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In addition to providing L-carnitine, it provides acetyl groups that may be used in the formation of the neurotransmitter, acetylcholine

Common symptoms include: Hematologic : Macrocytic (megaloblastic) anemia Pallor and shortness of breath on exertion Neurological : Paresthesias (tingling, pins and needles) in hands and feet Gait disturbances and balance problems Cognitive changes: memory lapses, brain fog, mood swings Gastrointestinal : Glossitis (inflamed tongue) Appetite loss and weight changes Nausea or diarrhea Because the nervous system can be permanently damaged if deficiency persists, early detection and correction are paramount

[9,18] Although pharmacologic approaches are the most important treatment strategies for MDD, response rates to the first-line antidepressants are moderate and remission is observed in about 3045% of patients

Barha et al., 2011