I understand the protocol that Dr Amy suggests and totally 'get" the need to do the steps in the right order. I have been through all of this myself and have found Dr Amy's guidelines invaluable. I think I have every problem there is when it comes to lithium dumping and needing to be careful with B12. My question though, is to do with something different..... I am not questioning the protocol.........my observation is that the general recommendations do not refer to actual serum B12 levels... or, if they do, they refer to B12 being HIGH because of low Lithium not getting the B12 into the cells. My big concern is..... what if serum B12 is very LOW. Is there a problem adding in Lithium BEFORE B12 and driving the serum level of B12 even lower... and therefore exacerbating low B12 symptoms ( in this case severe depression ) My friend has severe depression not responding to meds. His B12 level is 120 and his Hair Lithium is <0.04 If he adds in Lithium with a B12 this low, will it make matters worse by lowering B12 further?