Why iron stores matter for mental health

When mental health struggles surface, iron levels rarely top the checklist. Yet growing research shows iron plays a critical role in how you think, feel and cope with everyday life.

Iron deficiency and anaemia, both preventable and treatable, affect millions worldwide. The impact spans every life stage, from toddlers who struggle to regulate emotions, to teenagers battling anxiety and fatigue, to adults facing low mood and brain fog, and older people experiencing memory decline and exhaustion.

“So many people don’t realise iron is essential for producing serotonin, dopamine and norepinephrine, the neurotransmitters responsible for mood, sleep, focus and emotional balance,” says Sister Karin Davidson, anaemia advocate and head of Cape Town Infusion Centre. “When iron stores drop, the brain cannot function optimally, and mental health symptoms often follow.”

The hidden burden of iron deficiency

Iron deficiency is one of the most common nutritional conditions globally. According to the World Health Organisation, anaemia affects around 1.62 billion people worldwide.

In South Africa, the picture is particularly concerning. Anaemia affects between 29 and 61 per cent of children under five, with one-year-olds at the highest risk. Across sub-Saharan Africa, around 43 per cent of women of reproductive age and 40 per cent of adolescent girls are anaemic.

“Babies born to iron-deficient mothers are often iron-deficient from birth,” says Davidson. “If this is not corrected early, children are placed at risk for lifelong physical and mental health challenges. The tragedy is how easy this is to test for and treat.”

How low iron affects the brain

Iron plays a direct role in brain development, neurotransmitter production and oxygen delivery. When iron levels fall, mental health often suffers.

Children and teenagers
Low iron can affect emotional regulation, learning and behaviour. Children may struggle at school or appear overstimulated. Teenagers may feel constantly exhausted, irritable, foggy and unable to cope socially or academically.

Adults
In adults, iron deficiency often presents as anxiety, low mood, restlessness, poor concentration and emotional flatness. Studies show people with iron deficiency anaemia face a higher risk of psychiatric conditions, including depression and anxiety.

Older adults
In later life, symptoms are often dismissed as a normal part of ageing. “We regularly see dramatic improvements in mood, clarity and energy once iron deficiencies are treated,” Davidson explains. “What many accept as decline is often a correctable deficiency.”

The sleep and mental health link

Low iron stores often disrupt sleep. Insomnia, restless legs and poor sleep quality are common symptoms of iron deficiency. Poor sleep then worsens conditions such as anxiety, depression and ADHD.

“When iron levels are restored, sleep often improves significantly,” says Davidson. “Better sleep supports better mental health, emotional regulation and resilience.”

When symptoms become normalised

One of the biggest risks with iron deficiency is how easily symptoms are overlooked or misdiagnosed.

“People adapt to feeling unwell,” Davidson warns. “They accept fatigue, brain fog and low mood as stress or burnout, when a blood test could change everything.”

Physical signs to watch for include persistent fatigue, headaches, dizziness, shortness of breath, pale skin, cold hands and feet, hair loss, brittle nails, insomnia and heart palpitations.

Mental health warning signs include low mood, anxiety, irritability, poor focus, memory problems, ADHD-like symptoms, loss of motivation and emotional overwhelm.

“Mental health symptoms matter,” Davidson concludes. “Fatigue is not normal. Brain fog is not normal. If you are struggling emotionally or mentally, ask your doctor for a full iron panel, not just haemoglobin. Checking your iron levels could be the first step toward restoring wellbeing.”