Anemia is a condition that occurs when you have a lower than normal number of red blood cells or hemoglobin in your blood. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of your body. When you have anemia, your body doesn’t get enough oxygen which can make you feel tired, weak, dizzy or have shortness of breath. Anxiety is a mental health condition characterized by persistent, excessive worry or fear about everyday situations. People with anxiety often have racing thoughts, feel restless or on edge, have muscle tension, and have difficulty concentrating. There has been some research examining whether anemia may contribute to feelings of anxiety, although the findings are mixed. In this article, we’ll explore the relationship between anemia and anxiety and look at the evidence.
Does anemia directly cause anxiety?
There are a few ways in which anemia could theoretically contribute to anxiety:
Fatigue and reduced oxygen
One of the main symptoms of anemia is significant fatigue. This is because with lower hemoglobin levels, your body is not getting enough oxygen delivered throughout. Feeling constantly exhausted can understandably make someone feel more on edge, nervous or worried. The fatigue may make it harder to cope with daily stressors.
In addition, some research suggests the lack of oxygen reaching the brain may directly impact mood and emotions. However, more studies are still needed on this.
Changes in neurotransmitters
Some neurochemicals and hormones are affected in anemia, including serotonin, dopamine and cortisol. Serotonin helps regulate mood, dopamine is involved in motivation and cortisol is the body’s main stress hormone. When these are out of balance, it could theoretically contribute to anxiety symptoms. But again, there is limited research demonstrating this mechanism directly.
Stress from illness
Being diagnosed with and living with any chronic medical condition can be stressful. The discomforts of anemia symptoms, need for treatment, and uncertainty about one’s health could plausibly raise anxiety levels. Things like medical tests, procedures and taking medications may also provoke anxiety, especially in those predisposed to it.
So in summary, fatigue, brain oxygen changes, neurotransmitter imbalances and general stress are possible ways anemia could be linked to anxiety. However, overall the research evidence for a direct causal relationship is weak. Many studies find the apparent link disappears when other factors are accounted for.
What does the research say?
There have been a number of studies examining rates of anxiety among those with anemia compared to the general population or people without anemia:
– A 2013 study in over 12,000 adults found no difference in anxiety levels between those with anemia versus those without.
– A 2016 study in over 1,500 elderly adults found participants with anemia were significantly more likely to have anxiety symptoms than those without anemia.
– A 2019 study in 1500 pregnant women found those with iron-deficiency anemia had higher rates of anxiety than those with normal iron levels.
– A 2021 study in 400 patients undergoing kidney dialysis found no link between having anemia and anxiety symptoms.
As you can see, results are mixed. Some studies do suggest a correlation between anemia and anxiety symptoms. However, due to their observational design, they cannot prove anemia causes anxiety. It is likely other factors are involved.
For example, groups vulnerable to anemia like the elderly, those with chronic diseases, pregnant women or heavy menstrual bleeders often have higher baseline anxiety rates. Other associated conditions like thyroid disorders and depression are also linked to both anemia and anxiety. Inflammation which can inhibit iron absorption is connected to anxiety. Socioeconomic status and discrimination which affect access to care and increase stress also correlate with anemia risk.
When analyses account for covariates like these, the apparent association between anemia and anxiety often disappears or weakens significantly. Essentially, anemia may not directly cause anxiety, but share common risk factors with anxiety.
More rigorously designed studies are still needed. But overall, current evidence does not strongly support anemia as an independent risk factor for clinical anxiety disorders. The link appears circumstantial, not causal.
Can treating anemia help anxiety symptoms?
Some research has explored whether treating anemia leads to improvement in anxiety levels:
– A 2016 study found anxiety symptoms significantly improved 3 months after anemia treatment in a small group of young women with iron-deficiency anemia.
– A 2017 study in patients on kidney hemodialysis found anxiety levels were reduced 3 months after raising hemoglobin levels with erythropoietin treatment.
– A 2019 study found pregnant women with anemia had decreased anxiety scores after 8 weeks of iron supplementation compared to the placebo group.
– However, other studies have found no significant difference in anxiety levels after anemia treatment.
The results are again mixed, but provide some evidence that treating anemia may alleviate anxiety in certain groups. This makes sense, as improving fatigue, brain oxygenation and overall physical health would be expected to reduce anxiety linked to those factors.
However, for those whose anxiety is unrelated to their anemia, treatment may have little effect on their anxiety symptoms. More research is still needed to determine which individuals are most likely to experience anxiety improvement with anemia treatment.
What are the types of anemia?
