Can low INR cause depression/mood swings/anxiety?

Hi, with the help of my clinic nurse we are nearly on track with getting the correct warfarin dose to get my INR within its target range (2.5-3.5), however my husband and I have noticed when it drops below the range I am depressed, anxious and moody. It's really causing problems. Before I started warfarin I was on a Heparin trial for 6 weeks, 3 weeks in we noted a real difference in my moods for the better. Does this sound familiar to anyone and if so is there light at the end of the tunnel?

14 Replies

  • I have also been having issues with anxiety and depression lately but I, personally, don't think it's related to INR. I think mine just correlates with how I'm feeling. Sometimes I have good days and bad days. Lately, I've had a bad couple of months. This disease is so unpredictable and it's caused me to have only 23% kidney function left so it's hard to always be happy and cheerful. I'm tired a lot and don't feel well a lot. It's causing friction between my husband and I. I don't think he understands that I have days that I don't feel like riding a bike or even getting off the couch because he's never been seriously ill. I believe he thinks this is a mind over matter thing and maybe it is occasionally. I will admit though that the illness has changed me. I'm not as happy as I was, I am more negative, and there are a lot of physical activities that I forego now because of my concerns with the risk of bleeding. It sounds like you are newly diagnosed. Having your INR in range will definitely make you feel better but you may also have some bad days. I guess it also depends on any other conditions you may have. I know that going for long walks with my dog tends to help my moods. Hang in there! Sorry if I was bleak! Being honest though.

  • Here is an article about APS induced mania. There might be some data showing that APS can cause psychosis. If APS can cause psychosis, I'm pretty sure it can cause depression and anxiety. You've got to figure that limited blood flow to the brain can potentially affect any are of the brain - including the part of the brain that can cause anxiety and depression. You're question is a valid question! There are probably more articles/studies out there, I'm just too lazy to do any research tonight. I hope this helps answer your question a little bit better.

    Here is the article:

  • Hi. I'm glad you asked this as I have noticed exactly the same and also wondered if it was INR related. I get far more anxious and less able to focus when my INR is on the lower side.


  • Hi I noticed the difference when I was on Clexane, infact when I first went on Warfarin I sat in the Doctors crying and asking to get back on it, I think it improves the blood flo to other places in the brain that other drugs don't reach. I have cerebral APS so perhaps that's why I can feel it more.

    I know when my INR is high I feel really anxious like I have drunk 10 cups of coffee, when low I can't think straight again.

    I am now on antidepressents for severe clinical depression which seem to work in the same way as the Clexane

  • Hi, I never been on Wafarin, only Fragmin fo pregnancies, but there is a common theme on here with the INR going low that people do appear to literally be feeling low! Hardly surprising really. If medication is not working at optimum level, Hope it settles down. MaryF

  • Interesting thread.

    Do people feel that, although warfarin and heparin both do the job of anticoagulation, warfarin actually relieves some symptoms of cerebral APS more than heparin does?

    I've asked this question and been given the impression that both should have the same effect although it doesn't seem to be the case to me.

  • -- more from the medically unqualified suburban English major from West Virginia:

    I don't think that the whole spectrum of APS mechanism has been documented. That would explain why treatment can be very individual: one patient is fine on warfarin, another on fragmin, another on asperin or plaquanel. There is no clear blood test that I know of which clues a doctor into which symptoms in which patient will be best treated by which medication. Experienced doctos are more likely to work closely with the patient to find the most effective treatments.

    But there is also a "which came first, the chicken or the egg" conundrum regarding autoimmune related fatigue and depression. Do we get tired because we are depressed; or vice versa?

    I vote for the "vice versa;" when I'm too tired to live my usual life and can't even concentrate on the book I'm reading, then -- duh! -- I get depressed! But I have met (at least) one doctor who believes that the depression causes the fatigue. He points to data which corrolates depression with autonomic nervous system dysfunction, which can produce fatigue and autoimmune dysfunction. My answer to this observation? This still doesn't point to either the chicken or the egg as the determiing factor.

    But again -- what do I know? I'm the English major housewife. But I am also a patient, and as a patient I have access to more data from my own body then any doctor can access. And this data tells me that a low INR, and/or random virus load usually results in fatigue, brain fog; which themselves cause depression.

    So yes, there is a light at the end of the tunnel. Getting the right meds at the right INR can empower and enable. But then again, this is a chronic disease so your track will lead through several tunnels in your lifetime.

    Which is one reason this site is so helpful! We share our experiences and cheer each other on.

    Go Tess!!!

  • Hello there, from my own experience I would definitely say low inr causes anxiety & in my case insomnia as well. I can tell my inr might be low as my thought processes tend to be negative. Since being on warfarin I "sleep through" the night which is mini miracle for me. My target inr is between 2-3 however when I've been 3.2 & 3.4 I felt fantastic! Good blood flow to the brain makes a world of difference. .... Carmen :)

  • Did you know Professor Hughes recommends INR 3.-3.5. I am on Clexane because my dr. Wanted my INR at 2.5-3 & it just wasn't thin enough for me..


  • That is very interesting. I have mood swings also but I never attributed to APS/Hughes. When my blood is to thick I have more pain, my arms & legs are cold, the livedo is more promitant, and I do get anxious & depressed. Maybe it does cause the depression & anxiety. Your right it is a problem for the ones around us.


  • Hello designer, I'm from perth Australia and I think standard inr range is 2-3 here. I would agree with professor Hughes though in that 3-3.5 should be the aim. For now 2-2.5 alleviates majority of my symptoms. At times I know I drop below 2 as I get brain fog. For now things ok but may change going forward. All the best to you & everyone else. :)

  • Hi, this is very interesting to me so thank you.

    2 years ago I was fortunate ago to survive CAPS having had APS since circa age 21.

    I never even thought about this before but it would seem my INR was out of range for a long time prior to CAPS due to GP failings etc no consultant follow up etc despite my enquiring having had several before I moved.

    Anyway in hindsight thinking back, although I had a few personal problems, for at least the 18 months preceeding I suffered from anxiety and depression which I couldn't understand as I was usually upbeat and quite resilient. I really felt like I was in a dark place with not much change of escape for a long time.

    Sorry if that sounds dramatic.

  • Thank you everyone for your comments, sounds like it's a fairly common symptom and controllable when the inr is correct. I've bought my own Coagucheck machine and although pricey definitely worth while to monitor my inr between clinic visits and therefore understand my symptoms better and even seem to be slowly convincing my clinic nurse and GP to allow some self testing. Yipee, blue skies ahead! Happy Christmas everyone xxx

  • I have read and noticed as I selftest myself, how important for a lot of APS-symptoms it is to keep the INR in the right target and maintain it there also. Make notes and you learn how you react!

    I am very happy for you that you have convinced your GP to let you selftest. I thing that blue skies are ahead!

    A Happy Cristmans to you also!

    Kerstin in Stockholm

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