A few years ago, a very sad young woman entered my office, ushered by her mother. She wasn't just depressed, she was also paranoid and had started to become delusional. She recognized this decline and was frightened by it. She didn't understand why it was happening. She had been a happy child up to her teens. Then she moved to a town and a new school and she just didn't seem to be able to bounce back despite her assertion that "nothing really horrible had ever happened to me". She did reasonably well in high school and participated in different activities, though she was becoming increasingly withdrawn.
Her concerned parents sought counseling help for her and when that didn't help, they agreed to medication. Conventional anti-depressants designed to increase the mood-enhancing neurotransmitter, serotonin, did nothing. She got some marginal help from bupropion (Wellbutrin) which also affects norepinephrine and dopamine levels. Her mom tried providing a healthy diet and used supplements such as 5HTP and even St. John's Wort, but still the depression marched on. Her mom would find this young woman in her bedroom with the lights off crying and rocking back and forth inconsolable. Finally, her mom had brought her to my office because she didn't know where else to go. She had tried all the other options. It was as if there something blocking her ability to stabilize her mood. This young woman has pyroluria.
What is pyroluria?
Pyroluria is a genetic condition that causes anxiety, depression and withdrawal most often starting in late-teens and continuing throughout the person's life. It can be very severe or very mild and very much affected by levels of stress. It's onset usually occurs with a traumatic incident such as going away to college or to the army, parental divorce or death of a loved one. There may be severe depression, schizophrenia, alcoholism, autism, bipolar disorder (manic-depressive disorder) or on rare occasions, DID (dissociative identity disorder more commonly known as multiple personalities) in the family tree. All of these are different manifestations of pyroluria.
Pyroluria is a blood disorder. When the body produces hemoglobin, a constituent of red blood cells, there is a byproduct called kryptopyrroles. Normally harmless, in this group of people the kryptopyrroles multiply too rapidly and block receptor sites for B-6 (pyrodoxine) and zinc leading to a serious deficiency of these two nutrients. Among other things, B6 and zinc directly help maintain a healthy emotional state.
Though pyroluria was identified over 40 years ago, it has only been recognized as a medical condition for about 10 years and many mental health practitioners are not taught about it in school. People with pyroluria don't respond well to common anti-depressants such as SSRIs and are often suicidal. It's wide-spread and estimates as high as 20% of all psychiatric patients and 40% of people with schizophrenia have pyroluria. It seems to affect women more than men. And the sad truth is that most people with pyroluria go undiagnosed.
Along with the emotional instability, pyroluria causes a multitude of physical problems. See the pyroluria quiz for these physical symptoms as they may help the person or her practitioner point to this diagnosis.
A more conclusive way to determine if you have pyroluria is a simple urine test which can be ordered with or without a doctor's prescription. While there are several labs that do this test, Bio Center Laboratory 1-800-494-7785 is especially well-known for its accuracy. In my experience, this test is more accurate in those who eat poorly and don't take B6 or zinc in any form including multi-vitamins. The lab recommends avoiding B6 and zinc for 7-10 days prior to taking the test, but I find that those who eat a nutritious diet still test borderline even though they see a dramatic improvement with treatment. This lab test runs about $73.00, shipping included if you are inside the United States.
Caution. Even if you think you have pyroluria, please do not start on the B6 and zinc without getting the test done. These are extremely high doses of B6 and may cause problems in those who are not pyroluric. Specifically, these large doses of zinc will lead to dizziness, nausea and anemia.
Recovering and controlling the pyroluria is not just a matter of taking B6 and zinc. The deficiency of these two nutrients lead to many secondary deficiencies such as manganese that will also need to be addressed. The encouraging thing about pyroluria is that the typical patient sees a great improvement within 24-72 hours, though it may take 3-6 months to reach a consistently stable level. Because of the varying presentations and severities of pyroluria, each person does best with a treatment plan specifically tailored to him. In my practice, this includes not just B6 and zinc, but classical homeopathy, herbs and diet to address the condition more comprehensively. Having a practitioner monitor this plan treatment to recognize symptoms over or under-dosing is essential.
Part of the pyroluria picture is less-than-optimal digestive health. If the person has had pyroluria for long enough or it's particularly severe, he may not be able to absorb B6 and other nutrients that are necessary through pills. These people take massive amounts of pills daily and don't see an improvement. I routinely offer injections to start the treatment process or prescribe a high quality liquid form of active B6 for the patient to pick up at the local pharmacy. In addition, I help the patient improve the health of their intestines so they can eventually absorb B6 and zinc through pills.
While pyroluria is a life-long condition, it doesn't have to control the person. The young woman I discussed earlier is happily re-engaged in life. And while she never forgets taking her B6 and zinc, she no longer has depression or delusional thoughts. In fact, when I last saw her, I asked about the rocking in the dark. She looked at me quizzically and said "did I really do that?".
Do you have pyroluria?