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HIBD Horizon

Part 3 · Living well with IBD · 13/22

Let's talk about mood

Anxiety, stress, feeling low: frequent companions of IBD. People rarely talk about them, yet they can be treated.

Your mood matters tooFeeling low with IBD is common, it is not a weakness, and it can be treated. Looking after your mind is also looking after your gut.

The gut-brain axis

↓From brain to gut: stress and anxiety increase pain, bloating and the urgent need to go to the toilet.

↑From gut to brain: inflammation is tiring and can bring your mood down.

There is no proof that stress causes IBD. But it can make symptoms worse, and untreated depression is linked to more flares.

Why does inflammation affect mood? Neuroinflammation

The messengers of inflammation (TNF, IL-6, IL-1) don't stay in the gut: they enter the bloodstream and alert the brain, in particular through the vagus nerve.

The brain in turn switches on its own defence cells. The result: fatigue, anxiety, wanting to stay in bed, low mood, just like when you have flu.

Inflammation also diverts tryptophan, the raw material for serotonin, one of the messengers of good mood.

It's biological, not a lack of willpower. And the good news: when the inflammation settles, mood often follows.

1 in 3have symptoms of anxiety, and 1 in 2 during a flare

1 in 4have symptoms of depression

1 in 3in remission still have pain without inflammation, of the “irritable bowel” type

Anxiety, the most common

It often takes these forms:

fear of not finding a toilet or of having an accident;
dread before going out, a journey, a meeting;
fear of the next flare or the next test;
constantly watching for the slightest signal from your gut;
sometimes panic attacks (racing heart, shortness of breath).

It is not trivial: it is linked to more hospital stays and more changes of treatment. It deserves to be treated.

Simple tools:

Breathe slowly: 5 seconds in, 5 out, for 5 minutes.
Plan your outings: find out where the toilets are, carry a toilet access card (in France, the afa “Urgence toilettes” card), a small change-of-clothes kit.
Don't avoid everything: giving up on going out brings relief in the moment but keeps the fear going. A psychologist can help you get back on your feet step by step.

What really helps

Talking to a psychologist

Cognitive behavioural therapy (CBT) has been proven for anxiety and depression.

Gut-directed hypnotherapy

It helps ease pain and urgency when there is no inflammation.

Moving

Walking, cycling, swimming… Physical activity suited to you improves mood and fatigue.

Sleeping

Lack of sleep increases pain and anxiety. Talk about it if your nights are bad.

Not staying alone

Talking with other patients often does a lot of good: groups run by afa (the French patient association), patient groups.

Antidepressants, a possible ally

Some are compatible with IBD treatments, and many also treat anxiety. In a large Danish study of nearly 43,000 patients, those who took them had fewer relapses and needed steroids or anti-TNF drugs less often. They may have a small anti-inflammatory effect, and at low doses some also ease pain. These results still need to be confirmed by trials, and antidepressants never replace your maintenance treatment: something to discuss with your doctor, without shame.

Mon soutien psy

In France: up to 12 sessions a year with a psychologist registered with the scheme, covered by the Assurance maladie (French national health insurance) and your mutuelle (top-up health insurance), without a prescription, for mild to moderate distress. Directory on ameli.fr.

afa

The French patient association: guidance towards psychological support and self-help groups for patients and their loved ones. afa.asso.fr

Loved ones

They live with the disease too. Explaining it to them helps, and they also have the right to ask for support.

3114free
24 hours a day, 7 days a week

Dark thoughts: you need to talk about them

They are more common with IBD: about 1 patient in 6 has had them, and the risk of acting on them is a little higher, especially in the first year after diagnosis. It is neither shameful nor a weakness. If you have dark thoughts or want to end your life, call 3114 (the national suicide prevention line in France) or talk to someone close to you or your doctor straight away. You are not alone.