Should IBD Patients Be Screened for Anxiety and Depression?

Getting a diagnosis of any sort can be a bit rattling, and receiving a diagnosis of inflammatory bowel disease (IBD) is no different. The mind and body are so closely interconnected, but sometimes it can be difficult for patients to verbalize when they’re experiencing mental health or mood problems, especially if they’re afraid or embarrassed to reach out. 

A recent (2020) systematic review and meta-analysis study found that about one-third of patients with IBD experience anxiety, and roughly one-quarter experience symptoms of depression, with symptoms more likely to present in female patients. Keeping in mind that these were patients who self-reported, the numbers of IBD patients who experience anxiety and depression are likely higher, prompting researchers to ask GI specialists and healthcare providers to screen IBD patients for particular mental health symptoms. Read on to learn more about IBD itself and what the symptoms of anxiety and depression look like. 

What Is IBD? Is It the Same as IBS?

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two very distinct types of disorders. While they share some of the same symptoms, such as gastrointestinal upset, IBS is a syndrome and mainly affects the quality of life, while IBD is a disease and needs to have its symptoms managed so that the intestines aren’t permanently damaged. 

IBD is a combination of two separate diseases—ulcerative colitis (UC) and Crohn’s disease. Patients classified as having IBD may have UC, Crohn’s, or both. Both of these involve inflammation of the digestive tract. Ulcerative colitis causes ulcers along the lining of the colon and rectum, while Crohn’s disease inflames the lining of the digestive tract, often in patchy spots. If not treated, either of these forms of IBD can permanently damage the digestive tract, and both heighten the risk of developing colon cancer. 

What Are the Symptoms of Inflammatory Bowel Disease?

Oftentimes, you may have a passing stomach bug or a mild case of food poisoning, which may cause stomach pain, diarrhea, or constipation. These types of problems usually pass within several days, and symptoms don’t persist. There are other times when you should take GI disturbances more seriously, especially when gastrointestinal symptoms are combined with other symptoms. Common symptoms of IBD include:

• Stomach pain and cramps 
• Urgent bowel movements
• Chronic constipation, diarrhea, or an alternation of the two
• Blood on toilet paper after wiping or blood in the stool
• Nausea and vomiting
• The feeling of not “completing” a bowel movement
• Unintended weight loss
• Unexplained fatigue 
• Failure to thrive (children and adolescents only)

Any incidence of blood in the stool or on toilet paper should warrant an immediate visit to your healthcare provider. If you have other GI symptoms, such as constipation, diarrhea, or stomach pain, that persist for more than several days, particularly if they are combined with fatigue or other symptoms, you should also contact your healthcare provider. 

Is IBD Curable? How Is IBD Treated?

There is currently no cure for inflammatory bowel disease, and this can be frustrating for patients. IBD symptoms do not necessarily present at all times; patients have uncomfortable flare-ups, which can be debilitating and strongly affect their quality of life. However, with lifestyle changes and medication options, symptoms of IBD can be put under control. 

Medication is the first-line therapy for IBD, and physicians typically try a type of anti-inflammatory class known as corticosteroids first, such as prednisone. 5-ASA drugs also decrease inflammation, particularly in the colon, so these drugs are widely used as well. 

Physicians may also prescribe immunomodulators and biologics, although the FDA has not specifically approved biologics for the IBD treatment. Sometimes laxatives and antibiotics are used in conjunction with other medications, especially when there is a flare-up. 

Your physician will likely also advise you to avoid dairy products, quit smoking if you do, and drink plenty of fluids, as it is vital to keep the lining of the colon lubricated. For the most severe cases of IBD, surgery, such as strictureplasty, colon removal, and rectum removal, are also options. 

What Do Anxiety and Depression Look Like in Those with IBD?

Depression and anxiety look different in everyone, including patients with IBD. Some people can hide their struggles well, while others are very open about what they’re experiencing. It is important to note that mental health is just as important as physical health. If you are experiencing feelings of anxiety or depression that do not subside, you should discuss this with your healthcare provider. Generally, symptoms of depression include:

• Loss of interest in things that were once enjoyed
• Feelings of hopelessness and worthlessness
• Loss of appetite, or overeating
• Loss of energy and fatigue 
• Feeling restless and irritable 
• Insomnia or oversleeping 

Everyone feels sad once in a while. But if these types of symptoms persist for longer than two weeks, you are encouraged to speak with a trusted professional. 

Many of the symptoms of anxiety are somewhat of the same vein. They include:

• Feeling restless and irritable
• Not being able to relax
• Not being able to stop worrying 
• Feeling as if something terrible will happen 
• Feeling nervous or on edge

Similarly, if these symptoms persist for two weeks or longer, you are encouraged to speak with a professional. 

Managing Anxiety and Depression

If you are already under the care of a professional and still wonder, “What more can I do about anxiety and depression?” There are some things you can do on your own to help break the cycle. When it comes to depression:

• Set small goals and achieve them in “chunks” if you have to. Keep things realistic. 
• Let go of “fake it til you make it” positive thinking. Accept that how you’re feeling now will pass and that it’s okay to feel your feelings.
• Go easy on yourself, and postpone any major decisions (and set boundaries with others if you must).
• Do make plans with others, and keep them. Staying social is imperative. 

https://www.youtube.com/watch?v=0orfjkG281w

When it comes to anxiety, you can take the reins as well to try to relieve some of the anxiousness. Some things you can do include:

• Try mindfulness and meditation exercises.
• Use breathing techniques if you find yourself in a panicked situation.
• Attend a support group.
• Find. a hobby you enjoy 
• Exercise to release extra energy (even light exercise like yoga can release endorphins).
• Make plans with others and keep them. Being social is imperative for everyone. 

A positive idea for those who have IBD is finding an in-person or online IBD support group. This way, you can discuss issues with people who genuinely understand what you’re going through.

Find IBD Support in Charlotte, NC

If you want to be screened for IBD or feel you need to be seen by a physician, contact us at Carolina Digestive Health Associates today. Our team of GI specialists can provide personalized and comprehensive care for all of your gastrointestinal concerns.