R U OK Day is an important day of the calendar year – it is a day that shines light on suicide prevention, by opening up conversations with those around you and asking them ‘r u ok?’ Through a series of blog posts around mental health and IBS, we hope that you learn something and feel more empowered in this space. Remember, it’s ok to not be ok!
First up – what is known and unknown about IBS and mental health?
What is known?
- There is a higher prevalence of mental health related symptoms and disorders in IBS compared to healthy controls or those without IBS
A 2019 systematic review and meta-analysis pooled together data from 73 studies globally to explore the prevalence of anxiety and depression in the IBS population (1). Researchers found that individuals with IBS are 3-fold higher to have either anxiety or depression compared to healthy subjects (1). They then went one step further to investigate differences between the different subgroups of IBS – IBS-C (constipation predominant), IBS-D (diarrhoea predominant), or IBS-M (mixed symptoms) (1). Interestingly, even though all types of IBS had increased anxiety/depression, participants with IBS-C were more likely to experience anxiety and depressive symptoms (1).
- IBS and mental health conditions are related through the ‘gut-brain’ axis
A 2019 study exploring anxiety, depression and IBS found that those with more severe psychological distress experienced more severe IBS symptoms (2). With increased anxiety and IBS symptoms, came increased symptoms of fatigue, and with increased depressive and IBS symptoms, came decreased work productivity (2).
There is a bi-directional flow of information between the gut and the brain, where stress or signals from the brain can exacerbate gastrointestinal symptoms or vice versa. It may sound simple and intuitive if you are someone who experiences increased stress/gastrointestinal symptoms, however there is still a lot to learn. While we know there is a connection between the gut and the brain, researchers are working hard to better understand these mechanisms.
- Gastrointestinal symptoms experienced in IBS impact daily living and quality of life
If you are someone that has to take time off work, or struggles socially due to your IBS, you are not alone. In a large multi-country survey of over 40 000 people, specific factors which impacted individuals with IBS more than those without IBS were: concentration, long journeys, physical appearance, the ability to eat out, the ability to lead a ‘normal’ life, as well as sexual and physical relationships (3).
The unknowns:
- The exact causes of IBS – researchers are working hard to learn more about the underlying aetiology of IBS
- The gut-brain connection – the roles of different nerves, their interactions and their implications in IBS
- The true role of the gut microbiome – we are still learning what defines a ‘healthy’ gut let alone exactly what an ‘IBS’ gut looks like. How all of this connects IBS to mental health conditions is full of unknowns!
Summary:
Mental health and IBS are areas of research that are rapidly evolving, particularly in relation to the gut microbiome. There is an ongoing need for well-designed human studies, that can translate interesting findings seen in animals into meaningful applications for humans. For now, we suggest for anyone struggling out there with either exacerbated gastrointestinal symptoms, or psychological symptoms to check in with the relevant health professional. Whether it be your regular psychologist, gastroenterologist, dietitian or your local doctor for any referrals – there is support there waiting to help you.
Our next blog in this series will be around psychological treatments (CBT, stress management, gut directed hypnotherapy and some pharmacological agents) that we know are effective in managing IBS – stay tuned and let us know what you think on our Social Media pages or email us at enquiry@monashfodmap.com
References
1. Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2019;50(2):132-43.
2. Midenfjord I, Polster A, Sjövall H, Törnblom H, Simrén M. Anxiety and depression in irritable bowel syndrome: Exploring the interaction with other symptoms and pathophysiology using multivariate analyses. Neurogastroenterol Motil. 2019;31(8):e13619.
3. Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17(5):643-50.
