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Depression

About Depression and IBD

Depression and/or Fatigue often coexist with Inflammatory Bowel Disease (IBDs)

Firstly, particularly if you are newly diagnosed, or are experiencing a "Flare" after a period of Remission, you may go through a grieving process similar to losing a loved one. Essentially, you are mourning the loss of the ‘healthy you’. This is a normal reaction to being diagnosed with a chronic illness.

Second, it may be difficult for you to continue your normal activities if you are experiencing symptoms.
- If you are finding it difficult to work, is there anything your employer can do to help? For example, a temporary reduction in hours, or reduced duties may help while you deal with the Flare.
- If you are finding it difficult to meet with friends, could they visit you at home? Taking up a new hobby can help to fill space left by activities that you are finding it difficult to do.

Third, Inflammation can cause the release of certain Chemical Messages in the body, or Cytokines, or Chemical Imbalances, some of which are known to cause unwanted effects, including:
Depression
Fatigue
Pain
Sleep Disorders (Too much or too little)

Pro-Inflammatory Chemicals are Implicated in Symptoms of Depression

There is a great deal of Scientific Background showing that Inflammation (especially Chronic Inflammation) causes the release of certain chemicals that induce a "Sick Syndrome" or "Sickness Behavior"[7]. Many of these chemicals are the same ones released during an Infection and are the reason you feel so unwell during a cold or the flu. During Chronic Inflammation, such as in Crohn's Disease, the "Benificial" Inflammatory Response instead can become a self-damaging one. This damage may occur to body tissues and can cause imbalance in chemical pathways. Many of the body's chemical pathways are known to be disrupted with Chronic Inflammation. These can induce Symptoms of Depression (but are not limited to):
- Lowered Levels of Serotonin
-- This chemical imbalance can be treated using medication from the doctor to correct the imbalance. You may need this medication in the short term while your IBD is being brought under control, or you may find it beneficial to be on a maintenance medication long term.

- Interleukin IL-1β
-- Increased Sensitivity to Pain, or Hyperalgesia, and Depression

- Increased IL6 - Interleukin 6
-- Can Cause Pain and Depression

- Indoleamine 2,3-Dioxygenase 1 (IDO1) -
-- Found to be increased in patients with Pain, Depression and Inflammation. Induced by IL-6.[6]

- HPA Axis (Hypothalamic - Pituitary - Adrenal Axis)

- GABA

If your symptoms are worse in winter, there may be an element of Seasonal Affective Disorder. This can be treated using a special light box, which mimics the effects of the sun, and stimulates production of hormones which affect your mood (amongst other things). Also taking extra Vitamin D may help.

Regardless of the reason for the depression, symptoms can be lessened by staying physically active and eating as healthily as is possible for you. Using the forum to discuss problems or offload worries (regardless of whether they are IBD related) may also help.

Don't be afraid to ask for help, depression is not a sign of weakness, and is actually very common.

Finally, caution must be exercised if you choose to take herbal remedies to help with depression, as they may interfere with your IBD treatments. Always check with your doctor or pharmacist before taking anything that is not prescribed by your doctor.

Science is now finding that depression is linked with people who have a low intake of Omega 3 and high intake of Omega 6 fatty acids. In addition to helping get rid of depression, there are many health benefits from improving your Omega 3 to Omega 6 fatty acid ratio. Consider taking an Omega 3 supplement like flax or fish oil daily.

Some very good videos on depression

References

3. De Jongh RF, Vissers KC, Meert TF, Booij LH, De Deyne CS, Heylen RJ. The role of interleukin-6 in nociception and pain. Anesth Analg. 2003; 96(4):1096–1103.
4. Maes M, Verkerk R, Bonaccorso S, Ombelet W, Bosmans E, Scharpe S. Depressive and anxiety symptoms in the early puerperium are related to increased degradation of tryptophan into kynurenine, a phenomenon which is related to immune activation. Life Sci. 2002;71(16):1837–1848.

5. O’Connor JC, et al. Lipopolysaccharide-induced depressive-like behavior is mediated by indoleamine 2,3-dioxygenase activation in mice. Mol Psychiatry. 2009;14(5):511–522.

6. Kim H, Chen L, Lim G, Sung B, Wang S, McCabe MF, Rusanescu G, Yang L, Tian Y, Mao J. Brain indoleamine 2,3-dioxygenase contributes to the comorbidity of pain and depression. J Clin Invest. 2012; 122(8):2940 doi:10.1172/JCI61884. http://www.jci.org/articles/view/61884/pdf

7. Maes M, Berk M, Goehler L, Song C, Anderson G, Galecki P, Leonard B. Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways. BMC Medicine. 2012; 10: 66: doi:10.1186/1741-7015-10-66 http://www.biomedcentral.com/content...7015-10-66.pdf

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