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As of 2020, India had approximately 1469 STPs with a total treatment capacity of 31,841 MLD, while urban sewage generation reached 72,368 MLD, leaving over 50% untreated

Taking both together makes sense for most people, though folate status should be adequate before starting high-dose b12 to avoid masking folate deficiency

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High B12 levels in serum are associated with good treatment response, high homocysteine levels which are common in folate / B12 deficiency and in those suffering from depression are associated with poor response to anti depressant treatment [15-17]