Nature Reviews Gastroenterology and Hepatology, volume 19, issue 11, pages 717-726

Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment

Publication typeJournal Article
Publication date2022-06-22
scimago Q1
wos Q1
SJR9.741
CiteScore52.3
Impact factor45.9
ISSN17595045, 17595053
Gastroenterology
Hepatology
Abstract
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a chronic, relapsing immune-mediated disease with a varying and sometimes severe disease course. IBD is often diagnosed in early adulthood and can lead to a substantial decline in quality of life. It has been suggested that patients with IBD are at increased risk of depression and anxiety, but it is still unclear to what extent these diseases co-occur and in what sequence they arise. This Review summarizes the literature on the degree of co-occurrence of IBD with depression and anxiety and the temporal relationship between these diseases. We also discuss the effect of psychological stress on the onset and course of IBD. In addition, we outline the possible mechanisms underlying the co-occurrence of IBD and depression and anxiety, which include changes in brain signalling and morphology, increases in peripheral and intracerebral pro-inflammatory cytokines, impairment of the nitric oxide pathway, changes in vagal nerve signalling, gut dysbiosis and genetics. Finally, we examine the possible effects of treatment of depression and anxiety on the risk and course of IBD, the influence of psychological interventions on IBD, and the effects of IBD treatment on psychiatric comorbidity. In this Review, Jess and colleagues describe the prevalence of depression and anxiety in patients with inflammatory bowel disease, the mechanisms underlying the bidirectional association between these diseases and the effect of treatment on their co-occurrence.

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