Inflammatory bowel disease (IBD) is a chronic condition, associated with a range of debilitating symptoms- from rectal pain and bloody stool to weight loss, joint pain, and even kidney and liver problems. In addition to these, there are also psychological aspects which factor in for shaping the disease course. Anecdotal evidence and clinical observations indicated that anxiety, depression, and/or stressful experiences could adversely affect the course of IBD.
Researches have shown that rates of depression are higher in people with ulcerative colitis (UC) and Crohn’s disease (primary conditions of IBD), compared with the general population. These manifestations occur more frequently during flares of the bowel disease. Additionally, an increased risk for surgery, lower adherence to medication and poorer quality of life have been reported in persons with anxiety. The rate of depression and/or anxiety in IBD is estimated at 15%–35% during remission and ≤80% for anxiety and 60% for depression during IBD relapse.
Living with IBD, as it is, has its own constant challenges that can impact on your mood and outlook, the psychiatric diseases coupled, may pose a whole host of even more challenges for persons with IBD, especially since there has been not much expansive research done to explore treatment of these conditions in persons with IBD.
IBD is a chronic, long-term condition that doesn’t have a cure yet. Most people living with it experience symptoms on and off for their whole life. The unpredictable nature of this disease can make sufferers of IBD often have trouble coping emotionally. It is this component of the disease that is frequently disregarded.
Factors associated with anxiety in ulcerative colitis and Crohn’s disease include:
- Severe disease
- Active flare-ups
- Not taking treatment as prescribed
- Being disabled or unemployed
- Having a low income
Factors associated with depression include:
- Older age
- Active flares
- Being disabled or unemployed
- Having a low income
How Mental Health and IBD Interact
Some researchers also believe that the connection between IBD and mental health goes beyond the unpredictable and chronic nature of the condition. There seem to exist a link between inflammation and depression. Inflammation is your body’s natural response to foreign substances and infections. However, when your body remains in an inflamed state due to an overactive immune system, it can lead to prolonged inflammation. Prolonged, chronic inflammation can result in brain and tissue damage which has been linked to a variety of diseases, including heart disease, cancer, and depression.
Now depression is not categorized as an inflammatory disorder. But inflammatory pathways in the brain can interfere with neurotransmitters. This reduces your level of serotonin, a chemical that plays a role in happiness and well-being.
Since chronic inflammation is one of the trademarks of IBD, this might explain the link between UC and mental health problems. There’s also evidence that stress can change the activity of cytokines, molecules in the immune system that may play a role in the onset of ulcerative colitis (UC) and its associated inflammation.
Recognizing mental health issues
Sings you should look for that could indicate anxiety and depression in people with IBD include:
- Persistent sadness or a feeling of emptiness
- Frequent nerves or anxious feelings for six months
- extreme fatigue
- irritability
- isolation or withdrawal from friends
- a change in eating habits
Coping with IBD
Depending on the severity of your symptoms, living with IBD can feel as if you are being held hostage by your own body. For these reasons, once IBD develops, the unpredictability, uncertainty, and chronic course of the disease can cause a wide range of psychological and interpersonal concerns to patients.
Dealing with these concerns need appropriate coping strategies and good adaption. Speaking with your doctor is the first step you should take to get help for anxiety or depression associated with IBD. Treatment may include adjusting your medication to better control inflammation. Your doctor may aslo prescribe an antidepressant or anti-anxiety medication to improve your mood.
However, it has also been observed that IBD patients rely significantly on passive coping strategies, utilizing fewer purposeful problem solving, and more escape-avoidance strategies.
Concerns about the condition and passive and/or avoidant coping on the other hand, lead to psychological distress and poor adjustment to the disease. Social support, however, seems to be the factor that helps some people with IBD. For patients who experienced moderate-to-high levels of perceived stress, high satisfaction with social support decreased the level of psychological distress and facilitated adjustment to the disease, a point which highlights the importance of social support in maintaining mental health in and adjustment to IBD.
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