It has long been known to researchers, as may be appreciated by IBD patients themselves, that stress and anxiety are more common among IBD patients than they are among the general population. A 2021 meta-analysis found that up to a third of IBD patients are affected by symptoms of anxiety. Amongst those with active disease, 52.3% of patients were impacted by anxiety.
Only in recent years has the research begun to better understand the reasons and outcomes of anxiety in IBD, both in Ulcerative colitis and Crohn’s disease.
Why does IBD cause anxiety?
It was first thought that stress and anxiety are largely reactive to the chronic illness condition. This phenomenon whereby anxiety and depression can arise secondary to the need to cope with a chronic physical illness has long been known in psychology, and is termed “reactive.”
While this is found in many chronic illnesses and can significantly further reduce the quality of life of patients already struggling with physical symptoms, it was recently realized that the inflammatory process in IBD may be associated with or perhaps even convey some direct changes in the brain, in particular the limbic system.
How Gut Inflammation Impacts the Brain
The limbic system is responsible for emotional function and behavioral responses, as found by studies using functional MRI. This area of the brain contains our amygdala, which initiates the brain processes that produce and regulate fear and anxiety, and may be involved in anxiety disorders.
These areas of the brain may be affected when inflammatory molecules from the gut make their way to the brain, or through other mechanisms, as the brain is usually secluded from molecules originating in the body organs. These findings may further explain the higher frequency of anxiety among IBD patients.
The Effect of Anxiety on Gut Inflammation
Another old and still not decisively settled argument is whether anxiety itself influences and exacerbates the IBD gut inflammation and symptoms. Research has not been conclusive but recent evidence points towards a stronger – perhaps even causative – link between anxiety and the tendency to develop more disease flares in IBD.
Interventional studies (i.e studies that test the outcome of deliberate intervention to help patients) have shown mixed results in terms of whether cognitive behavior therapy (CBT) and mindfulness can reduce IBD activity, but almost all have produced significant improvement in stress and anxiety and in patients’ quality of life.
In some patients, anti-anxiety medications or herbal-based remedies may also be used to alleviate the stress and anxiety that are so detrimental to patients’ sense of well-being and which hamper their coping with the IBD itself.
Shomron Ben-Horin
