A young person, just out of college and planning for the future, is suddenly and inexplicably hit with chronic diarrhea and pain. Tests show it’s not a virus or food poisoning. It’s Crohn’s disease (CD), the most serious form of inflammatory bowel disease (IBD). Although it can go into remission for periods, CD typically worsens over time.
While all age groups can be affected, Crohn’s most often strikes adolescents and young adults. No matter the age, it’s easy to see why being diagnosed with this chronic, incurable, and frequently painful disease can trigger or worsen depression.
The Crohn's and Colitis Foundation estimates 700,000 Americans have Crohn’s disease, with men and women affected equally. In addition to diarrhea, CD can cause malnutrition, fever, bowel obstructions, and abdominal abscesses, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Crohn's can also increase your risk for colon and small bowel cancers.
Why do people get Crohn’s disease? No one knows, but genetic, autoimmune, and environmental factors may play a role, explains digestive disease specialist Heba Iskandar, MD, an assistant professor of medicine at the Emory University School of Medicine in Atlanta. And scientists studying what triggers both the progression and periods of remission of Crohn’s are finding that a complex interplay between depression and CD may influence the course of the disease and its often debilitating symptoms.
Although depression is not a definite risk factor for developing Crohn’s, Iskandar notes that several studies have shown there are higher rates of depression among people who have CD, compared to the general population. “While we have to be careful making cause-and-effect conclusions, the association between CD and depression is strong. There is evidence that the course of the disease is worse in depressed patients,” she says. Further complicating the depression and Crohn’s connection is the fact that steroids, which are often used to treat the disease’s symptoms, can cause depression, Iskandar points out.
After being in remission for a period, Crohn’s disease can become active again – a period called a flare – and depression may be somehow involved. “Flares of Crohn's are influenced by multiple factors, which makes causal relationships hard to ascertain. However, depression may end up being one of a more complex set of reasons for flares in any given patient,” Iskandar says. “We are all interested in preventing flares, so keeping depression symptoms under control could mean a lot for helping maintain Crohn's patients in good health.”
In fact, a recent Vanderbilt University study sponsored by the Crohn's and Colitis Foundation adds weight to the idea depression may spark active CD symptoms. The researchers found that patients with Crohn’s disease who were experiencing symptoms of depression had a higher risk of symptoms flaring.
In another study, Vanderbilt researchers looked at a group of patients with IBD, most of whom had active Crohn’s disease, to see if treating their symptoms with immunosuppressive medications (which calm inflammation and reduce pain) would help the patients’ documented symptoms of depression. The results of the study, published in the journal Digestive Diseases and Sciences, showed that after 60 days levels of depression plummeted in those who received the symptom-reducing therapy. What’s more, even the patients who had been at risk for moderate-to-severe depression had improved significantly.
While much more research is needed to pinpoint the extent of depression’s impact on Crohn’s disease -- and vice versa -- Iskandar urges patients with Crohn’s to tell their doctors if they have symptoms of depression so they can receive treatment for the condition. She also advises family members and partners of patients with Crohn's to be alert to the symptoms of depression in their loved ones.
“Since we know depression is more common in Crohn's patients, many centers treating IBD, including Emory, are screening patients to assess their psychological well-being,” Iskandar says. “There is generally a big focus in the medical community on improving the quality of life in Crohn's disease, including treating depression.”
March 25, 2015
Christopher Nystuen, MD, MBA