Ulcerative Colitis and Your Mental Health

Medically Reviewed by Jennifer Robinson, MD on May 20, 2021

Ulcerative colitis (UC) can make life hard to predict. A flare-up of symptoms is stressful and can leave you worn out for days, weeks, or even months. Even in remission, you might get tired a lot or have a hard time meeting friends or going to work. It’s easy to see why living with this long-term inflammatory disease can affect your mental health.

There's no evidence that stress actually causes inflammatory bowel disease (IBD), which includes UC and Crohn’s disease. But stress can definitely bring on a flare-up. And you're more likely to feel anxious and depressed than your friends without UC. Your chances are even higher if you are a woman. Even rats with IBD in lab studies show signs of mood problems.

But there are steps you can take to lift your mood, even when your symptoms get you down.

It's tough on the body and mind if you're sick a lot. It's important to stay tuned in to your emotional well-being if you have a chronic condition such as UC. Mood issues, especially depression, seem to shorten the time between flares in some people. It can also be hard to stick to your treatment when you feel blue. And you are more likely to have symptoms like diarrhea or stomach cramps if you don't take your medicine.

Experts aren’t sure what the exact link is between stress, mood, and UC flares. But there are some theories:

Inflammation. Stress causes your body to release inflammatory chemicals called cytokines. These proteins can help the body heal if you are hurt or sick. But if they hang around all the time, experts think they may raise your chances of developing depression and anxiety. One reason may be that inflammation affects serotonin, a chemical messenger mostly made in the intestines that is involved with your mood.

Your gut and brain talk. Some experts think anxiety and depression make your UC symptoms worse, and then your upset gut does the same to your mood.

Gut bacteria. The amount and kind of microbes that live in your intestines, also known as the microbiome or microbiota, can change when you feel stressed. Studies show gut bacteria can affect your emotions, immune system, and pain level.

Medication. Corticosteroids that you might take for UC can change your mood while you take them.

Breathe. You can trigger the body to relax when you take slow breaths that fill your belly with air. Called diaphragmatic breathing, some research shows that it can reduce anxious and depressed feelings. Here’s how you do it:

  1. Breathe in through your nose for 4 or 5 seconds.
  2. Place your handon your belly. Only your stomach should expand.
  3. Hold your breath for a couple of seconds.
  4. Breathe out through your mouth for about 6 seconds.
  5. Repeat for 5-15 minutes.

Focus your mind. Some studies found that mindfulness-based meditation, like paying attention to your breath, may:

  • Lessen feelings of anxiety and depression
  • Help you feel less pain

Brain scans show that people who pay attention to the moment tend to hurt less because the pain center in their brain is less active.

Intestinal behavioral therapy. You don’t have to have a mental illness to benefit from this kind of treatment. It's designed for anyone who wants to deal with the stress around UC.

Ask your doctor about:

  • Cognitive behavioral therapy (CBT)
  • Gut-directed hypnotherapy
  • Stress-management therapy

Get moving. You probably already know that exercise is good for your mood. Studies show it works just as well as antidepressants for some people. But listen to your body. If you are really active for a long time, it can cause more inflammation and make some IBD symptoms worse. Marathon runners sometimes get diarrhea or intestinal bleeding. That might not be a great activity to do if you have UC.

Try this:

Reach out to someone. You might feel better if you talk to a therapist, especially one who's familiar with UC. You can also meet up with people who know what you are going through. The Crohn’s & Colitis Foundation can help you find a support group in your area.

Antidepressants may help. There is evidence they might boost your spirits and ease the pain of your gut symptoms at the same time. But talk to your UC doctor before trying any mediations for your mood. Some can cause side effects that worsen IBD.

Get enough sleep. You should try to snooze long enough that you aren’t tired during the day. That’s probably somewhere between 7-9 hours for adults. Talk to a specialist if you have trouble getting or staying asleep. Insomnia is linked to depression and higher levels of inflammation.

Go outside. Exercising out in nature may lower anxiety more than sweating it out in the gym. There is also evidence that walking in trees or looking at greenery can help lower stress levels in general.

Give yourself a break. You don’t have to pretend everything is fine. Along with all the other things that help you manage your emotions, experts say you will probably feel better sooner if you sit with your bad feelings for a little while instead of trying to make them go away.

Hopefully, your doctor would check in with you about your emotional life during your regular UC visit. But if that doesn't happen, bring it up if your mood is bothering you or has gotten worse. Talk about it even if you don’t think it amounts to a mental illness. Don't just accept it as "the way things are."

Symptoms to look out for include:

  • You are sad a lot, hopeless, or feel like nothing matters.
  • You no longer enjoy your hobbies.
  • You can't concentrate.
  • You sleep too much or too little.
  • Your appetite changes.
  • You are irritated.
  • You can't stop worrying.

If you've had thoughts about death or suicide, get help right away. You can talk to your doctor, a counselor, or call the National Suicide Prevention Lifeline at 800-273-8255.

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