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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 988 Lifeline at 988.

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.

Transcript

for me personally my Crohn's is very

00:03

affected by the state of my mental

00:05

health when you're sick I constantly

00:07

have things in the back of your head

00:09

thinking about test results you have or

00:12

procedure you have there's a lot of

00:14

stress and anxiety associated with that

00:16

more and more working with a

00:19

psychologist is considered part of

00:22

treatment when it comes to IBD because

00:25

we recognize that the emotional and the

00:28

physical are very interconnected and so

00:31

when you're given a diagnosis initially

00:34

it can feel very overwhelming I was

00:37

diagnosed with Crohn's disease about

00:40

four years ago I think it was a shock I

00:44

didn't really understand medically what

00:47

it meant it's normal to have you know

00:50

those emotions of feeling overwhelmed

00:52

feeling anxious feeling depressed it's

00:55

sort of this vicious cycle that develops

00:58

between the gut and brain especially a

01:02

fear in pain you're constantly thinking

01:04

about that pain and certainly in therapy

01:06

we work on a lot of strategies so that

01:08

you're not perseverating on the pain got

01:11

directed relaxation diaphragmatic

01:14

breathing I try to meditate a couple

01:17

times a week stop and take a breath you

01:20

don't have to figure everything out in

01:21

that moment in that day you're still the

01:25

same person you just have this new label

01:27

you're not alone just know that there

01:30

are a lot of other people out there that

01:32

have IBD

01:34

you

01:34

[Music]

English (auto-generated)

Depression

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

  • Restlessness, irritability

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

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

  • Trouble relaxing

  • 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!

Transcript

00:03

Dr. Megan Real and I'm a clinical

00:06

psychologist with specialization in the

00:08

treatment of gastrointestinal issues and

00:10

part of my daily work with patients is

00:13

to focus on helping them cope with their

00:16

disease the best they can and so once a

00:20

treatment plan is in place with a

00:21

gastroenterologist it's nice for me to

00:24

be able to join the team to help with

00:27

the long term management of a chronic

00:29

disease so while we know that stress

00:31

does not cause IBD it certainly can

00:34

contribute to flares and having the most

00:39

kind of well-rounded toolbox in order to

00:42

manage stress and anxiety which is

00:44

inevitable at various life stages that's

00:48

what I work on with patients so we work

00:50

on relaxation strategies cognitive

00:53

behavioral therapy giving people

00:55

strategies to help with coping in the

00:58

workplace and in relationships and we

01:02

know that stress and anxiety can

01:04

certainly lead to more functional bowel

01:07

symptoms if a chronic disease ulcerative

01:11

colitis Crohn's as well-managed and in

01:13

remission so I'm really looking forward

01:16

to talking more today about why that's

01:19

important and I'm really just having a

01:21

conversation about how stress can impact

01:23

your life and what you're doing about

English (auto-generated)

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.

Transcript

00:03

so stress and anxiety can lead to

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additional risk factors for people to

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have IBD so patients that have increases

00:13

an anxiety are at more risk for surgery

00:17

they have a reduced medication adherence

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sometimes a lower quality of life and

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also a higher perceived level of stress

00:26

so basically that means that you feel

00:28

less capable of dealing with certain

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stressors when your anxiety is too high

00:32

and so one of the ways that I talk with

00:36

patients about managing stress and how

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to incorporate some of the stress and

00:43

cognitive behavioral strategies to

00:45

manage stress is the GI stress cycle so

00:50

with the GI stress cycle I often start

00:52

with where you how you're feeling and if

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you're waking up in the morning and

