The gut-brain connection
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Studies suggest that changes in the gut affect the brain and how we behave, impacting mood and anxiety. The gut and the brain are connected through different pathways in the body.
Our gut collects messages and sends them to the brain and the brain collects messages and sends them to the gut. This is what’s called “bidirectional” communication. It’s through these pathways that the bacteria of the gut are able to constantly communicate with the brain - more so than other organs.
In people with IBD, the balance of the bidirectional communication is disturbed which can affect a person’s psychological state or emotional response. In turn, stress, anxiety, or depression may trigger IBD symptoms.
Does stress, anxiety, or depression cause IBD?
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There’s no doubt that IBD symptoms and flare-ups can cause stress and that stress can worsen IBD symptoms and flare-ups. But, which comes first?
On one hand, the impact of Crohn’s and colitis on a person’s quality of life can cause stress, anxiety, and depression. Symptoms can interfere with work, school, relationships, travel, and physical and emotional well-being.
On the other hand, the perception of stress can increase symptoms and cause a flare-up. In times of emotional stress, people can experience increased symptoms like abdominal pain or diarrhea. These flare-ups are not related to increased inflammation, but rather, the body’s decreased ability to fight inflammation during times of emotional distress.
Regardless of which comes first, research has shown that stress, anxiety, and depression do not cause Crohn’s or colitis. Instead, they are reactions to an existing illness. They can, however, cause flare-ups. The origin of depression and anxiety in patients with IBD is insufficiently explained.
People with IBD are at an increased risk of developing anxiety or depression. These emotional factors affect how a person experiences, perceives and copes with the disease.
Studies show that in colitis, depression was usually diagnosed the year before IBD symptoms began, suggesting depression may be the result of living with an undiagnosed bowel condition. In Crohn's disease, depression followed the diagnosis of IBD, suggesting depression may be a result of the symptoms and treatment of IBD.
How does stress, anxiety, or depression impact IBD?
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As we know through the gut brain connection, physiological symptoms contribute to psychological symptoms. In periods of active disease, psychological functioning is poorer.
Mental health problems in patients with IBD are associated with a significant impact on quality of life, worse disease course and more severe symptoms, increased rates of treatment failure with medications, and increased risk of surgery. Here are some of the ways these conditions can impact IBD.
Stress and anxiety can trigger IBD symptoms (but there is no evidence for intestinal inflammation). Knowing this, patients can work with their healthcare provider to improve strategies to deal with stress. If you’re not managing stress well, it can certainly worsen the disease.
Anxiety and depression
Findings are mixed on whether anxiety or depression are predictors of poor outcomes in IBD. Some studies report that only anxiety is a risk factor while others report depression is a risk factor as well.
People with anxiety have reported a lower quality of life, lower adherence to medication, and increased risk for surgery. People with depression have reported a poorer response to treatment and increased risk of disease relapse.
Fatigue associated with anxiety and depression is common in people with IBD and affects the quality of life, reduced physical activity, medication use, and anemia.
Depression or anxiety is also associated with an almost 30% increased risk of surgery in Crohn’s disease, more colonoscopies and an increased likelihood of using immunomodulator medications.
Patients who have been prescribed antidepressants reported improvements in their IBD.
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Watch the video below to learn from an expert psychologist about the relationship between mental health and IBD, and the gut-brain connection: