Depression and iron deficiency anemia

Anemia and depression: What is the link?

Anemia and depression are two health conditions that may have some associations. Research suggests that people with anemia may develop symptoms of depression, such as low mood, low self-esteem, and loss of interest in daily activities.

For example, a 2018 cross-sectional study found an association between anemia and depressive symptoms.

Symptoms of anemia can also be similar to symptoms of depression.

This article explores the relationship between anemia and depression and discusses the symptoms, causes, risk factors, and available treatment options.

According to a 2016 study that examined the association between anemia and depression among healthy middle-aged adults, people with depression are more likely to have anemia than people without depression.

A 2018 cross-sectional study of 1,616 older adults suggests that anemia can cause the onset of depressive symptoms. In addition, people with depressive symptoms may have a higher prevalence of anemia than people without depression.

According to the National Library of Medicine, people with anemia may have some depressive symptoms, including tiredness, weakness, and a lack of energy.

A 2022 study published in the Journal of Affective Disorders indicates that people with anemia may develop depression as a result of:

low oxygen levels in body tissues
lack of physical activity
impaired monoamine synthesis

According to a study published in Neuropsychiatric Disease and Treatment, anemia can affect a person’s mental health, causing psychiatric symptoms such as depression and cognitive function disorders.

Additionally, if a person has a preexisting mental health condition and has not received treatment for it, anemia can worsen that condition.

Anemia and depression may have similar symptoms, but they are separate conditions.

Symptoms of anemia

According to the National Institutes of Health (NIH), symptoms of anemia may progress slowly or quickly depending on the cause. Different types of anemia have similar symptoms, such as:

weakness
tiredness
paleness
bleeding
chills
headache
shortness of breath
dizziness
fainting
jaundice

Symptoms of depression

A person with depression may show the following symptoms:

tiredness
low mood
changes in appetite
loss of interest in activities
weight loss or gain
difficulty thinking
lack of concentration
inability to make decisions
suicidal thoughts

Anemia has several types, each of which has distinct symptoms and an underlying cause. Common types of anemia include:

aplastic anemia
iron deficiency anemia
hemolytic anemia
vitamin B12 deficiency anemia

Iron deficiency anemia and depression

Iron deficiency anemia is the most common form of anemia.

It is due to insufficient iron in the body. The body needs an adequate amount of iron to produce hemoglobin, the oxygen-carrying component in red blood cells (RBCs).

According to a 2020 study, iron deficiency anemia can increase a person’s risk of depression. Iron deficiency can cause low levels of serotonin, an important neurotransmitter and mood stabilizer.

Pernicious anemia and depression

Pernicious anemia is an autoimmune condition in which the body cannot absorb enough vitamin B12, or cobalamin. This may be due to a lack of intrinsic factor, a glycoprotein that the body needs to absorb vitamin B12.

A survey by the Pernicious Anaemia Society found that 86% of the 1,300 participants experienced emotional symptoms, including impatience, irritability, mood changes, and thoughts of suicide.

Research from 2015 suggests that pernicious anemia can cause neurological effects such as depression, mania, and psychosis.

The main causes of anemia are:

Blood loss: Excessive blood loss can lead to anemia if the loss of RBCs is greater than the production of new RBCs. This also reduces the iron necessary to produce new RBCs. Any condition that causes a person to lose a lot of blood — including bleeding from the menstrual cycle, a serious injury, or surgery — can increase their likelihood of iron deficiency anemia.
Age: Older adults may have a greater chance of anemia than people in other age groups. This may be due to age-related chronic conditions or iron deficiency that depletes RBCs.
Family history: A person can inherit anemia if their parents carry the trait in their genes.
Other health conditions: Conditions such as cancer, autoimmune diseases, and infections can cause the body to produce fewer RBCs than a person needs.

Health experts do not know the exact cause of depression. However, they have identified certain risk factors that can increase a person’s risk of the condition, including:

stress
drug or alcohol use
a family history of depression
life changing events such as divorce, financial problems, relocation, work issues, and grief
use of certain prescription drugs such as interferon, beta-blockers, and corticosteroids

This section looks at how doctors can diagnose anemia and depression.

