The Silent Struggle: Pernicious Anaemia, Mental Health, and the Elephant in the Room

When we hear the term “Pernicious Anemia,” many of us immediately think of fatigue, weakness, or low vitamin levels. However, there is a significant issue that we need to address: the substantial impact this condition can have on mental health, including the risk of suicidal thoughts.

Pernicious Anemia (PA) is not merely a blood disorder; it is an autoimmune condition that impairs the body’s ability to absorb vitamin B12, a nutrient essential for proper brain and nerve function. While fatigue and breathlessness are common symptoms, many people first present with cognitive and psychiatric signs long before anaemia is detected (Lindenbaum et al., 1988).

People living with undiagnosed or poorly managed PA often report:

• Memory loss
• Difficulty concentrating (brain fog)
• Mood swings
• Anxiety or panic attacks
• Depression
• Paranoia or psychosis in severe cases

A survey by the Pernicious Anaemia Society found that:

• 86% of respondents experienced emotional and mental health symptoms such as irritability, low mood, and anxiety.
• 22% reported having suicidal thoughts as a direct result of their illness (Pernicious Anaemia Society, Mental Health Survey).

Imagine asking for help and being told you’re “just tired” or “overreacting”, when in reality, your body is starving for a vital nutrient and your mind is unravelling as a result.

This is the elephant in the room, the hidden, and often dismissed, connection between vitamin B12 deficiency and mental health.

The Science Behind the Symptoms

Vitamin B12 is essential for:

• Producing myelin, which insulates nerves
• Regulating neurotransmitters such as serotonin and dopamine
• Supporting methylation, which affects mood, cognition, and energy

Deficiency can result in:

• Depression
• Delirium or confusion
• Cognitive decline resembling dementia
• Hallucinations, mania, or psychosis (Lachner et al., 2012)
• Increased risk of suicidal behaviour, particularly in older adults (Kim et al., 2023)

In some cases, these symptoms are reversible with appropriate and timely B12 replacement, often via intramuscular injections. But delayed diagnosis or treatment can lead to permanent neurological damage.

The Psychological Impact of Being Dismissed

Beyond the biochemical effects, many people with PA report feeling:

• Invalidated by healthcare professionals
• Gaslit or accused of exaggeration
• Isolated and hopeless during the long wait for a diagnosis

A 2020 study in BMJ Open confirmed that patients living with PA felt “ignored, not believed, and stigmatised” by clinicians, especially when their symptoms didn’t fit textbook descriptions (BMJ Open, 2020).

The emotional toll of being dismissed adds to the psychological burden and increases the risk of depression and suicidal ideation.

What Needs to Change

1. Greater awareness among GPs and mental health professionals of the psychiatric signs of B12 deficiency and PA.
2. Routine B12 screening for patients presenting with unexplained depression, cognitive issues, or psychotic symptoms.
3. Faster referrals for those with persistent neurological or psychological complaints.
4. Compassionate, person-centred care that listens, believes, and supports.

You Are Not Alone

At SOS Silence of Suicide, we know how life-saving it can be to feel seen and supported. That’s why we’re speaking up for every person who has been misdiagnosed, dismissed, or left to struggle in silence.

If you or someone you love is facing a mental health challenge linked to B12 deficiency or Pernicious Anaemia, speak up. Ask questions. Demand answers.

This is the elephant in the room, but together, we can name it, face it, and save lives.

If you’re struggling right now, we’re here to listen. Call our Freephone Helpline: 0808 115 1505

Mon–Fri, 8 pm–midnight | Sat–Sun, 4 pm–midnight

References:

1. Lachner, C., Steinle, N.I., Regenold, W.T. (2012). The Neuropsychiatry of Vitamin B12 Deficiency in Elderly Patients. The Journal of Neuropsychiatry and Clinical Neurosciences, 24(1): 5–15. PubMed
2. Kim, K. Y., Jung, W. Y., Kim, C. (2023). Associations Between Folate and Vitamin B12 Levels and Suicide Attempt in Patients With Depression. Frontiers in Psychiatry. PMC
3. BMJ Open (2020). “Patient experiences of medical treatment for vitamin B12 deficiency: a qualitative study”. BMJ
4. Pernicious Anaemia Society (2023). Mental Health & PA Survey Results. PAS
5. Lindenbaum, J., Healton, E. B., Savage, D. G., et al. (1988). Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. New England Journal of Medicine, 318(26), 1720–1728. PubMed