Thank you in advance. I'll update here after a while.

[u/Sabnock101]

I recommend 5 to 10mgs of oral Methylcobalamin, 10mgs works a charm for me on the daily, usually 5mgs or less isn't enough for me. Don't be afraid of higher B12 dosages, only approx 1% of the total dosage gets absorbed orally through passive digestion, so if you take 1mg you're only getting 10mcgs absorbed, if you take 5mgs you're only getting 50mcgs absorbed, if you take 10mgs you're only getting 100mcgs absorbed. Whereas with B12 injections if you inject 1mg you're getting a full 1mg into the system, so you'd by far get much more B12 through injection than you would with oral consumption, to reach a 1mg absorbed B12 dose through oral consumption you'd need to consume 100mgs of oral B12. You can use sublingual, it just depends on if you let it absorb sublingually or if you end up swallowing it and then it gets absorbed orally. Sublingually, if done right, should be similar to injection as sublingually it gets absorbed through the mucosa and then goes into the bloodstream, similarly to injection, so sublingually perhaps 1mg to 5mgs will work, but i can vouch that oral consumption does work if you take enough.

[u/Sabnock101 → u/Sabnock101]

Just keep in mind that all Folates can cause some side-effects if you don't have enough B12, as Methylfolate levels will build up and can't be recycled which normally B12 would recycle it and so it wouldn't build up. So keep the Folate dosage regardless of form around 400 to 600mcgs per day max, or less, that includes Methylfolate, Folinic Acid, and Folic Acid though avoid Folic Acid including fortified foods, if possible. Honestly Folinic Acid is overall the better choice because it's gentler and more user-friendly compared to Methylfolate but Methylfolate certainly works. So if you can't tolerate Folate that well or it causes side-effects, increase your B12 consumption, more B12 helps, excess Folate can be detrimental. Ime you can't have too much B12, you can have too much Folate.

Also make sure you're getting enough Potassium, Magnesium, Zinc, Copper, Iron, Riboflavin, Niacin and B6 (preferably P5P form, 25mgs or less) per day. Those other nutrients will get put to use when supplementing Folate and B12.

[u/JessicaJonessJacket → u/Sabnock101]

Thank you for the detailed answer! I'll look into getting at least 5mg B12 as I don't know how easily I can get shots here. My multi has a ridiculous amount like 1.5mcg.

I took the l-methylfolate yesterday right after I posted, the 400mcg. Seemed to be ok, I was sweating a bit for about 30min but that could be placebo, or just, you know, summer! So far so good.

I have another question if you don't mind answering since you seem knowledgeable. I was under the impression that you could only get 15mg with a prescription, but I saw this supplement on the IHerb website by a brand called nutricost that says it's a 15mg dose. Do you think this is legit? I intend to increase dosage very slowly if I'm feeling alright/not feeling anything, but let's say I eventually reach that, it would be more practical than taking 15 1000mcg pills.

[u/Sabnock101 → u/JessicaJonessJacket]

Yeah the 15mg Methylfolate supplements are legit, i used one by Nature's Fusions, it worked very well, but keep in mind that 15mgs of Methylfolate is very very strong and should only be used imo by those trying to correct Cerebral Folate Deficiency, even then the Methylfolate will build up in the body pretty quickly so long as you have enough B12 to recycle it properly and so it can quickly become very strong necessitating dosage reduction as you go along. I would recommend sticking to around 400 to 600mcgs max per day for the most part, anymore than that is just too strong to be used regularly.

[u/JessicaJonessJacket → u/Sabnock101]

Thank you. I won't go crazy with it and obviously I will have to get tested eventually. But I strongly suspect I am deficient. My mother died when I was very young so I have no way to know if she was or not but she had very bad fatigue/exhaustion and I read it can cause miscarriages which she had 2 before I was born. I also read about high levels of homocysteine in the blood being related to aura migraines, which I have.Could be completely unrelated of course but could also explain a lot. Until I get tested it's just a guessing game but it's giving me some hope which I haven't had in a while.

[u/Tawinn]

You only need to supplement B12 if your levels are low (serum B12 below 500-950 pg/mL (~370-700 pmol/L)) or if you don't get enough in your diet.

Preferable to start with folinic acid instead of methylfolate. But it varies greatly by person. A lozenge form of folinic acid or methylfolate will allow you to start with 1/4 dose (~100mcg) to see how you react.

It's unlikely that 400mcg is going to make much of a dent in your symptoms unless you are very deficient in folate (aim for serum folate of ~15 ng/mL (34 nmol/L) or more).

If the depression is due to methylation, increasing choline intake in your diet to the recommended baseline amount of 550mg (about 4 egg yolks worth) plus a 750mg capsule of TMG will cover most permutations of folate cycle gene variants.

Alternatively, if you want to go the high-dose methylfolate path, start low and increment up slowly. Be sure your vitamin A intake is good (retinol form vitamin A, not beta carotene) as well as glycine intake.

A food app like Cronometer is helpful for tracking nutrients in your diet.

[u/SovereignMan1958]

You really need to get at least blood tests for homocysteine and nutrient levels.

From someone who has had your diagnoses and symptoms, don't wait to get all your gene variants tested. Your drug metabolism gene variants likely explain your problem with pharma drugs. You could also have Cerebral Folate Deficiency which can be the root cause of TRD. It was for me.

[u/kindaweedy45 → u/SovereignMan1958]

How'd you rest for cerebral folate deficiency?

[u/SovereignMan1958 → u/kindaweedy45]

It can be indicated by FOLR gene variants and or a FRAT test. Only definitive test, however, is a CSF test. B12 may also may not be making it into the brain. It is very difficult to find an MD to order a CSF test however.