Diagnosing anemia

To diagnose anemia, a doctor will ask questions about specific risk factors. They may also order the following tests to rule out some underlying causes:

RBC count, which measures the number of RBCs in the body
hemoglobin count, which measures the amount of hemoglobin in the blood
hematocrit level, which measures the space between RBCs in the blood
mean corpuscular volume count, which measures the average size of RBCs in the body

Diagnosing depression

There are no specific diagnostic tests for depression.

However, a doctor can ask a person to complete a questionnaire to measure the severity of a person’s depression.

They may use the Hamilton Depression Rating Scale, which consists of either 17 or 21 questions to measure the severity of depression.

The Beck Depression Inventory can also help mental health professionals assess a person’s symptoms.

People can manage both anemia and depression in a few ways.

Diet

If a person has anemia and depression, a doctor will recommend a healthy, balanced, iron-rich diet that includes nuts, seeds, seafood, and dark leafy greens to replenish the body’s iron.

They will also advise that a person consume vitamin C-rich foods and avoid foods that can block iron absorption.

Exercise

A doctor may recommend some light exercises to improve blood circulation and prevent fatigue.

According to the United Kingdom’s National Health Service (NHS), 150 minutes of moderate-intensity exercise per week can improve a person’s mood and increase their energy levels.

Iron supplements

A 2020 study found that taking iron supplements as a doctor recommends can reduce the risk of psychiatric disorders in people with anemia.

People taking iron supplements should stick to the dose their doctor recommends because taking too much can lead to iron poisoning.

Improving sleep

A small 2015 study suggests that iron deficiency anemia can affect a person’s sleep quality. Experts associate poor sleep quality with depression.

A doctor may recommend sleep hygiene practices to improve sleep quality, such as:

reducing exposure to natural light
limiting TV and phone use before bedtime
avoiding caffeine before bedtime

Therapy

Psychotherapy or talk therapy can help people identify factors that may be causing depression.

It can also help them learn the skills to deal with depression effectively. A person can try various approaches to psychotherapy, including cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy.

The outlook for a person with depression and anemia depends on the individual.

Sometimes, people may manage anemia and depression through dietary habits alone. However, some types of anemia and depression can be life threatening and may require more in-depth treatment protocols.

A person may have a good outlook with early diagnosis and treatment.

According to a 2021 review, people can prevent some forms of anemia. A person can avoid iron deficiency anemia by maintaining a balanced diet and taking iron supplements if a doctor recommends doing so.

While a person may not be able to avoid anemia due to blood loss, urgent medical attention can improve the outcome.

Anemia occurs when a person does not have enough RBCs circulating in their body.

Research suggests that people with anemia may have a high risk of depression. This may be due to low oxygen and a lack of physical activity as a result of anemia.

If a person experiences symptoms of anemia, depression, or both, they should contact a doctor immediately.

Is There a Link? I Psych Central

Could there be a medical reason behind your gloomy mood and lack of energy? If you live with depression, anemia may be partly to blame.

A common depression symptom is the feeling that even the simplest tasks take more energy than you have. Anemia can also make you feel this way.

When you have anemia, your blood can’t transport as much oxygen as it should. This can impact many areas of your body, including your brain.

Not only does anemia reduce your energy levels, but it can also affect the way you think and feel. Anemia, particularly the iron deficiency kind, has been linked to mental health conditions like depression and anxiety.

Anemia is a condition that affects your blood cells and reduces their ability to transport oxygen.

The World Health Organization (WHO) estimates that nearly 25% (1.62 billion) of the population worldwide has some anemia. Most of these cases are due to an iron deficiency.

Depression is one of the mental health conditions that low iron can cause.

The area of your brain called the basal ganglia contains a higher amount of iron than other brain regions. Because of this, it responds readily to changing iron levels.

Researchers previously thought that the basal ganglia was mainly responsible for movement, but recent research suggests that this area also shapes the processing of emotional stimuli. So, if your iron isn’t at the right level, your brain might not process emotions properly.

