IBD & Mental Health

Disclaimer: This information is based on my own research into this particular aspect of IBD as well as some personal experience and should not be used as medical advice or a diagnostic tool. The suggestions given within are taken from sources laid out in the references header.  If you seek advice regarding your mental state, please make contact with your GP for medical advice or reach out to Samaritans for anonymous therapy and guidance.

It is normal to feel sad and anxious as you live with inflammatory bowel disease (IBD). While some people may have fleeting bouts of sadness or stress relating to their IBD, it’s important to see a mental health professional if your symptoms last for several weeks or more at a time.

Rates of depression are higher among patients with Crohn’s disease and ulcerative colitis as compared to other diseases and the general population. Anxiety is also common in IBD patients. It is important to recognise the signs that you are struggling emotionally and seek help just as you would for your physical symptoms. It is important to note, though, that there’s no evidence to support stress, tension, or anxiety directly causing IBD. But there are factors that can have a major impact on how you experience and cope with the disease.

Depression

Depression is a serious mood disorder that causes feelings of sadness and loss of interest. Depression can make you feel exhausted, worthless, helpless, and hopeless. It can also make dealing with daily tasks difficult. Tasks associated with managing a chronic illness may feel insurmountable.

In some people with IBD, being diagnosed with the disease can bring about feelings of frustration or sadness, and cause them to become withdrawn.

Other people may be worried about specific aspects of the condition, such as having bouts of gas, diarrhoea, or pain in a social situation or public place. This can directly bring about anxiety or lead them to become isolated, which may in turn cause feelings of loneliness and despair and contribute to depression.

The risk of anxiety also rises after diagnosis which indicates that, in many people, the disease may contribute to anxiety.

It’s not just your risk of developing IBD that may be affected by depression and anxiety. In a study published in June 2016 in the journal Clinical Gastroenterology and Hepatology, researchers found that “depression was associated with a greater incidence of flares in Ulcerative Colitis.”

Anxiety

Anxiety consists of feelings of panic, worry, and nervousness. When anxiety becomes persistent and excessive, it can interfere with your mental and physical health.

Types of Anxiety Disorder

There are different types of anxiety disorder, each of which will have slightly different symptoms and treatment. Some examples of anxiety disorders include:

• Generalised Anxiety Disorder
• Panic Disorder (regular sudden attacks of panic or fear)
• Post-traumatic stress disorder (PTSD)
• Social Anxiety Disorder
• Obsessive-Compulsive Disorder (OCD)
• Specific Phobias (overwhelming and incapacitating fear of a specific object, place, situation or feeling)

Most anxiety can be focused around one of all of the following emotions:

• dissociation – one way the mind copes with too much stress, such as during a traumatic event.
• rumination – thinking a lot about bad experiences, or thinking over a situation again and again
• depersonalisation – feeling disconnected from your mind or body, or like you’re watching someone else (a type of dissociation)
• derealisation – feeling disconnected from the world around you, or as if the world isn’t real (which is another type of dissociation)
• worrying a lot about things that might happen in the future

Stress

Stress is your body’s hormonal response to any situation that demands you take action, whether it’s getting to a meeting on time or dealing with a major medical issue. The release of those hormones is what’s known as “the fight or flight response”. They are responsible for physical reactions to stress, such as increased heart rate, perspiration, and tightening of your muscles.

Psychological stress has been shown to increase the permeability of the intestines — how easy it is for nutrients and other particles to pass through. This can reduce the effectiveness of the mucosal lining.

There’s also evidence that stress can change the activity of cytokines; the molecules in the immune system that may play a role in the onset of IBD and its associated inflammation. And inflammatory cytokines may also play a role in the onset of mental health issues, contributing to anxiety when their levels go up due to intestinal inflammation.