00:57

you're noticing that you're feeling

00:59

maybe some urgent diarrhea or nausea

01:02

if you're not physically feeling well

01:04

naturally that starts to lend itself to

01:06

some emotional and cognitive experiences

01:11

so if you're feeling nauseous and having

01:14

heard of diarrhea and you have a meeting

01:16

later in the day you might start to go

01:18

oh gosh here we go again I'm gonna have

01:20

to postpone this meeting or miss this

01:23

meeting and so as those cognitions start

01:26

to rev they really are unhelpful

01:28

cognitions and as we have those

01:31

unhelpful thoughts it then leads to an

01:33

increase in emotions such as stress

01:36

anxiety frustration embarrassment

01:40

so really the unpleasant emotions that

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can go along with negative cognitions

01:45

and as we feel anxious and stressed it

01:49

then starts to rev what's called our

01:52

sympathetic system and our brain has

01:56

this ability in times of stress to begin

01:59

to produce sympathetic arousal and

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that's your body's fight flight or

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freeze response and as this happens it

02:07

begins to cause an increase in heart

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rate your breathing may get short and

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shallow

02:13

and it can really start to impact the GI

02:15

tract because it can clench and tense

02:17

the muscles in the digestive system

02:19

which can then lead to urgency and

02:22

diarrhea and even at time slowing things

02:26

down to have more constipation and as

02:28

all of that happens it begins to then

02:31

worsen symptoms and we get into this big

02:34

cycle of symptoms leading to emotions

02:37

which leads to a worsening experience of

02:40

the symptoms

English (auto-generated)

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.

Transcript

00:00

you

00:02

so the wonderful thing about our brain

00:04

is that we have built-in mechanisms to

00:07

help us relax

00:08

so when your sympathetic system is

00:11

revving eventually it's going to get to

00:13

a point where it says that's enough and

00:15

the parasympathetic system can jump in

00:18

and that's your body's relaxation

00:20

response so simple techniques like

00:23

diaphragmatic breathing and different

00:25

muscle relaxation strategies when you

00:27

start to feel that muscle group tense

00:30

and tighten your heartbeat escalating

00:33

and your breathing getting short and

00:34

shallow can begin to calm down those

00:37

mechanisms in your body so we have

00:40

different relaxation strategies that can

00:42

help to break that cycle and they can be

00:46

implemented right away so while your

00:48

body will eventually allow that

00:51

parasympathetic system to kick in when

00:53

you have tools and strategies that are

00:56

easy to reach for such as diaphragmatic

00:59

breathing or muscle relaxation you can

01:02

begin to break that cycle a lot quicker

01:04

and gives you some control and if you

01:07

find that you know you need more

01:09

assistance and learning how to break

01:12

that cycle a psychologist or mental

01:15

health provider can certainly be helpful

01:18

to work from a cognitive behavioral

01:20

perspective on that cognition piece so

01:23

as you're beginning to have that rev of

01:26

negative thoughts and emotions that can

01:29

begin when you're feeling poorly there

01:32

are ways that you can learn more

01:34

adaptive ways of thinking about feeling

01:37

poorly so for example as you begin to

01:40

feel like oh gosh here we go again this

01:43

is going to be bad that can lead to some

01:45

catastrophic thoughts and negatively

01:47

predicting the future and anticipatory

01:49

anxiety and working with a therapist can

01:53

really help you to find new ways to

01:55

observe your negative thoughts and then

01:58

change them to more adaptive ways of

02:00

coping with those cognitions

English (auto-generated)

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.

  • Relaxation and breathing exercises
  • Practicing yoga or tai chi
  • Light aerobic exercise, such as walking or swimming
  • Cognitive behavioral therapy or psychotherapy with a psychologist or social worker
  • Medication to address your emotional and mental state
  • Meditation or hypnotherapy
  • Biofeedback
  • Books, recordings, guided imagery, or journaling
  • Creating a support network of friends, family, and health care professionals
  • Pursuing hobbies and activities you enjoyed before your diagnosis
 

Managing Stress

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

  • Relaxation

  • 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

Related Resources

Fact sheet

Emotional Factors (.pdf)...

Fact sheet on emotional factors

Infographic

Mental Health and IBD Infographic...

Mental health and IBD infographic