Saturday, November 17, 2012

Stress, Depression, and IBD


Stress and IBD


Depression is a very real disorder that is comorbid with IBD.  The holiday season gets kicked off this week with Thanksgiving (family, food, and football).  The stress of travel and the focus on consumption are enough to give IBD sufferers an extra helping of distress, and can be an aggravator of depression.

Traditionally, the holiday season is associated in the public mind with an increased suicide rate.  In reality, the overall suicide rate drops during the holiday season.  (1)  A lower suicide rate, however, does not mean that there aren’t stressors.  With IBD, additional stress can exacerbate symptoms, which can deepen depression, which can exacerbate symptoms, which can deepen depression….

There are multiple types of stress, both acute and chronic.  Acute stress can be caused by a singular event, such as a pending layoff at work.  Chronic stress can be due to a life situation, such as caring for an incapacitated loved one.   Acute stress has well known but short term gastrointestinal effects – predominantly an increase in water into the colon and increased motility, leading to diarrhea.  The GI effects of longer-term stress are less well understood.  The majority of literature shows that there is a small amount of increase in inflammation and a lower immune response due to chronic stress.  For IBD sufferers, this translates into a higher rate of symptom occurrence and an increased likelihood of a flare.   It is especially difficult to disentangle the stress from the disease itself from outside stressors, leading to a confusing landscape.  Unfortunately, traditional stress reduction techniques haven’t shown a consistent benefit in IBD sufferers in terms of disease-related symptoms abating, but they do have the same overall effects that non-suffers benefit from.  (2,3) 

Depression and IBD


Depression is psychological disorder defined as having a “depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day”

·         Depressed mood most of the day.
·         Diminished interest or pleasure in all or most activities.
·         Significant unintentional weight loss or gain.
·         Insomnia or sleeping too much.
·         Agitation or psychomotor retardation noticed by others.
·         Fatigue or loss of energy.
·         Feelings of worthlessness or excessive guilt.
·         Diminished ability to think or concentrate, or indecisiveness.
·         Recurrent thoughts of death (4)

Any IBD suffer recognizes several of these as impacts of the underlying Crohns or UC.  All IBD sufferers have had weight issues (sometimes unintentional gain on steroids, or unintentional loss when flaring), fatigue is common with the disease, and the need to be constantly vigilant for a nearby bathroom can affect the pleasure of common activities.  Major depression is much more likely to strike IBD sufferers over their lifespan by almost twofold (27% for IBD sufferers v. 12% for the general population), and the most likely time is at the time of diagnosis.(5)

Because of the increases likelihood of depression, both patients and providers should be on the lookout for the onset of symptoms.  Treatment is available in the form of both psychological (e.g. Cognitive Behavioral Therapy) and pharmacological (e.g. Selective Serotonin Reuptake Inhibitors –SSRIs) approaches.  Your GI doctor can recommend a mental health professional that deals specifically with those who have a chronic illness.

While this blog focuses on those with IBD itself, thought must be given to the friends and family also.  Seeing a loved one suffer and feeling helpless to do anything about it can take as much of a psychological toll as being affected with the disease itself.   The holiday season is a time for celebration with friends and relations, and a time for reflection.  If depression appears to be affecting someone you care about, take the opportunity of holiday closeness to discuss it.

Have a safe and happy Thanksgiving!

(1)     David P. Phillips PhD, John S. Wills.  A Drop in Suicides around Major National Holidays.  Suicide and Life Threatening Behavior, 1987.
(2)    J E Mawdsley, D S Rampton.  Psychological stress in IBD: new insights into pathogenic and therapeutic implications.  Gut, 2005.
(3)    Robert G Maunder MD, FRCPC.  Evidence that stress contributes to inflammatory bowel disease: Evaluation, synthesis, and future directions.  Inflammatory Bowel Diseases, 2005.
(4)    DSM-IV-TR.
(5)    Lesley A. Graff PhD, John R. Walker PhD, Charles N. Bernstein MD.  Depression and anxiety in inflammatory bowel disease: A review of comorbidity and management.  Inflammatory Bowel Disease, 2009.

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