A Japanese study from 2018 with 11,876 participants identified a link between self-reported depression and self-reported iron-deficiency anemia.

In a 2014 study, anxiety symptoms were linked to low iron. Neurotransmitter stability and energy metabolism influence emotions like anxiety, which are affected by iron levels.

This means that if your iron level is too low, changes to your energy and brain chemistry might make you feel anxious.

Hypoxia (reduced oxygen levels) from anemia affects multiple areas of your body, including your brain. It can cause physical, cognitive, and mental health symptoms, some of which include:

fatigue
weakness
irregular heart rate
dizziness
chest pains
cognitive impairment (trouble remembering, learning, concentrating, or making decisions)
mood changes

Anemia’s connection to mental health extends beyond long-term (chronic) blood oxygen deprivation. The most common form of this condition, iron deficiency anemia, has the added impact of insufficient iron.

Iron does more than help red blood cells carry oxygen. Along with preventing anemia, iron is involved in many essential cognition areas, including:

central nervous system (CNS) enzymes and proteins
CNS development
DNA replication and repair
white matter myelination (brain cell insulation)
development of neurotransmitter systems

A 2013 study revealed a link between iron deficiency and diagnoses like mood and developmental conditions.

It’s theorized that iron deficiency in childhood is linked to the abnormal myelination (covering) of neurons and altered neurotransmitters that contribute to child and adolescent-onset psychiatric conditions.

The cause of anemia depends on the type.

For example, iron-deficiency anemia results from inadequate amounts of iron in your body. You might not have enough iron in your diet, or you may not absorb it well. You can also lose iron through blood loss conditions such as menstruation, ulcers, or trauma.

Meanwhile, other types of anemia have causes such as genetics or autoimmunity.

There are several types of anemia, all of which can decrease the amount of oxygen transported in your blood.

Iron deficiency anemia

Iron deficiency anemia (IDA) occurs when you don’t have enough iron to make the blood hemoglobin you need to transport oxygen.

Pernicious anemia

This type of anemia is caused by a deficiency in vitamin B12, which is required to produce healthy red blood cells. People who have pernicious anemia sometimes lack intrinsic factor, which helps the body absorb B12. Other causes include diet, infections, medications, and surgery.

Thalassemia

Thalassemia is a genetic condition that causes low hemoglobin levels. Reduced hemoglobin means your red blood cells can’t carry enough oxygen.

Sickle cell anemia

Sickle cell disease is also genetic but causes abnormalities in some red blood cells. These cells become abnormally shaped, rigid, sticky, and unable to carry oxygen.

Aplastic anemia

Aplastic anemia occurs when something interferes with the production of new blood cells, leading to a blood cell count that is too low. The most common cause is when your immune system attacks bone marrow cells.

Depression can significantly impact your life, but it’s manageable. If iron deficiency anemia is causing your depression, it may be easy to treat with a change to your diet or iron supplement.

Dietary change

Many doctors recommend improving your diet before taking an iron supplement unless a blood test shows that your iron is very low.

Dietary sources of iron include:

red meat
chicken
beans
peas
dark green leafy vegetables
fortified cereals

Foods containing vitamin C increase iron absorption. On the other hand, dairy products, tea, and coffee are examples of foods that interfere with iron. It helps to familiarize yourself with these interactions to maximize the effect of your dietary changes.

Iron supplementation

A 2020 study revealed that people with iron deficiency anemia have a higher chance of psychiatric disorders, but this decreases when they take an iron supplement.

It’s important to note that excess iron can accumulate in your body to unhealthy levels. It’s recommended that you have your iron level measured with a blood test before taking an iron supplement. Iron is a vital nutrient, but having too much can be as problematic as not having enough.

Sleep improvements

Proper sleep is a critical self-care goal. If you find it difficult to get an appropriate amount of restorative sleep, you might want to consider improving the consistency of your schedule. Sleep hygiene practices can also help, like mid-day caffeine cut-offs and a cooler bedroom temperature.

Light exercise

You can exercise with anemia but do so carefully and under a healthcare professional’s supervision. Regular movement increases circulation, improves sleep, and contributes to good health.

