Case report: Vitamin B12 deficiency and megaloblastic anemia with treatment-resistant depression and somatoform symptoms

Megaloblastic anemias are group of disorders that usually are caused by deficiency of vitamin B12 or folate. Vitamin B12 deficiency occurs with a wide range of symptoms of hematology، neurology، gastrointestinal or psychiatry. Untreated anemia prevents the appropriate treatment even if the patient be treated properly for psychiatric disorder، will be often having inadequate response or resistance to treatment. This paper presents a 33 years old woman who had experienced depression and mood lability and had been under psychiatric treatment with various psychiatric diagnoses such as borderline personality disorder، major depressive disorder and mood disorder NOS. During the six month before admission balance impairment، paresthesia، coldness and pain in lower limbs was gradually added to her symptoms. She was admitted to psychiatric hospital as a result of her suicidal thoughts and function disturbances. Complete blood count and serum B12 and folic acid levels were performed with suspicion to megaloblastic anemia. Following confirmation of diagnosis (low serum B12:90 pg ml) and treatment onset، symptoms disappeared dramatically within a few days. Patient was discharged from psychiatric hospital and in order to determine causes of megaloblastic anemia she was referred to an internist. Mental disorders are prevalent in cobalamin deficiency، so even in the absence of anemia or neurological symptoms of B12 deficiency، probability of megaloblastic anemia should be considered in atypical symptoms or psychiatric disorders، refractory to conventional treatments، fluctuating and uncommon symptoms.