Depression and Crohn s Disease

By Kathleen Hall

Reviewed by QualityHealth's Medical Advisory Board

It's understandable that a chronic illness such as Crohn's can make you feel depressed. The occasional blue days are normal and we all experience them from time to time. When depression becomes severe or prolonged, however, it can negatively affect symptoms caused by other existing illness, such as Crohn's disease.

In Crohn's patients, depression increases symptoms and rate of relapse. People who have depression and another medical illness don't adapt as well to their illness and spend more on healthcare costs than those who do not.

It's Not All in Your Head

There is no evidence that depression causes Crohn's disease. However, depression is common in people with Crohn's. In one study, the incidence of psychiatric illness in Crohn's was significantly greater in patients with the disease (50 percent) compared to those without (8 percent).

Studies confirm a relationship between clinical depression and an inflammatory response caused by acute psychiatric stress. Under challenging conditions, depression is associated with greater resistance to substances in the body that would normally terminate inflammatory activity.

This relationship between depression and Crohn's disease is significant. Depression correlates to the number of relapses you may experience and to how long it takes for the first recurrence of the disease. As you would suspect, people who have high anxiety and lower reported measures of quality of life, have more frequent relapses. People with Crohn's disease who exhibit low stress and few avoidance behaviors (for example, drinking) are least likely to experience a relapse.

When Crohn's is active, it can interfere in your day-to-day activities, so, of course, you want to maintain remission for as long as possible. If you experience depression, experts recommend include psychological therapy into your overall treatment plan.

Crohn's patients who take advantage of therapy spend fewer days in the hospital and use fewer sick days at work. Therapy, in conjunction with other treatment methods, provides positive results in people with Crohn's disease, and research is yielding evidence that treating depression can also help improve treatment outcome for the co-occurring illness.

Symptoms of depression

Persistent sad, anxious or "empty" feelings
Feelings of hopelessness and/or pessimism
Feelings of guilt, worthlessness and/or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details and making decisions
Insomnia, early-morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment