Ulcerative colitis and mental health: What’s the link?

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The gut-brain axis is the link between the gut and the central nervous system. Gastrointestinal muscles and mucosa are controlled by nerve signals, and the gut likewise communicates back to the central nervous system.

More recently, research has found that the gut microbiome can affect brain signals, activating areas of the brain that regulate emotions.

People with ulcerative colitis are more likely than others to experience anxiety or depression. One-third of people with inflammatory bowel disease experience symptoms of anxiety, and a quarter experience symptoms of depression.

Concerns about the timing and extent of ulcerative colitis symptoms may be a source of anxiety and stress. Various research evidence indicates that anxiety and stress can, in turn, cause inflammatory bowel diseases such as ulcerative colitis to flare up.

For this reason, it can be important to receive treatment for the physiological and psychological effects of ulcerative colitis.

The Crohn’s & Colitis Foundation also notes that people with this condition may be more likely than others to:

• feel overwhelmed
• be “in denial” about the effects on their health
• have a poor self-image
• have dependent behaviors

In an older 2015 study of participants with ulcerative colitis and a mental health disorder, researchers found that mood disorders were more likely to precede ulcerative colitis than the other way around.

In a 2017 study, researchers found that around 30% of people recently diagnosed with an inflammatory bowel disease also experienced anxiety or depression. They recommend that doctors screen and monitor for signs of these conditions.

In a 2016 study, researchers found that anxiety and depression can worsen ulcerative colitis symptoms. They also noted that people with depression had a greater recurrence of flare-ups.

Exploring the two-way link between the brain and the gut helps health experts understand that addressing mental health conditions can help reduce digestive symptoms of ulcerative colitis.

The Crohn’s & Colitis Foundation highlights two main treatments for depression: cognitive behavioral therapy (CBT) and prescribed antidepressant medication.

CBT involves working with a psychologist to identify harmful or unhelpful thought patterns and behaviors.

People with ulcerative colitis may also benefit from the following ways to ease anxiety and stress:

• Other forms of psychotherapy: A psychologist or counselor can help a person understand the sources of their anxiety and find effective treatment strategies.
• Relaxation techniques: Breathing exercises, meditation, yoga, tai chi, and other relaxation techniques interrupt the body’s stress response.
• Support groups: Meeting, virtually or in person, with others who face the same mental and physical health issues can help, as can building a network of supportive family members, friends, and healthcare professionals.

Pain and fatigue are common symptoms of ulcerative colitis, and they can cause distress. A range of strategies and treatments can help.

A doctor’s first approach is to reduce these symptoms by managing the underlying condition. They may also prescribe acetaminophen (Tylenol) to ease the pain. Unlike nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen is not associated with an increased risk of ulcerative colitis flare-ups.

It may also be worth noting that a 2018 systematic review did not find conclusive evidence that NSAIDs increased the risk of flare-ups.

Doctors sometimes prescribe anticonvulsants to ease nerve pain, though there is very limited evidence that these drugs can address pain when it relates to bowel symptoms.

Doctors also prescribe antidepressants to people with irritable bowel syndrome as an “adjuvant analgesic,” a drug not designed to relieve pain but effective for that purpose.

Meanwhile, fatigue is common in people with ulcerative colitis. Treatment to reduce the inflammation can help with fatigue, as can drugs called immunomodulators and aminosalicylates.

To manage pain and fatigue, the Crohn’s & Colitis Foundation also recommends:

• mind and body exercises, such as yoga and meditation
• medical cannabis
• physical therapy
• light exercise

To support and enhance mental well-being while dealing with ulcerative colitis, a person might try:

• eating healthy, nourishing food that does not cause digestive upset
• limiting the consumption of alcohol and caffeine
• exercising regularly
• trying to get plenty of sleep each night
• practicing relaxation techniques such as deep breathing exercises or yoga
• using supplements if a doctor recommends it

The following techniques may also help reduce anxiety and depression:

• setting achievable goals by starting small and working up to larger goals
• establishing a daily routine
• challenging negative thoughts or self-doubts as they arise
• accepting that not everything can be controlled
• celebrating best efforts, not perfect achievements
• learning about and managing triggers

Having social support can also help. People may benefit from:

• making time for a fun activity or an enjoyable social interaction each day
• taking on new responsibilities, such as volunteering
• talking with a trusted friend, family member, or another supportive person

Let a trusted healthcare professional know about any symptoms of depression or anxiety. They may prescribe medication or make a referral to a therapist.

Some general signs and symptoms of depression may include:

• finding little or no pleasure in once enjoyable activities
• having feelings of worthlessness that are excessive
• having a consistently low mood
• moving or talking more slowly than usual
• having less energy than usual
• having trouble sitting still
• having trouble sleeping
• experiencing persistent headaches
• having thoughts of suicide or death

Anxiety may manifest as:

• numbness or tingling sensations
• hot flashes, sweating, shaking, or cold chills
• difficulty breathing
• discomfort or pain in the chest or throat
• nausea or abdominal discomfort
• aches and pains
• restlessness, irritability, and hypersensitivity
• dizziness, light-headedness, or faintness
• worrying about death or a loss of control
• feeling disconnected from one’s self
• difficulty sleeping

A person can start by speaking with a trusted healthcare professional who can recommend support groups, psychologists, and other helpful resources.

To find mental health support and resources, a person can also contact the Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-662-HELP (4357).

In addition, the Rome Foundation provides a directory of therapists who specialize in helping people with gastric conditions.

A person with ulcerative colitis may be more likely than others to develop depression, anxiety, or both — and these issues can make ulcerative colitis symptoms worse.

Managing the physical and psychological aspects of the condition can alleviate the symptoms, and there are several effective medical and holistic approaches.

A doctor can provide resources, treatment, and guidance. Trusted family members, friends, and support groups can also help.

Read this article in Spanish.