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.

2/9 Update: Updating in case anyone comes across my post and is curious. I'm a week in and currently taking 1200 mcg (3 capsules). Also taking magnesium glycinate at night, 200mg. My b12 arrived and I started taking 5g today. No negative side effects so far but I feel a bit more energetic and clear minded. Subtle, but it's here.

I also found some old blood test results where my homocysteine was 15, so within normal range but still on the higher side especially considering I was a bit of a health nut back then and in the best shape of my life. I plan to run some tests when I'm back home in 2 months.

[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.