- Psychotic depression carries high morbidity, mortality, and suicide risk yet remains frequently underdiagnosed.
- Vitamin B12 deficiency may mimic, trigger, or worsen depressive, psychotic, and catatonic symptoms even without anaemia, complicating diagnosis.
- Combined vitamin B12 supplementation with antidepressant and antipsychotic therapy yielded clinical improvement; screen B12 in atypical or treatment resistant psychiatric cases.
Rev Med Liege. 2026 Sep;81(9):550-556.
ABSTRACT
Psychotic depression is a high-risk clinical entity associated with increased morbidity, mortality, and suicide risk, yet it remains frequently underdiagnosed. We report the case of a patient hospitalized for a depressive episode that evolved into psychotic symptoms and a catatonic episode in the context of vitamin B12 deficiency without anemia. This case highlights the difficulty of differentiating psychotic depression from neuropsychiatric manifestations related to cobalamin deficiency, which may mimic, trigger, or exacerbate depressive, psychotic, and catatonic symptoms. Diagnostic investigations revealed vitamin B12 malabsorption associated with neurological involvement. Combined treatment with vitamin B12 supplementation and antidepressant-antipsychotic therapy led to clinical improvement. This vignette underscores the importance of targeted screening for vitamin B12 deficiency in atypical, treatment-resistant, or neurologically associated psychiatric presentations.
PMID:42751846
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