Health and Psychology

There are 400 different types of anemia.  All of them contribute to depression and are often not diagnosed or treated adequately.  It's the first medical condition that needs to be ruled out in cases where depression hasn't responded to psychotherapy prior to initiating medication.  (The second condition is undiagnosed infection).

Anemia is a condition that develops when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen.  Symptoms of anemia include pain in long muscles like thighs and arms, abdominal pain, chest pain, dizziness, confusion, and fatigue.  I often describe red blood cells as little life rafts that hold oxygen molecules, and transport them around the body.  Oxygen is needed for every organ to function adequately, especially the brain and the heart.

Anemia can be divided into three broad classes

• Anemia caused by blood loss
• Anemia caused by decreased or faulty red blood cell production
• Anemia caused by destruction of red blood cells

Blood loss can occur slowly or quickly.  Menstral bleeding can cause a cyclical type of anemia in women and is common.  Gastrointestinal bleeding can be caused by a number of conditions including gastrointestinal disorders such as Crohn's disease, gastritis, malignancy, blood vessel malformations, and hemorrhoids.  The use of asprin or non-steroidal antiinflammatory medications or other medications designed to thin the blood can cause bleeding.  It can also occur quickly and massively in the form of accident or injury.

When anemia is caused by decreased or faulty red blood cell production the body produces too few blood cells or the blood cells may not function correctly. In either case, anemia can result. Red blood cells may be faulty or decreased due to abnormal red blood cells or the a lack of minerals and vitamins needed for red blood cells to work properly. Conditions associated with these causes of anemia include the following:

• Sickle cell anemia
• Iron-deficiency anemia
• Vitamin deficiency
• Bone marrow and stem cell problems
• Other health conditions like celiac, or chronic illness or inflammatory diseases like lupus, and rheumatoid arthritis, or thyroid disease.

• Aplastic anemia 
• Thalassemia 
• Lead exposure 
• Toxins from advanced liver or kidney disease
• Inappropriate attack by the immune system
• Vascular grafts, prosthetic heart valves, tumors, severe burns, chemical exposure, severe hypertension, and clotting disorders
• Hyperspleenism

• Weakness and fatigue are the most common symptoms of anemia. Even iron deficiency without anemia can reduce working capacity in some people.
• Shortness of breath on exertion
• Rapid heartbeat
• Lightheadedness or dizziness
• Headache
• Ringing in the ears (tinnitus)
• Irritability and other mood disturbances
• Pale skin (however, healthy-looking skin color does not rule out anemia if a patient has risk factors and other symptoms of anemia)
• Mental confusion
• Loss of sexual drive
• Pica. One odd symptom, is the habit of eating unusual substances, such as ice (called pagophagia), clay, cardboard, foods that crunch (such as raw potatoes, carrots, or celery), or raw starch. The pica often stops, particularly in children, when iron supplements are given. Pica is difficult to detect because patients are often ashamed to admit to such cravings.
• Frequent Breath Holding. Children who hold their breath frequently when angry or upset, even to the point of fainting, may be iron-deficient.

• Inflammation of the mouth (stomatitis)
• Inflammation of the tongue (glossitis), which involves shrinkage at the surface and edges of the tongue
• Over time, psychiatric and neurologic problems develop. Vitamin B12 deficiencies cause neurologic symptoms (numbness and tingling, depression, memory loss, and irritability), and folate deficiency may result in depression and dementia (in severe cases).

Symptoms of Pernicious Anemia. Early neurologic symptoms of pernicious anemia are due to B12 deficiency. They include

• Numbness and tingling
• Depression
• Memory loss
• Irritability 
• Loss of balance and staggering
• Confusion
• Dementia
• Spasticity
• Loss of bladder control
• Erectile dysfunction

Folic acid deficiency does not cause neurologic damage, although people with this deficiency can be irritable, forgetful, and experience personality changes.