Affluent Savvy
Affluent Savvy
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Iron deficiency is usually associated with a low level of serotonin. Previous studies have shown that serotonin deficiency may cause a relapse of depression [39, 40]. In addition, evidence has shown that impaired emotional behaviors are associated with iron deficiency via modified dopamine metabolism [39,40,41,42,43].
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Read More »This nationwide population-based cohort study indicated IDA as a potential risk factor for developing psychiatric disorders, even after adjusting for age, gender, income, urbanization, and comorbidities. Among the different psychiatric disorders, our results revealed that IDA was associated with an increased risk of anxiety disorders, depression, sleep disorders, and psychotic disorders. IDA with iron supplementation was associated with significantly lower risks of psychiatric disorders. Furthermore, IDA patients receiving iron supplementation had a lower risk of sleep disorders. Our results are generally consistent with the findings of previous studies [14,15,16, 25, 26]. A hospital-based case-control study with 100 cases and 100 controls showed a relationship between IDA and depressive disorder; and the severity of symptoms of depressive disorder increased with the degree of IDA [15]. A web-based survey, which consisted of 1000 individuals and 10,876 controls, indicated that IDA was associated with a self-reported history of depression [26]. A case-control study which included 2957 IDA patients and 11,828 healthy controls showed a higher risk of psychiatric disorders, including mood disorders, autism spectrum disorder, attention deficit hyperactivity disorder, and developmental disorders [14]. Our study used a large population-based dataset and longitudinal design, which may have reduced surveillance bias and enabled the consideration of possible confounders for the development of psychiatric disorders. Therefore, it could be useful for explaining the causality between IDA and psychiatric disorders. In the present study, we demonstrated that IDA was associated with an increased risk of sleep disorders. A cross-sectional study showed that IDA affects sleep quality irrespective of psychological symptoms such as depression and anxiety [16]. A possible explanation was that changes in neurotransmitter metabolism due to iron deficiency, psychological status, or possible RLS affected sleep negatively. In addition, the incidence of bipolar disorder was similar between the two groups in the present study. The following is one possible interpretation. The causes of bipolar disorder are not entirely understood. A large body of evidence has indicated that there are a number of factors working together to make a person more likely to develop bipolar disorder, such as genetics, chemical imbalances in the brain, environmental factors, physical illness, and stress [27]. It is possible that IDA only accounts for a small part of the factors affecting bipolar disorder. Therefore, we conjectured that IDA may not be the main risk factor for bipolar disorder. Previous studies have reported the effects of iron on brain activity and mood presentation [10, 28, 29]. Iron is involved in many neurological activities and deficiency is associated with anxiety and depressive symptoms as well as developmental problems [2, 10]. In the present study, iron supplementation was shown to mitigate the risk of psychiatric disorders. We found that iron supplementation in non-IDA female subjects was associated with significantly lower risks of psychiatric disorders. Our results also found that iron supplementation has the benefit of reducing risks of sleep disorders in IDA patients. Similar to our finding, a study in Japan demonstrated that iron intake could reduce the risk of depression [26]. Another study in Korea found a negative association between depression and intake of iron after adjusting for confounding variables [30]. A meta-analysis also indicated an inverse association between dietary iron intake and risk of depression [31]. Moreover, a couple of studies also indicated that higher iron intake has a beneficial effect on lowering the risks of developing depressive symptoms [30, 32]. Several mechanisms are suggested for the relationship between iron deficiency and psychiatric disorders. Iron deficiency results in an alteration of monoamine neurotransmitters and the abnormal myelination of white matter [33, 34] . Glutamate and GABA homeostasis are modified by fluctuations in brain iron status [35]. Such alterations bring about emotional and psychological problems. Iron is essential for a number of enzymes involved in neurotransmitter synthesis, including serotonin, dopamine and norepinephrine [36], which are involved in the regulation of mood, neuronal activity, and anxiety [37, 38]. Iron deficiency is usually associated with a low level of serotonin. Previous studies have shown that serotonin deficiency may cause a relapse of depression [39, 40]. In addition, evidence has shown that impaired emotional behaviors are associated with iron deficiency via modified dopamine metabolism [39,40,41,42,43]. Therefore, these possible biological mechanisms may explain why iron intake could reduce the risk of psychiatric disorders.
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Learn More »In the present study, the development of psychiatric disorders in IDA patients with or without iron supplementation was significantly higher than the non-IDA group. These results are similar to those from research by Hong et al. [44]. They found IDA patients displayed a higher risk of Parkinson’s disease, which remained unaffected by iron supplementation [44]. This may be due to non-responsiveness to iron therapy in some patients with IDA [45]. In addition, patients with IDA, inflammation or other coexisting conditions may have reduced intestinal absorption of iron and inhibited release of iron from stores [46]. Therefore, even IDA patients receiving iron supplementation had a higher incidence of psychiatric disorders compared to the non-IDA group. Our results are consistent with previous studies that showed a higher prevalence rate of IDA among the female population [47,48,49]. We observed that in the national population, among patients with IDA, the number of male patients (n = 4506, 23.23%) was fewer than the number of female patients (n = 14,891, 76.77%). A previous study demonstrated that women who have particularly heavy or prolonged menstrual bleeding, as well as pregnant and lactating women, are especially at risk of developing IDA [50]. Moreover, women with hypermenorrhea have more frequent visits to clinics or hospitals, where ICD codes are coded and diagnoses obtained accordingly, compared to men. These are possible explanations for the high prevalence rate of IDA among the female population.
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