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Patients frequently experience: Fatigue and generalised weakness that persists despite adequate rest Breathlessness on exertion due to anaemia Palpitations and reduced exercise tolerance Pallor of the skin and mucous membranes These symptoms result from megaloblastic anaemia, where impaired DNA synthesis leads to the production of abnormally large, dysfunctional red blood cells with reduced oxygen-carrying capacity

Interestingly, we observed that as age increased, the risk of incident depression decreased which has been reported previously (Reference Briggs, McCarroll and OHalloran20)

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Unsupported diagnoses often trigger denials