The patient is a man born 1921. He developed hypertension in 1980 and was treated with a betablocker (metoprolol, 50 mg daily) and a loop diureticum (bumetanid, 2 mg daily), and potassium, 750 mg daily.
A carcinoma of the prostatae was detected 1993. A distal venous thrombosis 1996 warranted temporary warfarin treatment. A pulmonary embolus in June 1996 warranted renewal of the warfarin therapy.
Half a year later, the patient had a brain infarct despite warfarin prophylaxis. He had a transient hemiparesis on his right side. CT demonstrated bilateral lacunar infarcts.
At check-up in April, 1999, no focal signs of neurological lesions could be found. According to his wife, the personality of the patient had changed. He was more moody, less patient.
In October, 1999, the patient was depressive and had lost 10 kg of body weight. He participated in a clinical trial. His depression scored 5 in the MADRS scale. His wife emphasized that the family history of the patient provided cases of vitamin B12 deficiency. One of the ten siblings of the patient had committed suicide due to depression.
The investigation demonstrated low serum cobalamins (70-78 pmol/L), serum folates within their reference ranges, and methylmalonic acid (2.3-3.0 nmol/L) elevated, upper reference range <0.37. Homocyseinte was elevated, 50 umol/L, approximately thrice its upper reference range.
As remission therapy, the patient got hydroxocobalamin (Behepan), 10 mg i.m. Maintenance therapy was then given with oral high-dose cyanocobalamin (Behepan), 1 mg daily. The cobalamin therapy was supported with oral high-dose folic acid (Folacin), 10 mg daily.
The patient was in a better shape at follow-up one month later. His depression had been reduced to score 1 of the MADRS scale. Homocysteine, 8 umol/L, and methylmalonic acid, 0.52 nmol/L, verified adequate clinical response.
The physician observed with satisfaction the anti-depressive effect of B vitamin therapy in the present patient.
Published July 18, 2000