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A diagnosis of MDD requires five or more of the following symptoms during the same two-week period: Depressed mood most of the day, nearly every day Loss of interest or pleasure in nearly all activities Significant changes in sleep or appetite Fatigue or loss of energy Feelings of worthlessness or excessive guilt Difficulty concentrating or making decisions Thoughts of death or suicide MDD is episodic

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Vitamin B12 deficiency neurological syndromes: a clinical, MRI and electrodiagnostic study

As described by Cant et al