Depression and Anxiety
It is normal to feel sad and anxious as you live with inflammatory bowel disease (IBD). While some people may have fleeting bouts of sadness or stress relating to their IBD, it’s important to see a mental health professional if your symptoms last for several weeks or more at a time.
Rates of depression are higher among patients with Crohn's disease and ulcerative colitis as compared to other diseases and the general population. Anxiety is also common in IBD patients.
It is important to recognize the signs that you are struggling emotionally and seek help just as you would for your physical symptoms. This fact sheet can help you understand and deal with the emotional impact of IBD.
If you have thoughts of self-harm or suicide, do not hesitate to reach out for help by calling 911, going to the closest emergency room, or calling the suicide hotline at 1-800-SUICIDE.
Mental health and IBD
Video Length 1:42
Mental health and IBD Managing Crohn's disease and ulcerative colitis means focusing on more than just the physical symptoms. Your mental and emotional well-being are equally important. Hear how patients view their mental health as they live with inflammatory bowel diseases.
for me personally my Crohn's is very
affected by the state of my mental
health when you're sick I constantly
have things in the back of your head
thinking about test results you have or
procedure you have there's a lot of
stress and anxiety associated with that
more and more working with a
psychologist is considered part of
treatment when it comes to IBD because
we recognize that the emotional and the
physical are very interconnected and so
when you're given a diagnosis initially
it can feel very overwhelming I was
diagnosed with Crohn's disease about
four years ago I think it was a shock I
didn't really understand medically what
it meant it's normal to have you know
those emotions of feeling overwhelmed
feeling anxious feeling depressed it's
sort of this vicious cycle that develops
between the gut and brain especially a
fear in pain you're constantly thinking
about that pain and certainly in therapy
we work on a lot of strategies so that
you're not perseverating on the pain got
directed relaxation diaphragmatic
breathing I try to meditate a couple
times a week stop and take a breath you
don't have to figure everything out in
that moment in that day you're still the
same person you just have this new label
you're not alone just know that there
are a lot of other people out there that
Depression is a serious mood disorder that causes feelings of sadness and loss of interest. Depression can make you feel exhausted, worthless, helpless, and hopeless. It can also make dealing with daily tasks difficult. Tasks associated with managing a chronic illness may feel insurmountable.
Depression often gets worse if it is not treated. We encourage both patients and healthcare providers to assess not just the physical symptoms of IBD, but also the emotional symptoms.
If you experience five or more of these symptoms for a sustained period of longer than two weeks, we encourage you to seek an evaluation from a qualified professional:
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, negativity
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss, or overeating and weight gain
Treatment for Depression
Depression is treatable. It is important to seek out a counselor who has experience in treating people who live with chronic illness. While it can take time for the symptoms of depression to go away, seeking treatment can help improve your mood, your quality of life, and your ability to cope with IBD.
Cognitive behavioral therapy (CBT) is an an evidence-based treatment for depression and anxiety. You will work with the therapist to identify and change negative thought patterns and behaviors which can contribute to depression.
Medication management may be necessary in addition to therapy with a trained professional. Your gastroenterologist may feel comfortable prescribing an antidepressant to help stabilize your mood, or may also suggest a consultation with a psychiatrist.
Managing Depression at Home
There are several things you can do at home to cope with negative feelings while you are getting treatment for depression.
Remember that feeling better takes time, and that your mood will likely improve gradually, not immediately. These tips have been adapted from the National Institute of Mental Health booklet on depression:
Set realistic goals, keeping your depression in mind, and take on a reasonable amount of responsibility in your daily life.
Set your priorities and break big tasks into smaller ones, doing the best you can to tackle them.
Make a point to spend time around other people. Confiding in a trusted friend or family member usually feels better than being alone and secretive.
Participate in activities that may make you feel better, such as mild exercise, seeing a movie, watching a sporting event, or participating in religious or social events.
Postpone major life decisions until your depression has lifted. These decisions may include changing jobs, getting married, or filing for divorce. Discuss important decisions with trusted friends or family members who may have a more objective view of your situation.
Don’t expect to “snap out of it.” Instead, expect to feel a little better each day.
Ask for and accept help from your family and friends.
Know that positive thinking will eventually replace negative thinking as your depression responds to treatment.
Anxiety consists of feelings of panic, worry, and nervousness. When anxiety becomes persistent and excessive, it can interfere with your mental and physical health.
If you have been bothered by some of these symptoms things for several days within the last two weeks and they have interfered with your ability to work and maintain relationships, you may consider an anxiety management program or seeking help from a mental health professional.
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Worrying too much about different things
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen
Understanding Stress and Anxiety in IBD
Video Length 1:25
Understanding Stress and Anxiety in IBD While stress and anxiety has not been shown to cause Crohn's disease or ulcerative colitis, they can certainly have an impact on your disease. Learn more!
