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For optimal results, we typically combine B12 injections with other evidence-based SAD interventions such as light therapy and appropriate physical activity

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This may apply when the biopsy is taken from a different anatomical site or when it is clinically independent of the primary service

In humans, cyanocobalamin must undergo intracellular enzymatic conversion to the active coenzyme formsmethylcobalamin and adenosylcobalaminwhich, depending on the pH environment, can interconvert with hydroxocobalamin (Gherasim et al., 2013), the most common B12 form in both food and human plasma (Obeid et al., 2015)