Can Anemia Cause Depression And Anxiety?

Anemia is a common medical condition caused by an insufficient number of healthy red blood cells in the body. While rare in men, it affects around 40% of children and 30% of women of reproductive age. If left untreated, this condition could lead to serious health consequences.

Once a doctor diagnoses anemia, they can suggest a number of effective treatments. Meanwhile, they would need to go further to discover the cause of this condition and address existing complications, one of which could be anxiety or depression.

Can anemia cause depression? Let's take a closer look.

What is anemia?  

Anemia is a condition defined by the lower-than-normal number of healthy red blood cells in the body. 

It could happen if you are:

• Not producing a sufficient number of red blood cells

• Destroying healthy red blood cells

• Losing healthy red blood cells

Red blood cells are vital to your health. They pick up oxygen from the lungs and carry it to the rest of your organs, where it is used to make energy. Oxygen is carried inside red blood cells on a protein called hemoglobin. When these cells come back to the lungs, they carry carbon dioxide, a toxic byproduct, so the body can get rid of it by exhaling.

If you have anemia, there aren't enough red blood cells to do the job, meaning your body isn't getting enough oxygen. 

This could cause a variety of symptoms, such as:

• Weakness

• Excessive fatigue

• Headaches

• Irritability

• Loss of appetite

• Problems with concentration

• Cold hands and feet

• Numbness and tingling in the extremities

Some symptoms don't become obvious until the number of red blood cells decreases significantly. 

Then you may notice:

• Bluish whites of the eyes

• Rapid or irregular heartbeat

• Chest pains or heart palpitations  

• Brittle nails and hair loss

• Lightheadedness (when you stand up)

• Paleness

• Shortness of breath even without strenuous activities

• Mouth ulcers

• Abnormal menstrual bleeding

• Low libido (in men)

Many different types of anemia exist, with iron deficiency anemia being the most prevalent. Iron is an essential component of hemoglobin. 

Several studies have been done to link mental health and anemia, and anxiety and depression could be connected to low iron levels in the blood.

Anemia and depression: evidence

The relationship between anemia and depression is complex. The physical symptoms of anemia, such as fatigue, weakness, and difficulty with daily activities, can contribute to feelings of sadness. More directly, the lack of oxygen in the brain caused by anemia can affect how the brain functions and lead to mood disturbances and depression.

On the other hand, depression can also lead to anemia by affecting appetite and food intake, causing poor nutrition, or by increasing the risk of gastrointestinal bleeding. Additionally, certain medications used to treat depression can cause anemia as a side effect. Several studies have been conducted looking at the connection between anemia and depression, but so far, it hasn’t been determined which one comes first. 

From depression to anemia  

One large cross-sectional study conducted in 2016 measured hemoglobin (an iron-containing protein in red blood cells) in 44,173 patients who were in good general health.¹

The study found that people with depression were more likely to have anemia. The likelihood of developing iron deficiency anemia increased with the severity of depression.

The study didn't identify the mechanisms behind the process or discover if anemia can cause depression or vice versa.

Anemia and depression in the older population

A smaller study conducted in 2005 looked at almost 1,000 older people living in Chianti, Italy. The mean age of the participants was 75 years. Researchers diagnosed anemia in 15% of study participants with depression.

The study demonstrated the relationship between depression and a higher risk of anemia. The risk of anemia went up as the severity of depression increased.

While only a small number of people participated in the study, it concluded that anemia and depression in older people are related.

Additionally, a cross-sectional study conducted in 2018 in Iran looked at 1,616 people older than 60. The study showed that the prevalence of anemia in people with symptoms of depression was higher than the prevalence of this condition in participants without depressive symptoms.²

Anemia and depression in women

A study published in the Journal of Affective Disorders in 2022 examined the relationship between anemia and depression according to gender. It used data from several Korean National Health surveys that contained information about 15,472 participants.

The study showed that the prevalence of depression was higher in women with anemia than in women without anemia.

