Living with a chronic condition such as Crohn’s disease or ulcerative colitis – both forms of inflammatory bowel disease (IBD) – affects every aspect of a person’s life. These diseases not only affect physical health but also affect mental and emotional health.
Research shows that mental health struggles among those living with IBD are common. People with IBD are 2 to 3 times more likely to have depression and anxiety than the general population, reports the Crohn’s and Colitis Foundation.
It’s easy to see how IBD symptoms, including severe diarrhea, chronic pain, fatigue, and loss of appetite, can lead to social isolation and feelings of depression. But recent research suggests the relationship between the two conditions may be a little more complex than that.
A new study, published in April 2022 in Journal of Gastroenterology and Hepatology, found a two-way link between IBD and depression (meaning people with one condition were more likely to develop the other). Furthermore, this link extended to the siblings of people with both conditions, also suggesting a genetic component for the connection between these diseases.
“I think it’s important for people to understand that these conditions don’t occur in a vacuum and that there’s no single cause,” says Stephen Lupe, PsyD, gastrointestinal psychologist and director of behavioral medicine in the department of gastroenterology, hepatology and nutrition at the Cleveland Clinic, which was not involved in the study. “We don’t know exactly what the mechanisms are, but it’s a combination of environmental, genetic and psychological factors.”
In addition to these, Bing Zhang, MD, a gastroenterologist with USC’s Keck Medicine in Los Angeles and author of the new study, says the gut microbiome – a community of trillions of bacteria and other microbes in the digestive tract – could also play a role. important.
IBD and depression: what the study found
For the study, the researchers analyzed data on more than 20 million people from Taiwan’s National Health Insurance Research Database, which contains complete medical records on more than 99 percent of the country’s residents. They monitored people with IBD or depression, as well as their siblings who had neither condition, for 11 years.
The results showed that people with IBD were 9 times more likely to develop depression than the general population, while their siblings were nearly twice as likely to develop depression. When it came to people living with depression, those suffering from mental illness were twice as likely to develop bowel disease, while their siblings without depression were one and a half likely to get bowel disease.
For Dr. Zhang, the discovery that people with IBD and their siblings were more likely to suffer from depression made sense.
“The symptoms of IBD can be constant and very disruptive to a person’s life,” he says. “With siblings, there may be caregiver exhaustion or fatigue.”
But the researchers were surprised to find that people with depression were prone to IBD.
“This is the first study to find a two-way link between IBD and depression,” says Zhang.
Understanding the gut-brain
Zhang speculates that the bidirectional relationship between IBD and depression has to do with the gut-brain axis. This is a scientifically established connection between the gastrointestinal system and the nervous system, consisting of the brain and spinal cord.
“The way I explain this to patients is to tell them to remember when they were kids and they had a very important test, or even more recently if they had a great performance or a job interview and all of a sudden, you have to go to the bathroom right away. first, “he says.” This is a kind of gut-brain response that anyone can relate to. “
When it comes to IBD and depression in particular, Zhang speculates that brain inflammation, which plays a role in depression, may be linked to gut inflammation, a hallmark of IBD.
The gut microbiome may also play a role. In recent years, studies have linked changes in the gut microbiome to a number of different diseases.
“We know that in patients with inflammatory bowel disease, there is something called intestinal dysbiosis where their microbiome has changed from their normal state,” he explains. “And this can also be found in patients with brain disorders. So one of the things we’ve speculated is that maybe there have been changes with the microbiome, which could actually trigger both. “
Emphasis on whole person care
The researchers say they hope their findings encourage doctors to take into account both family history and the connection between gastrointestinal disease and mood disorders when evaluating or treating patients with IBD or depression.
As a practicing gastroenterologist, Zhang always asks his patients about their mental health.
“I always make sure to ask how they are mentally coping with their gastrointestinal symptoms, whether or not they are feeling tired, stressed or depressed, and whether they are sleeping well,” she says.
Depending on their responses, patients may benefit from seeing a mental health professional.
As a general rule, Dr. Lupe says that if a person is considering seeking that extra support, it’s a good indicator that they should.
“Surely if they are in trouble, if they start not being able to commit to their life anymore, if there is a lot of friction in their relationships, it might be useful to have that external perspective,” he says.
Bringing family members as part of the treatment plan can also be helpful.
Not only can family members provide support to the sick person, but they can also be a way to shield loved ones for both depression and IBD.
“I think it’s helpful to get an idea of what the situation is like at home and also ask about things like caregiver fatigue and caregiver burnout,” says Zhang. “And because we know there is a family component to IBD, if we are talking to a sibling or a first degree relative, they may realize that they too have symptoms. This could lead to early diagnosis so they can get better care. “