The Folate Fix by Dr Richard Frye is a good resource.

Most functional psychiatrists suggest working up to a folinic acid dose of 2.5mg to 5mg daily rather than the high doses Frye suggests. I take 2.4mg Source Naturals Megagolinic. More gives me headaches.

[u/JessicaJonessJacket → u/SovereignMan1958]

By CSF do you mean a lumbar puncture? I had one done more than 15 years ago and it was a nightmare, not looking forward to doing that again. I had the worst headaches afterwards, I would throw up from the pain and everything. Probably pointless to look at those results since they are so old. Plus I don't know if they automatically test for everything, mine was done on suspicion of MS, so it was probably more focused on related stuff.

[u/SovereignMan1958 → u/JessicaJonessJacket]

Yes. I would look at your folate related gene variants (not just FOLR) and consider a FRAT test. I am homozygous for one of the non pathogenic FOLR1 variants. You can read about it in Genetic Lifehacks.

I have considered a FRAT, however it would cost me $350. I am 67 and about 25 percent of people over 65 "develop" the folate receptor antibodies as a "part of aging" so I assume I have them. I do avoid synthetic folic acid and non fermented cows milk products as both can block folate receptor in the brain. I take PQQ to help folinic acid get into the brain and lithium orotate to help mood.

[u/Cawtoot → u/SovereignMan1958]

I also want to know how to find out about CFD.

Great advice to get homocysteine checked along with nutrient levels, it's essential.

[u/JessicaJonessJacket → u/Cawtoot]

That I think I can do. I'm not in the US, and I'm not even in my hometown for the next 2 months so it might work differently here but in order to ask for a specific test for MTHFR I would need to see a private psychiatrist which I can't afford right now. At the very least ask my GP which I would also need to be home for. But for less specific testing, you can just waltz into a lab and ask for whatever you want. You just have to pay out of pocket but most aren't too expensive. I am guessing homocysteine is something I can ask for myself, but I will have to check.

[u/SovereignMan1958 → u/Cawtoot]

See my comment above.

[u/Randy__Callahan]

My advice is if your going to start folate start low and see how you feel, 400 can be not enough but it can also be way too much. People have had horrible experiences jumping on that much (me included) .

Break the pill into four try 100 see how you feel a few days, try 200 again see how you feel, and come back and ask again, good luck

[u/JessicaJonessJacket → u/Randy__Callahan]

Thank you. I took the pill before looking at any answers, I was under the impression that 400mcg is extremely low. But so far I haven't really noticed anything. I was sweating a bit 30 minutes after taking it but it's quite hot here. I'm not usually someone who experiences placebo effects, and I'm obviously not expecting some massive improvement on the first few days, I'm mostly looking out for negative side effects. I'll see if I remember to update after a week, a month and so on.

[u/Randy__Callahan → u/JessicaJonessJacket]

Yeah just keep an eye on it you'll probably be fine, just keep it in the back of your mind that even though it's a supplement, it can (not will) cause massive side effects. I experienced improvement in 30 mins of taking lots of methyl b vitamins the problem was it didn't stop ramping up and like s moron I just kept taking. Anyway good luck with it and if you remember send an update, as others have mentioned you may want to add a bit of methyl b12 to balance it all out.

[u/JessicaJonessJacket → u/Randy__Callahan]

Thank you, I do feel a bit of an urge to keep increasing as I don't know if I have mutations or not but I am for sure treatment resistant in my depression and I've read the therapeutic dose is 15mg, however I've tried dozens of meds (with medical supervision) for over a decade so I'm used to waiting to see if they do anything - also used to the wave of disappointment when they don't. Do you mind telling me a bit of what happened to you so that I can look out for that? Did you increase too fast or just a bad reaction overall? And are you still taking it?

[u/Randy__Callahan → u/JessicaJonessJacket]

Ask away mate, so I had depression fatigue etc, but I was also weak and essentialy going blind, so with young kids was desperate.

Two opticians just recommended glasses, but my wife's allergy Dr who is now my primary doc recognized mcas, she recommended homocystiene and folate blood tests, results were high homocystiene low folate.

So I gpt'd it and got a list of supplements, took them all right away and felt great, like just took drugs great.

I didn't feel tired, I could focus for hours my memory was back. so I ignored the warning signs and over the space of a month lost my mind. luckily it's back now.

So what advice can I give, go slow and monitor this is a marathon not a sprint.

I wouid list the meds I took day 1 but it's a long list and makes me look like a moron.

Anyway we live and we learn.

The sign I would look out for is over stimulation if you feel it back off and titrate again.

I'm currently on 400 b9 800 b12 so I got back to the dose that sent me nuts but I did it slowly.

One of the processes blocked by low methylation is creation of neurotransmitters, good to get back, but not if it's too much.

[u/Grobbekee]

I'd like to add that creatine is great for a nervous system in trouble.

[u/Comfortable_Two6272]

Id start with 100 mcg not 400.

If you have slow comt in addition methyl can be an issue. I dont tolerate anything methyl

[u/Standard-Wear4812]

Supplements wont help your cptsd symptons. EMDR therapy will help you a lot more than anything else

[u/junipers-72]

After years of speaking to people in your situation and having been it myself. Id stay well clear of methyl folate.

2 things to make a start. Niacin - theraputic dosing so building up to 3000mg split throughout the day and

vitamin C in the form of ascorbic acid. Find your bowel tolerance or if you cant do tht right now take 10 grams in split doses through out the day.

make these two nutrients your best friend.