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Most experienced users implement cycling protocols with breaks between treatment periods as a precautionary measure, though no specific problems with extended use have been identified

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Invest Ophthalmol Vis Sci

Deficiency leads to megaloblastic anaemia (pernicious anaemia), causing fatigue and weakness

For example, referral to psychiatrists may be helpful since ME/CFS seems to coexist with anxiety disorders, symptoms of ME/CFS overlap with Major Depressive Disorder (MDD), and patients with severe ME/CFS may also be at risk of developing secondary MDD (36, 532)