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A recent meta-analysis found treatment with metformin to be significantly associated with an increased incidence of vitamin B12 deficiency and reduced serum levels.8 It is therefore possible that the etiology in this case may have been twofold

In addition, the hypothalamus is anatomically and functionally related to the pituitary gland (or hypophysis), a bean-sized organ suspended from it by a stem called the infundibulum (or pituitary stalk)

This creates a pharmacokinetic advantage: higher hippocampal exposure with lower systemic exposure reduces the risk of peripheral side effects while maintaining therapeutic receptor activation

How this translates when combined with prescription blood thinners remains unknown

Omics approaches open new horizons in major depressive disorder: from biomarkers to precision medicine