Anemia might cause fatigue or shortness of breath, so if you exercise, start slowly and keep your workouts short.

Sometimes a medical condition like anemia can contribute to a mental health condition such as depression. On the one hand, this may seem like you have more issues to manage. But understanding how different conditions influence each other can make them easier to treat.

Once you’ve talked with a healthcare professional about an anemia assessment, you can take steps to improve your physical health that will also help your mental health. This could mean learning more about anemia or reaching out to a nutritionist for guidance.

There are support groups available and therapists you can meet with to continue along your path of healing and self-discovery.

Fatigue and depression as a result of iron deficiency

: Natalia Pichugina

MEDI SPA is often visited by clients who report chronic fatigue, loss of concentration, depression, sleep disturbance or dizziness. Most of these patients already have diagnoses such as "vegetative dystonia", "psychosomatic illness" or "depression" and received appropriate treatment. However, Dr. Beat Schaub, MD, suggested that these conditions may be associated with iron deficiency, which was confirmed and corrected in a number of cases. nine0011

When recommending spa treatments to help manage non-specific symptoms that have been identified, whether it be fatigue, loss of concentration, depression, sleep disturbance or dizziness, consider whether they are associated with iron deficiency.

According to the World Health Organization (WHO), approximately 4 billion people suffer from iron deficiency . In Europe alone, about 50 million people suffer from it.

Although iron deficiency syndrome affects half of humanity, this disease is not recognized by conventional medicine. However, Beat Schaub, MD, has come a long way in researching iron deficiency, and has come to the conclusion that the vast majority of people suffering from iron deficiency can be completely cured. nine0011

Many people suffer from a range of non-specific symptoms. Often the cause of these symptoms, despite extensive research, cannot be identified and is ultimately misinterpreted as psychosomatic or even psychic. Most of these patients had diagnoses such as "vegetative dystonia", "psychosomatic illness" or "depression" and received appropriate treatment. However, a closer examination of this issue in some cases reveals deeper relationships. nine0011

MD Beat Schaub has come a long way in the study of patients suffering from non-specific symptoms, comparing medical records. In this way, he identified coincidences, which in turn showed causal relationships.

In 1997, in collaboration with programmers , Beat Schaub created a special program - a medical database for optimizing patient care (MEDAPORT). It provided an opportunity to gradually answer many questions that remained open. nine0011

As a result, in 1998 he found that the majority of women suffering from these symptoms were of childbearing age. Their iron content is only about ten percent of that of men, and symptoms usually disappear when they get the missing iron. Only 12% of them were simultaneously diagnosed with iron deficiency anemia. 88% suffered from the iron deficiency syndrome discovered by Beat Schaub.

Doctor found three matches. The first coincidence: the bulk of patients with conditions of fatigue are women of childbearing age. The second coincidence: "neurasthenic" women have very little iron. The third coincidence: if we compare the concentration of iron in the blood of women with iron deficiency with the concentration of iron in men, then the symptoms caused by iron deficiency in most cases disappear by themselves. nine0011

Beat Schaub adjusted the treatment according to the "dictation" of the patients. It quickly became clear that most patients with low blood iron concentrations benefited from intravenous iron. Their chronic fatigue disappeared, or at least significantly decreased. When additional tests were carried out, many patients not only felt "returned to life", but also unanimously listed other symptoms that disappeared due to the introduction of iron. As a result of a computer assessment, Beat Schaub determined that iron deficiency can cause not only chronic fatigue, but also loss of concentration, sleep disturbances, dizziness, depression, stiff neck and hair loss. nine0011

The term " Iron Deficiency Syndrome " (Iron Deficiency Syndrome, IDS) was chosen consciously, because we are talking about a range of symptoms that have a common cause and take on a specific framework.

The knowledge gained back in 1998 convinced Beat Schaub that iron deficiency can cause various symptoms even before the onset of anemia. As a researcher, as a person and as a doctor, Beat Schaub wanted to offer his patients the best possible treatment, so he had no doubts that this topic should be studied further. Far too many patients have suffered years of uncomplaining iron deficiency and have to undergo useless examinations and treatments. Instead of making up for the lack of iron, they often receive useless explanations and treatments that only alleviate their suffering. The main problem lies in two fallacies of the classical medical school:

Iron deficiency only appears when iron deficiency anemia sets in.
A ferritin level of 10 ng/ml is sufficient for all patients.

