Crohn's Disease And Depression

Depression is a very common illness. It would be surprising if you did not know someone who has lived with depression since approximately 1 in 5 women and 1 in 10 men will experience a major depression at some point in their life. Depression is different than normal sadness or discouragement because it has a wider range of effects on feeling, thinking, and physical function and because, if not treated, it usually persists for weeks or months.

 

People who live with chronic diseases, such as IBD, are at increased risk of experiencing depression. There are probably many reasons for the increased risk. The losses and frustrations that come with living with a disease; the biological effects of inflammation (since many of the body's chemicals that increase immunity and inflammation also have effects on the brain); and the effects of medications, such as prednisone, may all contribute to depression.

 

Recognizing the symptoms of depression when it occurs is very important because depression usually responds well to treatment. Some of these symptoms may be hard to interpret when you have ulcerative colitis or Crohn's disease. Most people experience one or two of these symptoms some of the time, without being depressed. Some can be caused by physical illness without being depressed. However, if symptoms persist and seem out of proportion to your usual experience of illness, talk to your doctor about the possibility of depression.

 

 

If it is not treated, depression adds substantially to the burden of illness. People with chronic disease who are also depressed tend to experience more pain, fatigue, and other symptoms. Depression makes it harder to keep up your motivation to see the doctor when IBD symptoms emerge and to stick to your treatment plan. If you are depressed, you are less likely to be able to work and you are less likely to be effective in all of your efforts to cope with IBD. The result is that depression and IBD can make each other worse in a vicious cycle.

 

 

Depression can be effectively treated with antidepressant drugs or with certain forms of psychotherapy. Very often these forms of treatment are most effective if used together.

 

 

There are many effective antidepressant drugs available now. Your doctor can help you to choose the drug that is best suited to your situation.

 

Treating depression requires daily use of antidepressants for several months, often longer. However, depressive symptoms usually start to improve after taking an antidepressant for about 2 weeks, although it may take up to 12 weeks to feel the full benefit.

 

With modern antidepressant drugs, side effects (such as tremor, difficulty sleeping, or upset stomach) are usually not difficult to tolerate. Side effects are usually strongest shortly after starting a new medication or increasing the dose, and tend to settle down after a couple of weeks. Your doctor can help you to find a drug that is compatible with your IBD symptoms and its treatment.

 

 

Some forms of psychotherapy (talk therapy) are as effective as antidepressant drugs for treating moderately severe depression. Cognitive-behavioral therapy and interpersonal therapy, for example, has been found to be highly effective in many studies of depression. Other forms of psychotherapy may also be effective.

 

In cognitive-behavioral therapy, you learn to identify patterns of thought that tend to lead to depression or that tend to make depressive feelings worse. It is very common for people with depression to evaluate their experience in a way that leads to negative conclusions. Seeing things as black or white (all good or all bad), for example, means that many experiences and events are labeled as being bad, just because they aren't perfect. Many depressed people find that they pay close attention to negative or unhappy events and do not pay the same degree of attention to positive events, which tends to reinforce a pessimistic view. Patients work with their therapist to recognize their typical patterns of thought, to re-evaluate how accurate they are, and to develop alternative modes of thought. Typically cognitive-behavioral therapy occurs weekly for 3 or 4 months, sometimes longer.

 

In interpersonal therapy, patients work through, with their therapist, the feelings that are associated with an important life event linked to the current period of depression. Typical examples are grief over the death of a loved one, dealing with the mixed feelings of making a critical developmental transition (such as moving from living with family to living on your own), dealing with conflict in a partner relationship, or coping with social isolation. Interpersonal therapy also typically occurs weekly for 3 to 4 months, sometimes longer.