The Link Between Depression and Crohn's Disease

By

Allie Lemco Toren

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depressed woman

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.

There are trillions of bacteria in our guts, and they greatly influence how our immune systems develop, contribute to our levels of inflammation, and help regulate our mental health. Among other roles, ‘good’ or beneficial bacteria make sure our immune systems function properly; they also produce neurochemicals, like serotonin, that our brains use to regulate our moods. ‘Bad’ or harmful bacteria, on the other hand, can kill off the ‘good’ bacteria, which can make our immune systems malfunction and create inflammation—one of the key culprits of both Crohn’s disease and depression. Multiple studies have shown that, when there are more harmful bacteria than beneficial bacteria in the gut, inflammation increases and people are more likely to be anxious, stressed out, and depressed. This inflammation causes Crohn’s symptoms to flare, as well.

You can increase the levels of ‘good’ bacteria by eating fermented foods as part of a balanced diet that’s low in sugar and carbohydrates. Some people also take probiotic supplements, which are small capsules containing beneficial bacteria—these can repopulate the ‘good’ bacteria in your gut.

What we know now about the relationships between gut bacteria, our immune systems, inflammation, and our mental health is just the tip of the iceberg. But in the next several years, it’s likely we will discover more and more about how best to overcome both depression and Crohn’s disease with help from our guts.

In the meantime, we must to stick to tried-and-true treatments for both conditions. If Crohn’s disease is well managed, depression is also well controlled, and vice-versa. Most importantly, if you or someone you know is showing signs of depression, such as feelings of prolonged sadness or hopelessness, loss of interest or pleasure in activities enjoyed in the past, and changes in appetite, among others, seek help from a professional as soon as possible. You can overcome depression with the right combination of medication and therapy. The same goes for Crohn’s: appropriate medication and emotional support can help you feel empowered to control your gut—instead of the other way around.

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Crohn's disease is an inflammatory bowel disease that injures the intestines. People with Crohn's discuss living with the disease.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 2, 2016

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