If you have anxiety or are thinking about starting a medication like Zoloft, you might have concerns about whether your prescription has the potential to affect your iron levels. Or are your iron levels the thing that's actually causing your anxiety?
Anxiety and anemia are definitely related. Still, experts can't say for sure whether low iron comes from taking antidepressants or anti-anxiety medications.
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Here's what you should know, plus what you can do to get the nutrition you need while addressing your mental health concerns.
First, What Is Iron-Deficiency Anemia?
Before diving into the relationship between anti-anxiety meds and anemia, let's review the basics. Iron-deficiency anemia is a type of anemia that can develop if a person doesn't have enough iron in their body. Mild or moderate cases typically don't cause symptoms, but when iron-deficiency anemia becomes severe, it can lead to fatigue, shortness of breath, dizziness, cold hands or feet and pale skin, according to the National Heart, Lung, and Blood Institute (NHLBI).
Iron-deficiency anemia develops when the body doesn't have enough iron to make hemoglobin, an important component of red blood cells, according to the Mayo Clinic.
This can happen from blood loss (like very heavy periods or gastrointestinal bleeding), iron absorption problems (which can stem from problems like celiac disease or endurance sports) or simply not eating enough iron-rich foods.
Pregnancy can increase the risk for iron-deficiency anemia too, because a person's iron needs increase during this time to supply hemoglobin for the growing fetus.
Iron-Deficiency Anemia and Anxiety
There's a known relationship between anemia and anxiety. But does anemia develop from taking anti-anxiety medications, or are people who are anxious already prone to having an iron deficiency? Let's take a look.
Can Anemia Cause Anxiety?
Iron deficiency can cause a number of physical symptoms, but for some people, the side effects can also be emotional.
"Iron deficiency can lead to symptoms of anxiety, rather than anxiety leading to iron deficiency," says Uma Naidoo, MD, director of nutritional and lifestyle psychiatry at Massachusetts General Hospital and author of This Is Your Brain On Food.
Indeed, people diagnosed with iron-deficiency anemia are at increased for psychiatric disorders, found a May 2020 analysis in BMC Psychiatry.
The reasons why are complex. "Iron is an important nutrient that helps carry oxygen throughout the body, and when it is deficient, individuals can experience symptoms similar to anxiety like stress and fatigue," Dr. Naidoo says.
Multiple studies have also shown that iron deficiency can alter the production and signaling of feel-good neurotransmitters like dopamine and serotonin, according to a November 2015 review in the Journal of Nutritional Biochemistry.
Can Antidepressants Cause Anemia?
Muddying the picture is the fact that medications commonly used to treat anxiety are tied to iron deficiency. A June 2020 analysis in Preventive Medicine found that both selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with lower hemoglobin levels.
SSRIs and SNRIs include drugs such as:
- Effexor XR
That's not to say that SSRIs and SNRIs cause iron deficiency.
"The majority of the research on the association has been cross-sectional, meaning that the association is analyzed at one point in time," Dr. Naidoo says. "Data would have to be assessed in individuals before and after starting these medications in order to see if they can trigger a deficiency in someone who previously had sufficient iron levels."
In other words, it could be that people who are prescribed anti-anxiety meds had their iron deficiency before they started taking an SSRI or SNRI, since iron deficiency can trigger anxious feelings. It's also possible that the medications could make an existing iron deficiency worse.
"It was recently postulated that the relationship is due to the fact that anti-depressant and anti-anxiety medications are linked to a higher risk of abnormal bleeding," Dr. Naidoo says, which is another theory to consider.
Still, these are all just that — theories — at the moment, because research hasn't been able to prove a cause-and-effect relationship.
Never stop taking SSRIs or SNRIs without consulting your doctor. "Psychiatric medications can cause unwanted effects similar to those of withdrawal when stopped," Dr. Naidoo says. Let your doctor know if you suspect that your SSRI or SNRI is affecting your iron levels (or causing other undesirable symptoms). Together, you can come up with a plan to adjust your meds.
Figuring Out Your Treatment Options
If you suspect your iron levels are low, talk with your doctor about having them tested to determine whether you should start taking a supplement. Getting your fill of the mineral will help you feel better physically, and it could potentially reduce your risk for mental health problems.
In patients with iron-deficiency anemia, supplementing with iron was tied to a decreased risk of psychiatric disorders, per the May 2020 BMC Psychiatry analysis.
If you're experiencing anxiety but haven't yet sought formal treatment, making an effort to eat more iron-rich foods isn't a bad idea. Lean red meat, shellfish, pumpkin seeds, beans, spinach, kale and sardines are all good options, according to the National Institutes of Health (NIH). (Paying attention to foods that inhibit iron absorption helps too.)
"Because the symptoms of iron deficiency are comparable to those of anxiety, increasing iron intake can result in improved symptoms of overall physical and emotional wellbeing, including reduced anxiety," Dr. Naidoo says.
That said, iron-rich foods or even iron supplements alone may not be enough to manage anxiety.
"They can offer a tangible start to managing symptoms," Dr. Naidoo says. But "if you feel that your symptoms are impacting your overall quality of life, I'd recommend seeking professional care as well."
With the help of a mental health expert, you can discuss standard anxiety treatment options like therapy or medication.
Should you opt to take anti-anxiety meds, you can have your iron levels checked to confirm whether your prescription is having a negative effect, Dr. Naidoo says. If that seems to be the case, you can work with your doctor and therapist to decide the best way to continue treating your anxiety while ensuring you get the iron your body needs.
- National Heart, Lung, and Blood Institute: "Iron-Deficiency Anemia"
- Mayo Clinic: "Iron Deficiency Anemia"
- BMC Psychiatry: "Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis"
- Journal of Nutritional Biochemistry: "Iron and Mechanisms of Emotional Behavior"
- Preventive Medicine: "Depression, antidepressants and low hemoglobin level in the Paris Prospective Study III: A cross-sectional analysis"
- National Institutes of Health: "Iron Fact Sheet for Health Professionals"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.