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Duration of treatment depends on the underlying cause: Lifelong therapy is required for pernicious anaemia or irreversible malabsorption (e.g., after gastrectomy) For dietary deficiency without malabsorption, treatment may be reviewed once deficiency is corrected and neurological symptoms have resolved Oral B12 supplementation is generally not recommended for patients with neurological symptoms, particularly when pernicious anaemia is the cause

In the UK, hydroxocobalamin is the preferred formulation, typically maintaining therapeutic levels for 8 to 12 weeks

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Other studies have shown issues with the ability of the enzyme dopamine beta hydroxylase which catalyzes dopamine into norepinephrine and the norepinephrine transporter enzyme which is involved in the reuptake of norepinphrine into the synaptic terminals (13, 14)