The Link Between Depression and Crohn's Disease
Our mental health and physical health are tied together in obvious ways—especially in our stomachs. You might get stomachaches or even vomit when you’re nervous, and when you’re depressed, you may lose your appetite entirely. When you’re in love, you might feel “butterflies” in your belly, and when you hear bad news, it can feel like your heart drops to the pit of your stomach. These mind-body reactions are common for everyone, but for people with gastrointestinal conditions like Crohn’s disease, this link is brought to a whole new level.
Crohn's disease is a chronic autoimmune disorder that affects the gastrointestinal (GI) tract, commonly referred to as the gut. If you have Crohn’s, your immune system doesn’t work properly and your immune cells mistakenly attack your tissues, which creates inflammation in your gut. This inflammation can damage the area and cause problems in your stomach and intestines, interfering with your ability to eat, digest, and get enough nutrition. Living with Crohn’s can be quite painful and sometimes even debilitating. Fortunately, there are many effective treatment options available to treat Crohn’s and keep it under control. But even with treatment, Crohn’s can still react to different triggers and symptoms can flare up—and for some people, a trigger is depression.
Being depressed can make it more difficult to control the disease; studies have shown that depressed Crohn’s patients experience more flare-ups, have more severe symptoms, and are more likely to need surgery for their Crohn’s. Unfortunately, depression is significantly more common in people with Crohn’s disease than in people without the condition—it’s estimated that 60 to 80% of people with Crohn’s experience depression. Experts believe the reasoning behind this is twofold: 1) living with Crohn’s disease can be so difficult that many patients become depressed as a result of their decreased quality of life, and 2) Crohn’s disease and depression may be caused by the same dysfunction in the gut, which increases the likelihood of them co-occurring.
One thing we know for sure: depression can negatively impact Crohn’s disease. That’s why it’s so important for patients and physicians to understand the link between the two conditions, in order to find strategies to overcome depressive symptoms and improve overall health.
Crohn’s Symptoms, Quality of Life, and Depression
One major hurdle for many patients managing Crohn’s is the fact that suffering through the pain, discomfort, and lack of control associated with the disease can cause many patients to develop depression. Crohn’s is a chronic disease without a cure, and while it can be managed with the right therapy, having Crohn’s can restrict your ability to live a normal life—it can interfere with your idea of your self-worth, your social confidence, and your sense of independence and control. People with Crohn’s must be very cautious about their diets and may need to consistently plan ahead, learning where rest rooms are located in areas they plan to visit and bringing safe snacks to social events. Sometimes, the pain of Crohn’s can be excruciating and limit a patient’s ability to function in daily life. A minority of Crohn’s patients receive an ostomy, a pouch surgically attached to their abdomen that collects their waste, and this can cause embarrassment and insecurity. Because of these factors, many people with Crohn’s may feel isolated and different than their peers, and these feelings can contribute to an overall sense of despondence and desperation, which can progress into clinical depression.
Depression and Crohn’s: A Gut Feeling
In the last decade, researchers have been increasingly interested in how the bacteria in our GI tracts affect the rest of our bodies. We’re finding that both depression and Crohn’s disease are heavily impacted by these bacteria, and it’s becoming clear that the underlying mechanisms causing Crohn’s overlap with those causing depression—potentially explaining why depression is so common in Crohn’s patients.
Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced
or reprinted without permission from Healthgrades Operating Company, Inc. Use
of this information is governed by the Healthgrades User Agreement.
- Emotional Factors. Crohn’s and Colitis Foundation of America. http://www.ccfa.org/assets/pdfs/emotional.pdf
- What is Crohn’s Disease? Crohn’s and Colitis Foundation of America. http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/
- Kurina LM, Goldacre MJ, et al. Depression and anxiety in people with inflammatory bowel disease. Journal of Epidemiology and Community Health. 2001;55:716-720. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731788/pdf/v055p00716.pdf
- Rathi A, Bhatia MS, Oberoi A. Depression in a Patient of Crohn’s Disease. Delhi Psychiatry Journal. 2011;14(2):390-391. http://medind.nic.in/daa/t11/i2/daat11i2p390.pdf
- Carpenter, S. That gut feeling. Monitor on Psychology. 2012;43(8):50. http://www.apa.org/monitor/2012/09/gut-feeling.aspx
- Mayer E. Gut feelings: the emerging biology of gut-brain communication. Nature Reviews Neuroscience. 2011;12(8):453-466.
- Mayer E, Tilisch K. The Brain-Gut Axis in Abdominal Pain Syndromes. Annual Review of Medicine. 2011;62:381-396. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817711/
- Ananthakrishnan AN, Gainer VS, Perez RG, et al. Psychiatric co-morbidity is associated with increased risk of surgery in Crohn’s disease. Alimentary Pharmacology and Therapeutics. 2013;37:445-454. http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=3162bd4c-d259-4386-8ac7-b3fc30984d6e%40sessionmgr101&vid=1&hid=116
- Bryant RV, van Langenberg DR, Holtmann GJ, Andrews JM. Functional gastrointestinal disorders in inflammatory bowel disease: Impact on quality of life and psychological status. Journal of Gastroenterology & Hepatology. 2011;26:916-923.
- Fiocchi C. Inflammatory bowel disease pathogenesis: Where are we? Journal of Gastroenterology and Hepatology. 2015;30(Suppl. 1):12-18.
- Depression (Major Depressive Disorder). Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/depression/basics/symptoms/con-20032977