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Other factors include: Underlying cause of deficiency : Pernicious anaemia, malabsorption disorders, or dietary insufficiency may affect treatment response Medication use : Metformin and proton pump inhibitors can reduce gastrointestinal B12 absorption (though this does not affect the efficacy of intramuscular injections) Individual variation : Differences in how efficiently your body utilises the injected vitamin Adherence to treatment schedule : Missing injections or delaying maintenance doses can slow recovery Discussing these factors with your healthcare provider helps set realistic expectations for your treatment journey

Yes, it is always good practice to rotate injection sites

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Although it cannot yet be determined whether vitamin B 12 deficiency plays a causal role in depression, it may be beneficial to screen for vitamin B 12 deficiency in older individuals as part of a medical evaluation for depression