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One of the main problems associated with low levels of vitamin B12 is elevated levels of methylmalonic acid (MMA) which is toxic to neurons (Ganji 2012)

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Monitoring is especially helpful during dose changes, since the bodys response can shift during those transitions

If depressive symptoms emerge, dose adjustment or medication discontinuation should be considered rather than persisting through potentially serious mood disturbance

Thyroid 34:295313 Hadrup N, Ravn-Haren G (2023) Toxicity of repeated oral intake of organic selenium, inorganic selenium, and selenium nanoparticles: a review