Anemia and mental health

According to a study published in 2015 in the Journal of Neuropsychiatric Diseases and Treatment, there is a connection between anemia and mental health. The study concluded that the prevalence of anemia in long-term or chronic psychiatric patients is higher than in the general population.³

Researchers also found that anemia can worsen pre-existing mental health disorders that the patient isn't getting proper treatment for.

Can iron deficiency anemia cause anxiety?

A person with anemia can develop anxiety because of iron deficiency. Besides being highly useful in many parts of your body, iron plays a major role in the way your brain functions.

In the brain, iron has many roles, which include:

• Oxygen transport: Low iron, leading to reduced red blood cells, and iron deficiency anemia can cause a lack of oxygen in the brain, which can affect brain function and cognitive performance.

• Neurotransmitter function: Iron helps make and control neurotransmitters, which are chemicals that transmit signals in the brain. Low iron levels can lead to decreased neurotransmitter function, particularly serotonin, which is involved in regulating mood and other functions.

• Inflammation: Iron deficiency anemia can also cause inflammation, which has been linked to decreased brain function and cognitive performance.

When the levels of brain iron fluctuate, the function of the brain can change. Strong evidence points to iron deficiency causing:

• Developmental delays in younger children

• Cognitive alterations (changes in attention spans, memory, concentration, etc.) in adolescents

• Changes in behavior

Children with iron deficiency can exhibit symptoms of anxiety or depression coupled with social problems.

A recent study shows that iron deficiency anemia is directly related to the increased risk of psychiatric disorders. Patients who received iron supplementation during the study had a decreased risk of psychiatric disorders.

Preventing anemia-related anxiety and depression

While more research is needed to understand the link between anemia and depression and anxiety, it is well-accepted that anemia should be prevented for not only the mental health benefits but the physical benefits as well. It is important to diagnose anemia promptly.

If you have symptoms of anemia, contacting your doctor is the best course of action. They can diagnose the condition by conducting a physical exam, reviewing your medical history, and running a simple blood test. If found to have anemia, they will also investigate the underlying cause of anemia.

Iron is obtained from dietary sources and is absorbed by the small intestine. Iron-rich foods include red meat, fortified cereals, beans and legumes, dark leafy greens, and dried fruit. 

If found to have iron deficiency anemia, depending on the degree of deficiency, you can start effective treatment to raise iron levels in your blood. Treatment can include:

• Iron supplements (tablets, liquids, or iron intravenous injections)

• Iron-rich diet

Other effective treatments for anxiety and depression can consist of lifestyle changes, psychotherapy, and medication.

There are many reasons behind a person developing iron deficiency anemia. Key causes are insufficient nutrition (often seen in people who follow a vegetarian or vegan diet),  gastrointestinal tract abnormalities (surgeries, ulcers, cancer), pregnancy, and heavy menstrual periods. 

It’s best to speak to your doctor about the underlying causes of your iron deficiency anemia and options for dealing with them promptly. Similarly, if you present with symptoms of depression or anxiety, as part of the workup, a simple blood test checking for anemia will be done.

The lowdown

Anemia could be a contributing cause of your anxiety and depression symptoms. Several studies link anemia, and more specifically iron deficiency anemia, to mental health problems. While more research is required to confirm the connection, for many people, these conditions go hand in hand.

If you are experiencing symptoms of iron deficiency anemia, it’s best to speak to your doctor as soon as possible. Anemia is a highly treatable condition. You can start the treatment immediately while addressing the underlying cause of the problem.

Frequently asked questions

Can low iron cause depression?

Low iron levels in the blood define a condition called iron deficiency anemia. Research links this type of anemia to depression and anxiety. However, more studies are required to confirm the connection.

Can anemia cause panic attacks?

Anemia reduces the amount of oxygen in your blood. The lack of oxygen could cause mental health disorders. Anemia causes symptoms such as shortness of breath, chest pains, palpitations, dizziness, and lightheadedness, which are symptoms also commonly seen in panic attacks. More research needs to be done to confirm the connection between anemia and panic attacks.

How does anemia affect you emotionally?

Anemia could lead to emotional problems and cause anxiety or depression. Meanwhile, the constant fatigue, weakness, and headaches associated with anemia can have a negative effect on your emotional condition.