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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

A further indication for this route is where patient compliance is a problem and depot preparations may be useful

To make this really real, I had a patient who was in the Marines and served at Secret Service for several White Houses, and he had a lot of osteoporosis, osteopenia, and bone loss