First, iron deficiency can indeed occur with a normal hemoglobin level. The body needs iron not only for the synthesis of hemoglobin. Iron is also a component of myoglobin, and in the respiratory chain it is involved in energy metabolism processes. Iron plays a significant role in cell proliferation, the synthesis of various transmitters and hormones such as adrenaline and dopamine, and in the destruction of free radicals. However, the body's primary use of iron stores is to produce hemoglobin. When the reserves of this “raw material” approach a minimum, the hemoglobin level remains at a normal level for a long time, while iron deficiency is already observed in other organs. nine0011

Secondly, Beat Schaub urges to simply be guided by logic: if ferritin levels between 10 and 400 ng / ml were really the norm, would people with iron levels in this range have at least one symptom that would disappear after administration of appropriate iron preparations? However, the reality is that it is these ailments that people often complain about, especially women of childbearing age. Consequently, this norm, determined by high university structures, should not be considered undeniable. In other words, it is simply wrong. The same relationship can be traced on the other hand: patients with the indicated symptoms and supposedly normal levels of ferritin in the blood very quickly stop complaining as soon as replacement therapy is completed and their concentration of deposited iron significantly exceeds the “allowed” lower limit so far. After treatment, it is usually measured in the range from 100 to 200 ng / ml, which is the best indicator from experience. nine0011

Between 1998 and 2005, Dr. Schaub developed a new concept for optimal diagnosis, treatment and prevention Swiss Iron System (SIS) , which is available to medical iron therapy centers as a Health Banking database via the Internet.

Thus, if a client came to you with a number of non-specific symptoms similar to those of autonomic dystonia, psychosomatic illness or depression, it makes sense to conduct a differential diagnosis with an iron deficiency condition, the correction of which, along with spa treatments, will help improve the life of your client. nine0011

< back
Next >

Fatigue and depression as a result of iron deficiency

Are you constantly tired? Are you not getting enough sleep? Can't concentrate even on simple tasks? Perhaps your body lacks iron!

According to the World Health Organization (WHO), approximately four billion people suffer from iron deficiency. In Europe alone, there are about 50 million such patients. However, most of them can be completely cured. nine0011

Iron Man

Iron (Ferrum, Fe, Iron) is a vital trace element in the human body. The main amount of iron is part of hemoglobin. However, iron is necessary not only to ensure normal blood formation, but also for a number of other vital processes occurring in the human body, such as the production of hormones and, ultimately, the production of cellular energy - that is, in other words, life energy.

Normally, our bodies get iron from food and store it in the form of a special compound called ferritin. The body uses it primarily to produce hemoglobin.

According to Dr. Beat Schaub, co-founder of the Swiss Iron Health Organization (SIHO)

Ferritin level in men: 100-200 ng/ml
Ferritin level in women: 10-70 ng/ml

The amount of iron in the blood (according to in vitro data)

Women 9.0 – 30.4 µmol/L
Men 11.6 - 31.3 µmol/l

When the supply of this “raw material” approaches a minimum, the level of hemoglobin, which can be determined using standard medical tests, remains within the normal range for a long time, while in fact iron deficiency can make itself felt.

The meal is served!

Products that increase hemoglobin

The first place in the list of products that increase hemoglobin is occupied by meat, namely beef - 22% iron. In pork and veal, this figure is slightly lower. 11% of iron is absorbed by eating fish. High levels of iron are also found in the liver. nine0011

Do not forget to include in your diet foods such as: buckwheat, spinach, oats and millet, beans, peas, eggs, apples, pears, persimmons, figs, nuts, sardines, mackerel, horse mackerel, herring, fish roe, bread , rice, potatoes, green onions, radishes, beets, plums, pomegranates, cherries, strawberries, raspberries, black currants.

