The Link Between IBS and Depression

Unfortunately, people often end up dealing with more than one health problem at a time. And sometimes, there may be shared underlying factors that result in a person's experiencing an increased chance of having more than one disorder. This seems to be the case with irritable bowel syndrome (IBS) and depression. This overview takes a look at what is known about the overlap of these two conditions, and what you can do to best manage the symptoms of both disorders.

What Is Depression?

Depression is an illness characterized by a persistent low mood or loss of interest or pleasure accompanied by a variety of other symptoms that interfere with a person's ability to function and enjoy life. Symptoms of depression may include:

• Changes in appetite and weight
• Difficulty concentrating
• Difficulty falling asleep and/or difficulty staying asleep
• Feelings of hopelessness, low self-esteem, excessive guilt, and pessimism
• Lack of energy and motivation
• Social isolation
• Suicidal ideation and attempts

There are several depressive orders with different features, including:

• Disruptive mood dysregulation disorder
• Postpartum depression
• Dysthymic disorder
• Premenstrual dysphoric disorder (PMDD)

Overlap of IBS and Depression

The most commonly diagnosed psychiatric disorder in IBS patients is depression. Researchers reviewed six studies and found that depression levels were significantly higher in IBS patients compared to healthy individuals. These numbers are higher than the rates of depression seen in patients who have inflammatory bowel disease (IBD) or in healthy individuals.

Why would IBS patients be at higher risk for depression? Researchers have been looking for answers. One area of inquiry has to do with early childhood trauma. Prevalence rates for childhood sexual and/or emotional abuse in IBS patients range widely, with some estimates as high as 50%. Experiencing such trauma also puts a person at risk for the development of a mood disorder such as depression.

IBS researchers have also been looking at the role that the neurotransmitter serotonin plays in both disorders. Serotonin is involved in many of the functions of digestion and plays a key role in communication between our brains and our guts. Serotonin levels are also associated with depression symptoms although the mechanism behind this relationship is not fully understood. Thus, problems with the body's regulation of serotonin may be behind the overlap.

Another good question is whether having IBS can cause depression. A large 12- year study did find that having IBS at the beginning of the study was associated with higher levels of anxiety and depression at the end of the study. However, the inverse was also true. Individuals who had higher levels of anxiety and depression at the beginning of the study were at a greater risk for the development of IBS by the end of the study. The study researchers conclude that dysfunction behind both disorders can occur in either direction, i.e. from the brain to the gut or from the gut to the brain.

What to Do if You Have Both

Although having two disorders at the same time can certainly be filed under the "life is not fair" category, there is a bit of a silver lining. What is good for one disorder may also prove helpful for the other disorder. You may find this particularly in the area of prescription medication.

Although it is considered an off-label use, antidepressants are frequently prescribed to IBS patients due to their beneficial effect on pain and gut functioning. It is thought that this helpful effect is due to the effect of the antidepressant on serotonin and other neurotransmitters.

Tricyclic antidepressants are a class of antidepressants that slow down the intestinal tract, possibly making them the better choice for patients who have diarrhea predominant irritable bowel syndrome (IBS-D).

Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of antidepressants that are thought to only target serotonin, resulting in less unwanted side effects, including constipation. Thus, a person who has constipation-predominant irritable bowel syndrome (IBS-C) may be better served to have his/her depression addressed by a medication from this class.

Another avenue to consider is the use of cognitive behavioral therapy (CBT). CBT has strong research support in helping to relieve the symptoms of both depression and IBS.