There are over 400 types of anemia, but they can be broken down into three main categories:
Anemia caused by blood loss
This includes conditions where red blood cells are lost through bleeding or destruction. Examples include:
– Iron-deficiency anemia – most common type, caused by low iron absorption or blood loss
– Trauma-related blood loss
– Gastrointestinal bleeds
– Heavy menstrual bleeding
– Hemolytic anemias like sickle cell where red blood cells break down
Anemia caused by decreased red blood cell production
Some conditions affect the bone marrow’s ability to produce enough red blood cells. These include:
– Aplastic anemia – bone marrow cannot produce blood cells
– Anemia of chronic disease – inflammation inhibits red cell production
– Bone marrow disorders like leukemia
– Vitamin deficiency anemias – lack of folate, B12 or vitamin C
– Anemia from kidney disease or dialysis
Anemia from increased red blood cell destruction
Some disorders cause the body to destroy red blood cells faster than they are made. These include:
– Sickle cell anemia
– Thalassemia
– Autoimmune hemolytic anemias
– Mechanical heart valves that damage blood cells
– Malaria infection
The most common worldwide are iron-deficiency anemia and anemia of chronic disease. The type of anemia is important, as treatment varies based on the underlying cause.
What are the symptoms of anemia?
Symptoms of anemia can include:
– Fatigue, weakness, low energy
– Shortness of breath with activity
– Rapid heartbeat
– Pale skin, lips or nail beds
– Dizziness or lightheadedness
– Headaches
– Brittle nails
– Strange food cravings
– Leg cramps
– Insomnia
– Difficulty concentrating
However, symptoms can vary from very mild to more severe based on the degree of anemia and underlying cause. Mild anemia may have minimal symptoms that develop gradually. Severe or sudden onset anemia can result in serious complications.
It is important not to assume symptoms are due to anemia. Full blood count testing is needed to confirm anemia and evaluate levels of hemoglobin, hematocrit, red blood cells and other markers. A clinical exam and additional testing can help determine the cause.
What are the complications of anemia?
Most cases of anemia are mild and cause relatively few problems. However, moderate to severe anemia can potentially lead to serious complications including:
Heart complications
To compensate for low oxygen, the heart beats faster trying to deliver more oxygenated blood. This places strain on the cardiovascular system. Over time, it can lead to an enlarged heart or heart failure.
Pregnancy complications
Anemia increases risk of preterm delivery, low birth weight and perinatal mortality. Severe anemia has risks for mother as well.
Developmental delays in children
Anemia early in life may impair normal cognitive, motor and social development. Effects seem most significant in severe, long-standing cases.
Reduced quality of life
Fatigue and other anemia symptoms can impair physical, social and emotional well-being. Most studies show quality of life significantly improves with treatment.
Decreased immune function
Anemia is associated with reduced immunity and higher infection rates. People with anemia seem to have a harder time fighting off infections.
Complications are rare with mild anemia. But moderate to severe cases should be treated not just to relieve symptoms, but prevent potential problems.
Who is most at risk of anemia?
Some groups at increased risk of anemia include:
Women
Due to menstrual blood loss and higher iron needs during pregnancy, women have higher rates of iron-deficiency anemia.
Young children and teens
Rapid growth increases iron demands, so those under 18 are susceptible to iron-deficiency anemia.
Vegetarians and vegans
Diets low in iron, B12 and sometimes protein can predispose these groups to nutritional anemias if intake is not supplemented.
Frequent blood donors
Donating blood reduces iron stores and can eventually lead to low hemoglobin levels.
Those with chronic conditions
Chronic inflammation, kidney disease, cancer, diabetes, thyroid disease and autoimmune disorders increase anemia risk.
Elderly
Natural declines in bone marrow function makes anemia more likely over age 60.
Pregnant women
Rapid expansion of blood volume requires increased iron, making anemia common during pregnancy if extra iron isn’t supplemented.
Heavy menstrual bleeders
Loss of excessive menstrual blood dramatically raises risk of iron-deficiency anemia.
Being aware of increased risk can help prompt earlier screening and prevent complications of anemia.
How is anemia diagnosed?
Anemia is diagnosed through a combination of symptom evaluation, medical history, physical examination and laboratory testing. Your doctor will likely:
– Ask about symptoms like fatigue, weakness and lightheadedness
– Take a thorough medical history
– Examine nails, skin, lips and conjunctivae for paleness
– Check for enlarged spleen or liver
– Test blood levels of hemoglobin, hematocrit, red blood cells and iron
– Examine blood cell size and shape under a microscope
– Conduct other testing to uncover underlying cause
In general, hemoglobin less than 13.5 g/dL for men and 12 g/dL for women indicates anemia. Low hematocrit, small red blood cells, and abnormal sizes or shapes can also indicate anemia. Your doctor can determine whether values are abnormal for your age and gender.
