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Importantly, folic acid should not be given alone before B12 deficiency is excluded or treated, as this can mask anaemia while allowing neurological damage to progress

[116] Long-term maintenance therapy may be appropriate for patients with recurrent depression or those at high risk for symptom recurrence

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A thorough clinical evaluation is essential to identify the actual cause

Expected 12-month results include 15 to 20% body weight loss (35 to 55 pounds for a 250-pound person), 4 to 6 inch waist circumference reduction, dramatic improvement in body shape and clothing fit, and substantial improvement in metabolic health markers