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A 2025 JAMA Neurology trial (n=1,500) demonstrated a 15-20% reduction in Hamilton Depression Rating Scale (HDRS) scores in deficient adults (serum B12 200 pg/mL and methylmalonic acid (MMA) 0.4 mol/L), with higher doses compensating for poor absorption or severe symptoms like megaloblastic anemia and neuropathy

I would recommend lipotropic B12 injection

[7] All potential female patients are screened and counseled on this point, and effective contraception is recommended for those undergoing NAD+ therapy if applicable