Iron absorption

So, we ate spinach and red meat. Now it is important that the iron is well absorbed by the body. For this we have helpers: vitamin C and folic acid. Vitamin C is found in large quantities in citrus fruits, kiwi, green vegetables, herbs and berries. For the absorption of iron, it is useful to drink orange or grapefruit juice with meals. Folic acid is found in green leafy vegetables that will brighten up any meal. nine0011

Calcium and iron are antagonistic enemies in our body. Foods rich in calcium, such as milk, interfere with the absorption of iron. So, if you eat buckwheat porridge with milk, then neither iron from buckwheat nor calcium from milk will practically be absorbed. It is better to separate such products: something in the morning, and something in the evening. Tea, coffee, coca-cola and chocolate also reduce the absorption of iron.

And remember that any excessive heat treatment can kill most of the beneficial substances contained in the product. nine0011

Who is primarily at risk with iron?

Women of childbearing age (losing iron with regular bleeding)
Children (increased need for a growing body)
Elderly (undernourished and malnourished)
Athletes (increased demand due to regular high loads)

How to suspect that there is not enough iron?

Perversion of taste and smell - Pica Chlorotica
A person is irresistibly attracted to eating unusual substances and objects: I want to gnaw chalk, suck paper or a scarf, I want clay, ice or starch. Inhalation of unpleasant odors from the point of view of a healthy person is a syndrome quite characteristic of iron deficiency anemia. More often you want to sniff gasoline, paint, fuel oil and nail polish remover.

Fatigue

Constant state of drowsiness, lethargy up to depression. It is difficult for a person to concentrate on their work or study. Sometimes he has to take breaks to lie down. nine0011

Sleep disturbance

It is difficult for a person to fall asleep, he wakes up several times a night. Even if he manages to fall asleep, he still does not get enough sleep.

Headache

Dizziness and aching, drawing, debilitating pain extending to the back of the head, stiff neck (tension and stiffness). Frequent dizziness, the person seems to be "taken away" and his gait becomes shaky.

Skin and hair problems

A person suffers from constant dryness of the skin and congestion in the corners of the mouth (stomatitis). Hair falls out and nails break.

Restless legs syndrome

Unpleasant sensations in the legs, most often in the evening and at night. As soon as a person changes his position or simply moves his legs, the discomfort disappears, but sleep is disturbed and the person cannot sleep.

If a person already has iron deficiency anemia, they may experience symptoms such as difficulty breathing, pale skin, and tachycardia (rapid heartbeat). nine0011

Self-test

Swiss Iron Health Organization (SIHO) offers special test:

Group 1: Fatigue condition
Group 2: Loss of concentration; Depressive states: Sleep disturbance
Group 3: Dizziness; Headache; Stiff neck
Group 4: Loss of hair; Brittle nails; Restless legs syndrome

Score: Each group with one symptom is worth one point.

1-2 points: iron deficit possible
3 points: iron deficit is likely
4 points: iron deficit is very likely

The rate of iron in the food diet:

-10-15-10-15-10-15-10-15 mg/day
in women - 15-20 mg/day
in pregnant women - at least 30 mg/day

Don't forget: if you regularly engage in intense physical activity, you need a third more iron! nine0011

So, you have suspected iron deficiency. To confirm this diagnosis, you need to see a doctor. The doctor will carefully examine and prescribe blood tests.

Basic laboratory tests for diagnosing iron deficiency:

Complete blood count - to evaluate the level of red blood cells and hemoglobin
Biochemical blood test - to assess the level of ferritin and TBI (total iron-binding capacity of blood serum - another characteristic of the work of iron in our body)
Vitamin B12 - B12 - deficiency anemia sometimes very similar to iron deficiency

Iron instead of antidepressants

Don't worry about iron deficiency or iron deficiency anemia. Only in 5% of patients, iron deficiency is associated with a serious pathology of the internal organs.

Treatment starts simple: proper nutrition and regular walks in the fresh air.

If the body still cannot cope with iron deficiency, doctors take over. nine0011

After the examination, the doctor calculates the amount of iron needed by the patient using special formulas.

Learn more