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Clinically significant vitamin B 12 deficiency and megaloblastic anemia are unlikely, unless these drug therapies are prolonged for two or more years, or if in addition, the person's dietary intake is below recommended levels

Severe deficiency can cause deep depression, paranoia, delusions, incontinence, loss of taste and smell, and other neurological damage

Without comprehensive, long-term human studies, these questions remain unanswered

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Women taking tirzepatide have reported changes in cycle timing, flow intensity, and menstrual regularity