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Women were stratified into two groups: Stratum I: no concomitant use of osteoporosis therapy or Stratum II: baseline concomitant use of osteoporosis therapies, which included calcitonin, raloxifene, tamoxifen, and hormone replacement therapy, but excluded other bisphosphonates

For instance, some individuals may experience side effects or have an immune system response that causes them to feel unwell temporarily

Most patients begin noticing changes around weeks 4-6, with more significant results by weeks 8-12

Multiple observational studies have found that individuals with low B12 are significantly more likely to report depressive symptoms, and intervention studies show that correcting the deficiency improves mood outcomes sometimes substantially

Individuals on certain medications : Medications like proton pump inhibitors, metformin, or H2 receptor antagonists can interfere with B vitamin absorption