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Key signs include: Peripheral neuropathy: tingling or numbness in the hands and feet Mood changes: irritability, anxiety, depressive symptoms Fatigue and weakness: beyond what caloric restriction alone explains Skin rashes: seborrheic dermatitis, particularly on the face and scalp Cracked lips and mouth corners: a condition called cheilosis Impaired immune function: more frequent infections than usual Confusion or difficulty concentrating: related to impaired neurotransmitter synthesis If you are on tirzepatide and experiencing persistent tiredness , anxiety , or body aches that do not resolve with standard management strategies, it may be worth having your B6 levels tested