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A significant contributing to factor to the severity of inflammatory bowel disease (IBD) turns out to be anxiety. Treating anxiety also treats flareups.

Inflammatory bowel diseases are notoriously difficult to manage in social situations. Diseases such as Crohn's disease and ulcerative colitis take their toll in chronic fatigue and achy joints, which are bad enough, but also with:

  • Urgent diarrhea which tends to occur after eating larger than normal portions, such as at a celebratory meal.
  • Nausea and vomiting after eating certain foods or even after thinking about or talking about certain foods, especially in Crohn's disease. A bad experience with a food leaves a strong memory that can be activated by the odor of the food or conversations about the food.
  • Intense abdominal cramps. It isn't just that IBD causes diarrhea. It causes diarrhea with severe abdominal cramps. The pain from these cramps can literally take your breath away, cause you to break out in a sweat, and even pass out, at precisely the time you need to be racing to the bathroom.

These symptoms are a major problem in daily life. However, anxiety and depression make them worse.

Scientists Explore the Relationship Between Anxiety, Depression, and IBD

A number of studies have found that people who have IBD also tend to have anxiety and depression. A lingering question has been whether IBD causes anxiety and depression or anxiety and depression cause IBD. A study at the University of York in the United Kingdom recently looked at this question.

Dr. Antonina Mikocka-Walus and her colleagues reviewed the literature and found that some studies seemed to find a relationship between psychiatric illness and IBD and others do not. Her research team attempted to resolve the ambiguity in research findings by studying 405 Swiss IBD patients across time to determine whether a causal relationship exists.

The researchers found that 20.2 percent of their study participants could be diagnosed with clinical depression, and 37.5 percent suffered from generalized anxiety disorder. At the baseline, however, there wasn't any clear relationship between having anxiety or depression and having inflammatory bowel disease. IBD didn't cause anxiety or depression, and anxiety or depression didn't cause IBD, because there was no statistically significant relationship between them.

However, people who had IBD and also anxiety and/or depression suffered flareups of IBD more often. There was a stronger relationship between depression and IBD flareups than there was between anxiety and IBD flareups. The researchers theorize that this could be because depressed people don't follow doctor's orders precisely, however, not that depression necessarily is a manifestation of a gut-brain relationship that also causes IBD.

If Anxiety and Depression Make IBD Worse, Does Treating Anxiety and Depression Make IBD Better?

IBD researchers have looked into the possibility that part of what people who have Crohn's disease or ulcerative colitis need is psychological support. The results of psychological interventions are mixed:

  • Computerized training to reduce anxiety levels helps some people to a modest degree, but only as long as the training continues.
  • Face to face psychotherapy doesn't change the course of IBD or affect symptoms, but patients feel they have a higher quality of life when they get it.

There was, however, one form of psychotherapy that seems actually to improve IBD.

Continue reading after recommendations

  • Keefer L, Taft TH, Kiebles JL, Martinovich Z, Barrett TA, Palsson OS. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Aliment Pharmacol Ther. 2013. 38(7):761–71. doi: 10.1111/apt.12449.
  • Mikocka-Walus A, Pittet V, Rossel JB, von Känel R
  • Swiss IBD cohort study group. Symptoms of Depression and Anxiety Are Independently Associated With Clinical Recurrence of Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2016 Jan 25. pii: S1542-3565(16)00047-1. doi: 10.1016/j.cgh.2015.12.045. [Epub ahead of print] PMID: 26820402.
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