Dr. Megan Real and I'm a clinical
psychologist with specialization in the
treatment of gastrointestinal issues and
part of my daily work with patients is
to focus on helping them cope with their
disease the best they can and so once a
treatment plan is in place with a
gastroenterologist it's nice for me to
be able to join the team to help with
the long term management of a chronic
disease so while we know that stress
does not cause IBD it certainly can
contribute to flares and having the most
kind of well-rounded toolbox in order to
manage stress and anxiety which is
inevitable at various life stages that's
what I work on with patients so we work
on relaxation strategies cognitive
behavioral therapy giving people
strategies to help with coping in the
workplace and in relationships and we
know that stress and anxiety can
certainly lead to more functional bowel
symptoms if a chronic disease ulcerative
colitis Crohn's as well-managed and in
remission so I'm really looking forward
to talking more today about why that's
important and I'm really just having a
conversation about how stress can impact
your life and what you're doing about
The GI stress cycle in Crohn's disease and ulcerative colitis
Video Length 2:41
The GI stress cycle in Crohn's disease and ulcerative colitis Sometimes symptoms can lead to stress and anxiety as you try to manage your disease and go through daily living. Learn more about this cycle.
so stress and anxiety can lead to
additional risk factors for people to
have IBD so patients that have increases
an anxiety are at more risk for surgery
they have a reduced medication adherence
sometimes a lower quality of life and
also a higher perceived level of stress
so basically that means that you feel
less capable of dealing with certain
stressors when your anxiety is too high
and so one of the ways that I talk with
patients about managing stress and how
to incorporate some of the stress and
cognitive behavioral strategies to
manage stress is the GI stress cycle so
with the GI stress cycle I often start
with where you how you're feeling and if
you're waking up in the morning and
you're noticing that you're feeling
maybe some urgent diarrhea or nausea
if you're not physically feeling well
naturally that starts to lend itself to
some emotional and cognitive experiences
so if you're feeling nauseous and having
heard of diarrhea and you have a meeting
later in the day you might start to go
oh gosh here we go again I'm gonna have
to postpone this meeting or miss this
meeting and so as those cognitions start
to rev they really are unhelpful
cognitions and as we have those
unhelpful thoughts it then leads to an
increase in emotions such as stress
anxiety frustration embarrassment
so really the unpleasant emotions that
can go along with negative cognitions
and as we feel anxious and stressed it
then starts to rev what's called our
sympathetic system and our brain has
this ability in times of stress to begin
to produce sympathetic arousal and
that's your body's fight flight or
freeze response and as this happens it
begins to cause an increase in heart
rate your breathing may get short and
and it can really start to impact the GI
tract because it can clench and tense
the muscles in the digestive system
which can then lead to urgency and
diarrhea and even at time slowing things
down to have more constipation and as
all of that happens it begins to then
worsen symptoms and we get into this big
cycle of symptoms leading to emotions
which leads to a worsening experience of
Breaking the GI stress cycle in Crohn's disease or ulcerative colitis
Video Length 2:03
Breaking the GI stress cycle in Crohn's disease or ulcerative colitis Hear important tips from a clinical psychologist on how to break the GI stress cycle, and the importance of support.
so the wonderful thing about our brain
is that we have built-in mechanisms to
help us relax
so when your sympathetic system is
revving eventually it's going to get to
a point where it says that's enough and
the parasympathetic system can jump in
and that's your body's relaxation
response so simple techniques like
diaphragmatic breathing and different
muscle relaxation strategies when you
start to feel that muscle group tense
and tighten your heartbeat escalating
and your breathing getting short and
shallow can begin to calm down those
mechanisms in your body so we have
different relaxation strategies that can
help to break that cycle and they can be
implemented right away so while your
body will eventually allow that
parasympathetic system to kick in when
you have tools and strategies that are
easy to reach for such as diaphragmatic
breathing or muscle relaxation you can
begin to break that cycle a lot quicker
and gives you some control and if you
find that you know you need more
assistance and learning how to break
that cycle a psychologist or mental
health provider can certainly be helpful
to work from a cognitive behavioral
perspective on that cognition piece so
as you're beginning to have that rev of
negative thoughts and emotions that can
begin when you're feeling poorly there
are ways that you can learn more
adaptive ways of thinking about feeling
poorly so for example as you begin to
feel like oh gosh here we go again this
is going to be bad that can lead to some
catastrophic thoughts and negatively
predicting the future and anticipatory
anxiety and working with a therapist can
really help you to find new ways to
observe your negative thoughts and then
change them to more adaptive ways of
coping with those cognitions
Managing Your Anxiety
It is common and understandable to worry and feel stress about managing your disease, but reducing your stress and anxiety can help you maintain a healthy emotional balance. There are many ways to try and reduce your stress. Keep trying until you find something that helps.
Stress is your body’s hormonal response to any situation that demands you take action, whether it’s getting to a meeting on time or dealing with a major medical issue. The release of those hormones is what’s known as “the fight or flight response.” They are responsible for physical reactions to stress, such as increased heart rate, perspiration, and tightening of your muscles.
Not all stress is bad! Everyone experiences some level of stress as they work to meet the demands of their day-to-day life. Small doses of “good stress” can motivate you to be productive, to avoid danger, and to even feel excited.
Prolonged exposure to stressors, such as a traumatic event or a negative lifestyle change, induces “bad stress” that can be harmful to your physical and mental health. Bad stress can be caused by demands of your IBD, especially when you worry how your symptoms will impact your daily plans.
There are emotion-focused strategies to help with stressors that you cannot control.
Acceptance of the situation
Utilizing social support, such as asking a friend to accommodate your needs
Constructive self-talk, such as “I did the best I could”
Let it go and move on
You can also reduce stress by planning ahead if episodes of diarrhea or abdominal pain make you fearful of being in public places.
Be aware of bathroom locations close to your destination
Carry extra underwear, toilet paper, or moist wipes