Testing helps diagnose anemia, determine severity, and guide treatment options based on the type of anemia uncovered.
What are the treatment options for anemia?
Treatment varies based on anemia type, but may include:
Iron supplements
Used to increase iron levels in iron-deficiency anemia. Oral or intravenous supplementation restores hemoglobin levels.
Folic acid and B12
Supplements of these B vitamins treat certain nutritional deficiency anemias. Food fortification has reduced these types.
Erythropoietin injections
This hormone stimulates red blood cell production and is used to treat some kidney disease and cancer chemotherapy anemias.
Blood transfusions
Used in severe, symptomatic anemia to immediately increase hemoglobin. Cause of anemia still needs to be treated.
Medications
Immunosuppressants, corticosteroids or other drugs treat anemias caused by autoimmune disorders or bone marrow problems.
Surgery
Splenectomy or surgical treatment of underlying gastrointestinal issues may improve certain hemolytic anemias.
Treating underlying disorders
Managing conditions like kidney failure, cancer, hypothyroidism or bleeding can resolve associated anemias.
The best treatment resolves the specific issues reducing red blood cells and hemoglobin in that individual. This may require multiple therapies combined for certain complex cases.
What lifestyle changes help manage anemia?
Certain lifestyle measures can benefit anemia:
Eat iron-rich foods
Foods high in iron include red meat, pork, poultry, seafood, beans, spinach, raisins and fortified cereals. Vitamin C aids iron absorption.
Cook in cast iron cookware
Iron leaches into food during cooking. Using cast iron pots and pans can increase iron intake, especially with acidic foods.
If vegetarian/vegan, be vigilant
These diets require diligent attention to ensure adequate iron, B12 and protein intake since animal products are excluded.
Take supplements
If unable to get enough iron and B vitamins through diet, over-the-counter or prescription supplements can help restore levels.
Treat heavy periods
Hormonal IUDs or birth control pills can reduce heavy menstrual bleeding that causes iron loss.
Limit strenuous activity
Aerobic exercise and strength training may need to be reduced to avoid fatigue and cardiovascular strain. Activity can increase gradually as anemia improves.
Reduce alcohol intake
Drinking alcohol can damage the stomach lining and inhibit iron absorption. It can worsen some types of anemia.
While not a replacement for medical treatment, lifestyle changes can be a helpful adjunctive therapy for people with anemia.
What is the outlook for people with anemia?
The prognosis for people with anemia depends on the severity, type, and underlying cause.
Mild iron-deficiency anemia generally has an excellent prognosis when treated properly with iron supplementation and diet. Most symptoms completely resolve and complications are unlikely.
Moderate or severe iron-deficiency anemia has increased risks during pregnancy and may impact development in young children. With prompt, aggressive treatment, outcomes are still generally good. However, higher risk of complications like impaired immunity and heart problems remain until anemia is corrected.
Anemia related to chronic conditions like kidney failure has a less positive outlook. While anemia itself can be treated, the underlying disease is often progressive. Even with management of anemia, overall prognosis depends on the severity of the chronic condition.
Rarer types of anemia like aplastic anemia have a poorer prognosis depending on availability of treatments like bone marrow transplantation. Sickle cell anemia can also severely impact lifespan and quality of life long-term.
In summary, mild anemia generally improves quickly with iron supplementation and dietary changes. More significant, long-standing or complex cases of anemia may have increased risks of complications, reduced lifespan, or poorer quality of life. Prognosis is best when anemia is caught early and managed proactively.
Conclusion
While anemia and anxiety share some common symptoms and risk factors, the research evidence overall does not strongly support a direct causal relationship. Mild anemia is unlikely to independently cause significant anxiety. Severe anemia may exacerbate anxiety, but treating the anemia often resolves those mental health effects.
For those with underlying anxiety disorders or mental health vulnerabilities, anemia-related fatigue and worry could potentially worsen anxiety. However, anemia treatment alone would be unlikely to cure an anxiety disorder in those cases.
More research is still needed to better understand connections between specific types of anemia, individual mental health, and outcomes of anemia treatment. Addressing anemia-related symptoms may help alleviate associated situational anxiety. But anxiety medications, psychotherapy or other mental health interventions are likely necessary for someone with a true anxiety disorder to get lasting relief.