Think about it. Who really wants to talk about Inflammatory Bowel Disease (IBD)? It’s not only a fickle condition, it’s not exactly dinner table talk. Unfortunately, the “let’s ignore it” approach to IBD doesn’t do anyone any good. There is no known cure for this devastating disease because there is no single contributing factor. Along with the most common types of bowel disorders, Crohn’s Disease and ulcerative colitis, IBD causes significant abdominal pain, cramping and urgent bowel movements. It is also growing not just in adults but among children too. If all this isn’t troubling enough, it can deliver lasting psychological damage on sufferers. Psychologist and author of IBD and the Gut-Brain Connection, Antonina Mikocka-Walus recently sat down with WellWell to offer insights on the extent of IBD’s reach and the often-overlooked mental challenges it brings.
What is the biggest misconception about IBD?
That it impacts a person solely on a physical level. IBD is an illness that affects a person’s overall well-being; it has not only biological but also psychosocial consequences–it impacts our employability, our ability to socialize and relationships with others. It should be treated as a biopsychosocial condition, in a holistic and integrated fashion, with a gastroenterologist involved in care but also with dieticians, nurses, psychologists and other health providers as necessary. Many people with IBD develop anxiety or depression. For some, these psychological symptoms are only present during IBD flares. For others, they are more persistent.
There was a recent major spike of IBD cases found among children and teenagers, what do you believe caused this?
Yes, IBD in children now accounts for 25% of the new cases. It’s one of the mysteries of IBD but has been linked to environmental factors–more children growing up without siblings, living in urban areas, in very clean houses, and thus not exposed to certain pathogens early in life. As a result, their gut bacteria are not as diverse as they should be to maintain a healthy gut. Our diets and use of antibiotics have changed as well. There is also more pollution. All these contribute to growing IBD diagnoses in adults as well as children.
How do stress and anxiety affect IBD?
We know that people with IBD who are chronically stressed, anxious or depressed report more severe bowel symptoms and more frequent IBD flares. Depression in particular has been linked to low adherence to treatment, so we are less likely to remember about our IBD medication. That’s one contributor right there. But there is also a greater risk of hospitalization, readmission to a hospital and even surgery due to IBD in people who are anxious or depressed.
Why is the depression rate in IBD suffers so high?
Again, it’s the brain-gut connection. If there is an inflammation in the gut, the brain is the first to know and responds accordingly. The gut and the brain do talk to each other and we know that stress and gut inflammation disturb this healthy communication. But people with all chronic conditions are at higher risk of depression. These conditions are unpredictable and incurable and that’s enough as a risk factor for depression. People with IBD also often have low levels of iron, B12 and other minerals and vitamins, which contributes to poor mental health. Some people report bowel symptoms even in remission–for these people there is no break from diarrhea or pain. It’s no wonder that they feel unhappy about it and may become depressed.
What is the most effective treatment for inflammatory bowel disease and IBD-related mental health symptoms?
Having a psychologist or another mental health provider involved in IBD care is essential. There are several psychotherapies that have shown positive results in dealing with IBD. One is cognitive-behavioral therapy, known as CBT. This involves people learning about how their thoughts impact their emotions and behavior and how to modify the negative thoughts for better mental health. There is also promise in the use of medications such as antidepressants. There is mounting evidence of their role in managing not just anxiety and depression but also pain, some functional gut symptoms, sleep and potential inflammation.
About Antonina Mikocka-Walus
Antonina Mikocka-Walus is a registered psychologist and Associate Professor in the School of Psychology at Deakin University in Melbourne. She completed her PhD in Psycho-gastroenterology at the University of Adelaide and has since worked at Monash University, University of South Australia, University of York (UK), and has been at Deakin University since 2016. Ms. Mikocka-Walus is an active researcher who has generated over 100 research publications, largely on the brain-gut links, psychotherapy and antidepressant treatment in chronic gastrointestinal conditions. Her research has received funding from such organizations as the Wellcome Trust, Crohn’s and Colitis Foundation of America, and Crohn’s & Colitis Australia.
To learn more please visit https://antoninamikocka.com
Chapter One of IBD and the Gut-Brain Connection: A patient’s and carer’s guide to taming Crohn’s disease and ulcerative colitis can be read for free at: https://www.book2look.com/book/GZcclwBs2j Her latest book, IBD and the Gut-Brain Connection: A patient’s and carer’s guide to taming Crohn’s disease and ulcerative colitis, is available at Amazon.