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.
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:
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Persistent sad, anxious, or "empty" mood
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Feelings of hopelessness, negativity
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Feelings of guilt, worthlessness, helplessness
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Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
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Decreased energy, fatigue, being "slowed down"
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Difficulty concentrating, remembering, making decisions
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Insomnia, early-morning awakening, or oversleeping
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Appetite and/or weight loss, or overeating and weight gain
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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.
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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.
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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:
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Set realistic goals, keeping your depression in mind, and take on a reasonable amount of responsibility in your daily life.
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Set your priorities and break big tasks into smaller ones, doing the best you can to tackle them.
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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.
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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.
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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.
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Don’t expect to “snap out of it.” Instead, expect to feel a little better each day.
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Ask for and accept help from your family and friends.
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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.
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Feeling nervous, anxious, or on edge
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Not being able to stop or control worrying
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Worrying too much about different things
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Trouble relaxing
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Being so restless that it is hard to sit still
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Becoming easily annoyed or irritable
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Feeling afraid as if something awful might happen
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.
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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.
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Acceptance of the situation
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Utilizing social support, such as asking a friend to accommodate your needs
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Relaxation
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Constructive self-talk, such as “I did the best I could”
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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.
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Be aware of bathroom locations close to your destination
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Carry extra underwear, toilet paper, or moist wipes
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