Crohn's Disease and Depression

The association between Crohn's disease and depression is strong; tell your doctor if you have symptoms of depression so you receive the right treatment.

A young person, just out of college and planning for the future, is suddenly and inexplicably hit with chronic diarrhea and abdominal 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). Crohn’s tends to flare up and die down for periods, but it typically worsens over time. Depression plays a role. Patients with depression have a tendency to report that their symptoms increase after a period of low mood, researchers say.

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Crohn's disease and depression

People can be diagnosed with Crohn’s at any age, although it most often first emerges between the ages of 15 and 35.

As many as 700,000 Americans have Crohn’s disease, with men and women affected equally. In addition to cramps and diarrhea, CD often comes with severe fatigue, and you may have fever and lose your appetite. Complications include malnutrition, intestinal blockages, ulcers, and general inflammation. About a third of Crohn’s patients develop symptoms outside of their intestines, which may include arthritis, eye inflammation, skin lesions, and inflammation in the pelvis. Crohn's also increases your risk of colon and small bowel cancers.

Why do people get Crohn’s disease?

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. More than a third of IBD patients are known to suffer from anxiety or depression, which is too often under-treated. A complex interplay between mood and CD may influence the course of the disease and its often debilitating symptoms.

Recent research with more than 3,300 volunteers concluded that patients in a depressed state report that their CD symptoms get worse. Iskandar notes that several studies have shown there are higher rates of depression among people who have CD, compared to the general population. In studies with mice, mice that are separated from their mothers are more vulnerable to intestinal inflammation. The intestinal symptoms improve if they receive antidepressants.

These patterns appear in population studies as well: In a study of more than 400,000 Canadians with diagnosed depression, they were more than twice as likely to have Crohn’s, but those that took antidepressants had less Crohn’s risk. Treating the intestines can affect mood as well; some depressed patients with IBD see their depression lift after receiving immune-suppressing drugs.

Crohn's flare and depression

After being in remission for a period, Crohn’s disease can become active again — a period called a flare — and “depression may be one of a 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.”

If your problem is mainly fatigue, that may be an indirect sign that a flare is making it harder for you to work through emotions, according to other research. Another reason to consider treatment for your mood: one study found that in depressed patients the immunosuppressant infliximab (Remicade) was less likely to achieve remission of symptoms.

Tell your doctor about depression

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 about mood symptoms. 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.”

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