Living with a chronic illness like 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 problems among people 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 the symptoms of IBD, including severe diarrhea, chronic pain, fatigue and loss of appetite, can lead to social isolation and feelings of depression. But recent research suggests that the relationship between the two conditions may be a bit more complicated than that.
A new study published in April 2022 in Journal of Gastroenterology and Hepatology, found a bidirectional relationship between IBD and depression (meaning that people with one condition are more likely to develop the other). What’s more, this association extends to siblings of people with either disorder, suggesting a genetic component to the association between these disorders.
“I think it’s important for people to understand that these conditions don’t happen in a vacuum and that there’s not just one cause,” says Stephen Lupe, PsyD, a gastrointestinal psychologist and director of behavioral medicine in the Division of Gastroenterology, Hepatology, and Nutrition. at the Cleveland Clinic, who 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, Dr. Bing Zhang, a gastroenterologist at Keck Medicine of USC in Los Angeles and an author of the new study, says the gut microbiome — a community of trillions of bacteria and other microbes in the digestive tract — may also play an important role. role.
IBD and depression: what the study found
For the study, researchers analyzed data on more than 20 million people from Taiwan’s National Health Insurance Research Database, which contains comprehensive medical records of more than 99 percent of the country’s residents. They followed people with IBD or depression, as well as their siblings who did not have either disease, 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 almost twice as likely to develop depression. As for people living with depression, those with mental illness are twice as likely to develop IBD, while their siblings without depression are one and a half times more likely to develop bowel disease.
For Dr. Zhang, the finding that people with IBD and their siblings are more likely to experience depression makes sense.
“The symptoms of IBD can be persistent and very disruptive to a person’s life,” he says. “With siblings, there can be burnout or caregiver fatigue.”
But the researchers were surprised to find that people with depression were predisposed to IBD.
“This is the first study to find a bidirectional relationship between IBD and depression,” Zhang says.
Understanding the gut brain
Zhang suggests that the bidirectional relationship between IBD and depression has to do with the gut-brain axis. It is a scientifically established connection between the gastrointestinal system and the nervous system consisting of the brain and spinal cord.
“The way I explain it to patients is to tell them to think back to when they were kids and they had a really big test, or even more recently, if they had a big presentation or a job interview and all of a sudden, you have to go to the bathroom right before,” he says. “It’s a kind of gut-brain reaction that everyone can relate to.”
As for IBD, and depression specifically, Zhang speculates that brain inflammation, which plays a role in depression, may be related 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 patients with inflammatory bowel disease have something called gut dysbiosis, where their microbiome is altered compared to their normal state,” he explains. “And this can also be found in patients with brain disorders. So one of the things we hypothesized was that maybe there are changes in the microbiome that can actually cause both of those things.
Emphasis on the care of the whole face
The researchers say they hope their findings will encourage doctors to consider both family history and the relationship between gastrointestinal disease and mood disorders when evaluating or treating patients with IBD or depression.
As a practicing gastroenterologist, Zhang always questions his patients about their mental health.
“I always make sure to ask them how they’re doing mentally with their gastrointestinal symptoms, if they’re feeling tired, stressed or depressed, and if they’re sleeping well,” he says.
Depending on their answers, patients may benefit from seeing a mental health professional.
As a general rule, Dr. Lupe says that if a person is thinking about seeking that extra support, it’s a good indicator that they should.
“Certainly if they find that they’re struggling, if they start to be unable to engage with their lives anymore, if there’s a lot of friction in their relationships, it can be helpful to get that outside perspective,” he says.
Involving family members as part of the treatment plan can also be helpful.
Not only can family members provide support for the person with the disease, it can also be a way to screen loved ones for both depression and IBD.
“I think it’s helpful to get an idea of what the situation is at home and also ask about things like caregiver fatigue and burnout,” says Zhang. “And because we know that IBD has a familial component, if we talk to a sibling or a first-degree relative, they may realize they have symptoms too. This can lead to an earlier diagnosis so they can receive better care.