There are emotion-focused strategies to help with stresses that you cannot control:

• Acceptance of the situation
• Utilising social support, such as asking a friend to accommodate your needs
• Relaxation
• Constructive self-talk, such as “I did the best I could”
• Let it go and move on

You can also help reduce stress by planning ahead if episodes of diarrhoea or abdominal pain make you fearful of being in public places. Be aware of bathroom locations close to your destination, and it can be hand to carry extra underwear, toilet paper, or moist wipes while you travel.

Evidence

‘The Manitoba IBD Cohort Study: A population-based study of the prevalence of lifetime and twelve-month anxiety and mood disorders. American Journal of Gastroenterology 2008′ – This 2009 American Journal of Gastroenterology study found that “about half of those with a mood disorder had a first episode of depression more than two years before the onset of IBD. While this is not entirely surprising given the common emergence of these disorders in adolescence (and earlier in the case of anxiety), these findings do raise some questions about emotional disorders as a risk factor for the development of IBD… These findings suggest a need for more routine screening for anxiety and depression in IBD patients as part of regular care. Fortunately, very effective psychological or medication treatments are available for these conditions, which can help people to cope more effectively with chronic illness.”

‘Adolescents with Inflammatory Bowel Disease: Their relationship with their disease, identity and illness perceptions’ – a University of Sheffield project funded by Crohn’s and Colitis UK found that “anxiety and depression are prevalent in young people with IBD, with young women in particular reporting a lower quality of life, and more frequent and higher levels of anxiety than their male counterparts.”

The report recommended that young people with IBD should be screened and monitored for the risk of developing depression and anxiety, and that there should be mechanisms in place to intervene early. The researchers felt there was a need “to help young people develop ways of coping with their disease, fearing the possible consequences less, understanding IBD better, feeling more positive about their IBD and fostering self-compassion”.

Self-Management

There are several things you can do at home to cope with negative feelings while you are getting treatment for depression.

Remember that feeling better takes time, and that your mood will likely improve gradually, not immediately. These tips have been adapted from the National Institute of Mental Health booklet on depression:

• Set realistic goals, keeping your depression in mind, and take on a reasonable amount of reasonability in your daily life.
• Set your priorities and break big tasks into smaller ones, doing the best you can to tackle them.
• Make a point to spend time around other people. Confiding in a trusted friend or family member usually feels better than being along and secretive.
• Participate in activities that may make you feel better, such as mild exercise, seeing a movie, watching a sport event or participating in social events.
• Postpone major life decisions until your depression has lifted. These decisions may include changing jobs, getting married or filing for divorce. Discuss important decisions with trusted friends or family members who may have a more objective view of your situation.
• Don’t expect to “snap out of it.” Instead, expect to feel a little better each day.
• Ask for and accept help from your family and friends.
• Know that positive thinking will eventually replace negative thinking as your depression responds to treatment.

It is common and understandable to worry and feel stress about managing your disease, but reducing your stress and anxiety can help you maintain a healthy emotional balance. There are many ways to try and reduce your stress. Keep trying until you find something that helps.

• Relaxation and breathing exercises
• Light aerobic exercise such as walking or swimming
• Medication to address your emotional and mental state
• Biofeedback – read more here.
• Books, recordings, guided imagery or journaling
• Practising yoga or tai chi
• Cognitive behavioural therapy or psychotherapy with a psychologist or social worker
• Meditation or hypnotherapy
• Pursuing hobbies and activities you enjoyed before your diagnosis
• Creating a support network of friends, family and health care professionals.

Do you have any questions or queries? Or just want to share your own experiences? You can leave me a reply here or leave comments via my social media accounts – on Twitter, find my blog page on Facebook and over on Instagram

Further Reading:

Dealing with Depression While Taking on IBD: Louise’s Story

Resources:

Crohns & Colitis Foundation – Depression and Anxiety    –     IBD and your Mental Health [leaflet]

EveryDay Health – The Link Between Mental Health Disorders and Ulcerative Colitis

Gastrointestinal Society of Canada – Depression & IBD

Crohns and Colitis UK News – Study Examines Impact of IBD on Young Peoples Mental Health