Anemia May Enhance Mood Disorders

Among friends, I'll refer to the sun as "poor woman's Prozac," not as class commentary but to emphasize how much our environment and external factors affect our mood. Of course, that's not to say depressed people should just do pushups and drink more water—this isn't that kind of article. Rather, it's time to look at a more obscure reason you could be needlessly suffering: anemia.

Life as a metaphor

As a writer, I tend to understand the world in terms of metaphor. My mind is a landscape, populated by species of thoughts and feelings. Some are weeds and others are flowers, with the only real difference being my own perception of them.

This isn't just a fun visual for an un-fun topic. I genuinely try to view inconvenient and painful mental activity as clues to a larger picture, rather than problems to fix. This gives me time and space to fully evaluate my symptoms, so when I notice feelings of mental fog, I'm prepared to uncover the source.

It turns out, as a vegetarian and a menstruating woman, I'm part of the key demographic that develops anemia. Anemia is an extremely common nutritional deficiency, with almost 10 million cases in the United States in 2020 alone. Typically afflicting women more often than men, anemia's physical symptoms include fatigue and, in severe cases, chest pain or shortness of breath. But that's not the end of the problems caused by this particular nutritional lack.

The brain needs food

"In adults, deficiencies of B12 and folate can worsen depression and cause permanent, irreversible nerve damage," said Sheldon Zablow, a nutritional psychiatrist and author in San Diego. "The brain runs on sugar (glucose), and when someone has low blood sugar due to malnutrition, the brain does not have the cellular energy to function optimally."

We need to consume plenty of food, if only because the brain requires so much fuel. Consider your brain's energy requirements in the context of Maslow's hierarchy of needs. In the same way an individual can't hope to contemplate the meaning of it all on an empty stomach in the wind and the rain, our brain can't aspire to higher-level functioning without basic needs sustained. Unfortunately, what the brain considers a higher level can be as essential to our daily lives as mood stability.

'The immediate impact is a reduction in brain function and mood, with reduced concentration, inattention and memory difficulties,'

"Iron deficiencies cause a small red blood cell microcytic anemia, while a B12 and/or folate deficiency causes undeveloped platelets to make excessive amounts of an enzyme called monoamine oxidase (MAO)," Zablow said. "It is this enzyme that breaks down the chemical messengers that allow communication between brain cells."

In layperson's terms, there are two types of anemia. Both types leave you feeling cruddy, and both lower your red blood cell (RBC) quantity and quality. Anemia specifically stemming from an iron deficiency leaves your blood cells starved of oxygenating hemoglobins and myoglobins, which reside in muscle. Low levels of these helpers lead to physical fatigue, which may, in turn, result in memory problems and trouble concentrating, both of which exacerbate mental health concerns.

The janitor and the waiter

The second kind of anemia relates more directly to this topic, as a lack of B12 and/or folate results in blood platelets—the entities responsible for clotting your blood—being released before they're mature. These runty platelets contain too much of the aforementioned MAO enzyme.

Think of MAO as your brain's janitor, removing the remains of emotion-causing hormones once your brain has used them. An excess of MAO means your brain is erasing precious serotonin and dopamine. Monoamine oxidase stops being a helpful janitor cleaning up spent hormones and becomes that pushy waiter taking your plate away from you before you've finished your meal.

Additionally, an anemic system transmitting serotonin and dopamine doesn't function as well as it should. So whatever dopamine or serotonin does manage to get through is then erased before you even get to enjoy it.

"The immediate impact is a reduction in brain function and mood, with reduced concentration, inattention and memory difficulties," Zablow said. "The long-term impact is possible irreversible nerve damage that decreases motor skills, which may cause falls. [There is also] the risk for depression, anxiety and dementia."

Maybe it's your diet?

Being anemic won't make you depressed, and being depressed won't make you anemic. However, the two are linked. Zablow pointed out studies have shown that 40 percent to 50 percent of people with depression have a deficiency of B12 and/or B9 (folate).

It's important to note that, although we've differentiated the two kinds of anemia, someone could suffer from both deficiencies simultaneously. Not only would they experience physical weakness from lacking iron, they may also be mentally operating suboptimally. Even if said person is lucky enough to figure out they're anemic, they may choose to course-correct with iron tablets or iron-fortified foods, which is useful but does nothing to address the lesser-known B9- and B12-related anemias. Plus, iron easily constipates. (Too personal? Too late!) An uninformed individual could wreck their gastrointestinal (GI) tract and still suffer the mental and emotional fog of B9- and/or B12-induced anemia.

Despite vegetarians and vegans being at the greatest risk for anemia, many foods high in folate are plant-based, such as edamame, lentils, asparagus, spinach and black beans.

As with so many issues in life, your doctor is one of your best allies in this situation. Talk to them about running lab work to identify what you need most, whether that's supplements, starting a new medication or changing an existing dose.

Diet also plays a helpful role. Despite vegetarians and vegans being at the greatest risk for anemia, many foods high in folate are plant-based, such as edamame, lentils, asparagus, spinach and black beans. All of these foods pack large quantities of daily recommended folate levels, as well as other health benefits.

Diet management is no substitute for therapy or psychiatric medication. However, anemia—and other nutritional deficits—is a factor that can lessen a medication's efficacy. If a psychiatric drug that's previously worked for you now seems to be decreasing in efficacy, diet may be one avenue to discuss with a medical provider in fine-tuning your mental health regimen.