Low mood, anxiety, fatigue, and irritability are some of the most common problems that lead people to seek medical attention; far too often, they are diagnosed with depression or an anxiety disorder without a full medical workup ever being done. Underlying nutrient deficiencies, particularly iron deficiency, can present very similarly to psychiatric conditions as well as contribute to the severity of these conditions. In Canada, a study conducted between 2009 and 2011 found that 7% of the population was iron-deficient, with the highest incidence among women aged 14-50, where at least 20% had an iron deficiency. Symptoms of low iron and depression, and anxiety (see the table below) overlap as well as occur together. Additionally, it has been found that correcting iron levels in people with low levels who also have psychiatric concerns can help improve symptoms because of the link between them.
| Anxiety Symptoms | Low Iron Symptoms | Depression Symptoms |
|---|---|---|
| Excessive worry | Fatigue | Fatigue |
| Nausea, vomiting, diarrhea | Low mood | Low mood |
| Muscle tension | Decreased concentration | Decreased concentration |
| Fast heart rate, palpitations | Fast heart rate, palpitations | Decreased interest or pleasure in activities |
| Dizziness | Dizziness | Weight and appetite changes |
| Shortness of breath | Shortness of breath | Thoughts of death or suicide |
| Sleep problems | Restless leg syndrome causing sleep problems | Sleep problems |
| Irritability | Irritability | |
| Restlessness | Anxiety | |
| Cold intolerance | ||
| Decreased exercise tolerance | ||
| Headaches |
Understanding Iron’s Role in Mental Health
Iron has many important roles in the body, mainly the transportation of oxygen in the blood and helping with energy production inside the cells. Markedly, lower amounts of oxygen and lower ATP (aka cellular energy) lead to decreased exercise capacity and higher susceptibility to fatigue.
Additionally, iron also plays a role in neurotransmitter synthesis; it is essential for the enzymes tryptophan hydroxylase (serotonin), tyrosine hydroxylase (norepinephrine and dopamine), ribonucleotide reductase (brain metabolism), and monoamine oxidase (neurotransmitter degradation). When iron is low, it affects the metabolism and levels of these neurotransmitters, which could explain the psychiatric symptoms that occur with low iron levels. Henceforth, this deficiency can show up as cognitive impairment and brain fog, mood disorders, decreased attention and motor dysfunction.
Iron Deficiency and Depression
Besides playing a role in cellular energy and the production of the neurotransmitters (noradrenaline, serotonin, and dopamine) that are involved in mood regulation, iron deficiency can also impact areas in the brain (mainly the hippocampus and prefrontal cortex) that are responsible for memory and the regulation of emotions. Iron deficiency has also been found to negatively impact sleep through its effects on the dopaminergic brain systems that are essential for sleep regulation, and through causing restless leg syndrome, which leads to more wakefulness and lower quality sleep. Though the link between iron deficiency and psychiatric symptoms is not fully understood, research shows that low iron levels can contribute to depression symptoms and correcting these levels can improve mood and reduce the severity of the depression. This is especially important in high-risk groups such as women of reproductive age, those with chronic illness, pregnant and post-partum women. Common signs of depression that are shared with low iron are fatigue, low mood, and decreased concentration or brain fog. Screening for low iron (especially in high-risk groups) whenever they present with these symptoms is important for this reason.
Iron Deficiency and Anxiety
Many of the same mechanisms that cause low iron to lead to depressive symptoms are also those that lead to anxiety symptoms in the brain. Subsequently, research has shown that infants and children who were iron deficient (even after the deficiency was corrected) during a certain window are still at higher risk for psychiatric disorders like anxiety and depression. This can be due to iron’s important role in the development of the brain and neurological circuitry during pregnancy and infancy. Anxiety and associated behaviours could be caused by the direct or indirect effects of low iron on both the serotonergic system and GABAergic systems in the brain. Nevertheless, low iron is correlated with worse anxiety symptoms, especially in young adults/adolescents. Sometimes iron deficiency can get mistaken for an anxiety disorder due to the overlap in physical symptoms like heart palpitations and accelerated heart rate, dizziness, sleep problems, as well as the feeling of anxiety. Correcting the low iron can help decrease these uncomfortable physical symptoms and lead to improvement in those suffering from iron deficiency who experience anxiety or those with true generalized anxiety disorders.
Who is at Risk for Iron Deficiency and Mental Illness?
Along with those with women of reproductive age and those with chronic illness/inflammation, there are also many other groups at risk for iron deficiency for the following reasons:
- Low dietary intake: Diets lacking in iron-rich foods, especially heme iron from animal sources, can lead to deficiency. Secondly, it is more difficult to meet iron requirements with a vegan or vegetarian diet because the form of iron (non-heme iron) available in non-meat foods is less easily absorbed by our bodies.
- Blood loss: Heavy/extended menstrual or bleeding from gastrointestinal issues like ulcers or hemorrhoids are common sources of chronic blood loss that can contribute to higher iron losses.
- Poor absorption: Conditions such as celiac disease, gastritis, past gastrointestinal surgery, or frequent antacid use can interfere with the body’s ability to absorb iron from food or from oral supplements.
- Increased demands: Life stages like pregnancy, infancy, adolescence, or periods of intense physical training increase the body’s need for iron and its use of it, which can lead to deficiency when there isn’t adequate intake or absorption.
Iron Deficiency Screening Process
Testing for iron deficiency is simple and often done as a part of routine bloodwork. The main measure is ferritin (which is a protein that stores iron) and hemoglobin, which is used to see if there is anemia is occurring due to the iron deficiency. Specifically, iron panels can be used to give more detail, and CRP (c-reactive protein), which is an inflammatory marker that can be ordered to assess inflammation status. Testing for inflammation is important because it causes falsely elevated iron levels in test results and hides the iron deficiency. Screening for depression and anxiety or using scales to help track symptoms is just as important as doing measures, like blood work, to figure out what is going on.
Low Iron Treatment Options
Addressing iron deficiency once found can be done in a variety of ways, and I always take a personalized approach, considering other health factors, tolerance of oral iron, and finances to provide the most effective treatment for you. Increasing iron in the diet can be done through eating more iron-rich foods (a list and iron amounts can be found here), combining iron-rich foods with vitamin C to enhance absorption, or using a lucky iron fish when boiling water for a little extra iron boost. Oral iron supplements can be used to increase iron levels, but they take a long time and often cause GI-related side effects like nausea, vomiting, diarrhea, or constipation. This makes them intolerable for some people. IV iron (monoferric or venofer) leads to a much faster elevation in iron levels and bypasses the GI system for those who cannot take oral iron. Comparatively, IV iron is 15x more effective at raising iron levels than oral iron and is safe and well tolerated in those who are anemic or just have low iron. Though IV iron can come with a higher price tag, the cost of the iron prescription from the pharmacy (usually $200 - $600) can be covered by some drug plans, and infusion prices ~$200-$300 can be covered by extended health benefits that cover Naturopathic visits.
Working with a healthcare worker who will not only do a thorough work-up but also provide a treatment plan that addresses both psychological factors, like depression and anxiety, as well as physical ones like nutrient status and inflammation, is essential to support healing from these conditions. If you have questions about IV iron or want to figure out if there's more to your fatigue, low mood, or anxiety, book in today to get started.
Dr. Tia Patychuk, ND
Naturopathic Doctor in Vancouver
Helping you restore balance, energy, and resilience.
This blog is for educational purposes only and does not replace individualized medical advice. If you're experiencing severe symptoms of burnout, depression, or anxiety, please consult a qualified healthcare provider.
