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These nerve-related changes can occur even without anemia being present, which means standard blood counts alone may not catch a developing deficiency

Fatigue accompanied by anhedonia, sleep disturbances, or changes in appetite beyond those expected from the medication warrants evaluation for depression, potentially using validated screening tools like the PHQ-9

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B12 injections supply vitamin B12 as methylcobalamin or cyanocobalamin, typically given intramuscularly into the deltoid, supporting red blood cell formation, myelin and nervous system health, and the metabolism of homocysteine, a process that can falter with vegan diets, malabsorption, or medications like metformin

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