Anemia and Mental Health: The Link

Introduction:

Iron deficiency anemia is regarded as the most widespread among all nutritional deficiencies by the World Health Organization (WHO). Iron plays a crucial role in the development of the central nervous system, endocrine system, cardiovascular system, and other systems. Iron's role in the brain's development is that it contributes to the myelination of white matter and the development and functioning of various neurotransmitter systems like serotonin, dopamine, and norepinephrine systems. Any alteration in the functioning or release of neurotransmitters or abnormal myelination of the white matter could result in psychiatric disorders.

What Are Anemia and Depression?

Anemia is a condition in which the normal number of healthy red blood cells is below the normal recommended range. It could happen if there is insufficient production of red blood cells, loss of healthy red blood cells, or destruction of healthy red blood cells. The normal levels of iron in the body should be 70 to 175 mcg/dL for men, 50 to 170 mcg/dL for women, and 50 to 120 mcg/dL for children.

Depression or major depressive disorder is a most common and serious mental condition in which one’s ability to feel, think and act may be affected. A link between anemia and mental health has been established. It is found that individuals with iron deficiency anemia may experience depression, anxiety, and bipolar disorder.

How Does Iron Deficiency Affect Mental Health?

Hemoglobin is a protein that allows red blood cells to transport oxygen to the cells and tissues. Iron is the major component in the production of hemoglobin. Low iron levels will result in reduced oxygen supply to the cells, which affects their function and results in many health issues. As mentioned above, iron is crucial for the functioning of the brain, and low iron levels can make one prone to developing psychological problems.

A study published in Neuropsychiatric Disease and Treatment states that anemia can influence the mental well-being of an individual, causing symptoms like depression and cognitive function disorders. Also, if an individual has a previous history of mental issues and has not taken any treatment for it, anemia can worsen the psychological symptoms.

Does Anemia Lead to Depression, or Is It Vice Versa?

A complex relationship exists between anemia and depression. Both are related in the following ways:

• Anemia Leads to Depression: The physical symptoms of anemia, like fatigue, difficulty in carrying out daily activities, and weakness, can make an individual sad and depressed. Also, anemia can directly influence the brain's functioning by affecting the oxygen supply to the brain, which causes depression and mood disturbances.

• Depression Leads to Anemia: Depressed individuals may have a poor appetite, which leads to reduced food intake, and eventually results in poor nutrition or can increase the risk of gastrointestinal bleeding. Also, anemia may be caused as a side effect of certain medications used to treat depression.

Though several studies are underway, it has not yet been determined which manifests first; anemia or depression.

What Are the Risk Factors for Depression?

The risk factors for depression are as follows:

• A family history of depression.

• Alcohol or drug abuse.

• Stress.

• Stressful situations like financial constraints, divorce, loss of loved ones, work issues, or relocation.

• Consumption of certain prescription drugs like beta-blockers, corticosteroids, and interferons.

What Are the Symptoms of Anemia and Depression?

The following are the symptoms of anemia:

• Tiredness, weakness, and paleness.

• Chills, dizziness, headache, and shortness of breath.

• Bleeding.

• Jaundice.

• Fainting.

The following are the symptoms of depression:

• Low mood, poor appetite, and lack of interest in routine activities.

• Fatigue.

• Difficulty thinking.

• Weight loss or weight gain.

• Lack of concentration, difficulty making decisions, and suicidal thoughts.

What Is the Link Between Various Types of Anemia and Depression?

Various types of anemia are as follows:

• Iron deficiency anemia.

• Aplastic anemia.

• Hemolytic anemia.

• Vitamin B12 deficiency anemia.

Iron Deficiency Anemia and Depression: It is the most common type of anemia and is caused as a result of insufficient iron in the body. Iron deficiency can result in low levels of serotonin. Serotonin, also called the ‘happy hormone’, acts as a mood stabilizer and is an important neurotransmitter (chemical messenger). A study conducted in 2020 found that iron deficiency anemia can elevate one’s risk of depression.

Pernicious Anemia and Depression: Pernicious anemia is an autoimmune condition in which the body is unable to absorb sufficient vitamin B12 or cobalamin. This can be a result of a lack of a glycoprotein or intrinsic factor that the body requires to absorb vitamin B12. Research done in 2015 stated that pernicious anemia can lead to neurological effects like mania, psychosis, and depression. Also, a survey conducted by the Pernicious Anemia Society found that 86 percent of the 1300 participants faced emotional symptoms like irritability, impatience, mood changes, and suicidal thoughts.

How Can Anemia and Depression Be Treated?

One can cope with anemia and depression in the following ways:

• Diet: A person having anemia and depression needs to consume a healthy, balanced, and iron-enriched diet that contains seeds, nuts, chicken, peas, beans, red meat, fortified cereals, seafood, and dark green leafy vegetables to restore the iron levels in the body. Foods rich in vitamin C can also be taken, and foods that hinder iron absorption, like tea, coffee, and dairy products, should be avoided.

• Exercise: Some light exercises may be prescribed by the doctor to deal with fatigue and improve blood circulation. The United Kingdom's National Health Service (NHS) suggests that doing 150 minutes of moderate-intensity weekly exercise can enhance the individual's mood and boost their energy levels. One must start with slow, short workouts since symptoms of anemia include fatigue or shortness of breath.

• Iron Supplements: Taking iron supplements as per the physician’s instructions can reduce the risk of psychiatric issues in individuals with anemia. One must take iron in dosages as prescribed by the doctor since consumption of too much iron can result in iron poisoning.

• Good Sleep: Iron deficiency anemia can have an impact on one's quality of sleep. Poor sleep can, in turn, result in depression. Certain sleep hygiene practices, like limiting the use of television and mobile phones before sleeping, avoiding caffeine before going to bed, and minimizing exposure to natural light, can improve one's sleep quality.

• Psychotherapy: Psychotherapy or talk therapy enables people to identify factors that cause depression. It also enables them to learn the skills required to manage depression effectively.

Various approaches to psychotherapy can be tried, such as cognitive behavioral therapy (a talking therapy that helps one manage their problems by altering the way that one thinks and behaves), psychodynamic therapy (this therapy facilitates one to have an in-depth understanding of one’s emotions and other mental processes), and interpersonal therapy (this therapy focusses on relieving symptoms by enhancing interpersonal functioning).

Can Anemia Be Prevented?

Some forms of anemia can be prevented. Iron deficiency anemia can be prevented by following a balanced diet and by taking iron supplements if the doctor prescribes it. Though anemia due to blood loss cannot be prevented, immediate medical intervention can improve the condition. Sometimes, anemia and depression can be dealt with through dietary habits alone. Some types of anemia and depression could pose a risk to life and may need in-depth treatment. Early diagnosis and treatment will have a good prognosis.

Conclusion:

A medical condition like anemia could affect the mental health status of an individual. Knowing how various conditions impact each other can make the treatment easy. One must discuss with a healthcare professional, assess the status of anemia, and take necessary steps to improve physical health, eventually improving mental health. Support groups and therapists are available to support those suffering from depression. Seeking appropriate help at the right time is all that matters.