Stomach pain, bloating, diarrhea, or constipation can cause enough distress in a person's life. But often they are not the only problems. Studies show that anywhere from 50 to 90 percent of people who seek treatment for irritable bowel syndrome (IBS) also have some psychiatric disorder. This may include panic disorder, anxiety, and major depression. Although anxiety is often a problem for IBS patients, depression can also play a role in aggravating symptoms. As far as scientists know, IBS does not cause depression, nor does depression cause IBS. Together, however, they can wreak havoc on a person's life.
If you have IBS with constipation you probably already know how important fiber-rich foods are for your comfort. Making the American Dietetic Association's recommendation to eat 20-35 grams of fiber a day your mealtime mantra is a great place to start. But in order for a high-fiber eating plan to work its magic, you have to do three things:
Reach the higher-fiber target (of 20-35 grams of fiber a day) almost every day.
Spread high-fiber foods throughout the day so it works better.
Some people are so worried that their IBS symptoms will flare up that they avoid going to going to work, school, or social functions. This fear may make them withdraw from social life. They may lose interest in activities they once enjoyed. They may feel restless or irritable. All these are symptoms of depression.
Or, the feeling of despair caused by depression may influence the way people cope with their IBS. They may feel too tired or hopeless to bother changing their diet to ease IBS symptoms. In the dark cloud of depression, people may think they can't treat IBS-related constipation or diarrhea effectively.
People with IBS may notice that emotional stress worsens their symptoms. People who are stressed often are more aware of pain and discomfort. IBS with depression can be a frustrating, often painful cycle.
Breaking the IBS, Depression Cycle
Antidepressants are used to treat both depression and some of the symptoms of IBS. But they're used in different ways for each condition, so it's important talk with your doctor to learn if you're truly depressed.
For example, Beth Schorr-Lesnick, MD, FACG, a gastroenterologist at Montefiore Medical Center in Bronx, New York, prescribes low doses of antidepressants to some patients who don't have depression. The drugs help block the brain's perception of pain, she says.
A number of studies have found that antidepressants can help with some IBS symptoms. Indeed, treatment guidelines published by the American College of Gastroenterology notes that tricyclic antidepressants like nortriptyline (Pamelor), amitriptyline (Elavil), or desipramine (Norpramine) or selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), paroxetine (Paxil), or sertraline (Zoloft),can help soothe IBS symptoms. But they also go on to say that more data is needed to be sure that antidepressants would be safe to use in the treatment of IBS.
Turning to Talk Therapy for Depression
Traditional psychotherapy and cognitive behavioral therapy may also help with depression. Traditional psychotherapy involves talking with a therapist to work out conflicts and understand your feelings. Cognitive behavioral therapy teaches you how to recognize negative and distorted thoughts, and replace them with positive, more realistic thoughts.
The American College of Gastroenterology has found that, in a majority of patients, behavioral therapy reduced some IBS symptoms. Patients who felt physically better also had fewer symptoms of depression and anxiety.