Crohn's inflammation causes depression??, medication doesn't work due to malabsorption???

I have Crohn's - diagnosed at age 50 (2008), suffered w/depression and anxiety most of my life. I have been on Humira for 2 years and last May was told I was in remission. 2 weeks later, saw a rheumatologist who said I had fibromyalgia. Since January, I've had bad depression, anxiety, extreme fatigue, diarrhea, gut pains, low grade fever, and now occasionally notice gas passing from my vagina.

I had a colonoscopy, upper endoscopy and MRI back in late March and my GI showed me pictures and said he thought my lower stomach looked like it had a granuloma (sp?) type of surface (biopsies reveal nothing), and that I had multiple diverticuli throughout, and did not see any fistula per se, but said I might need a pelvic MRI. Then I finally get a brief, terse letter stating I might need to see a surgeon. This has not helped my depression or anxiety - the not knowing and a Dr. who seems to be dismissive and is very arrogant and rude (I need to fire him, but need to get through this flare first, right?)

I saw my Psych meds Dr. yesterday and she explained that Crohn's CAN cause depression b/c of the effect of the inflammation on our brain.

I asked if it is possible that my anti-depressant medication might not be fully effective if I am not absorbing because of scaring in my ileum and/or constant diarrhea, and/or not digesting food properly.

Is there any medical opinion out there about digesting and full utilization of any kind of drug we take orally and whether it can be counted on to work if you have absorption problems or constant diarrhea?

I have never heard of Crohn's causing inflammation in the brain. It is a gut disease! I know that certainly many of us suffer from anxiety and depression which is likely a consequence of dealing with a chronic disease but I personally do not believe the disease kicks in depression.

Your question on the absorption of the drug is an interesting one. I know that Prozac is metabolized in the liver and converts to fluoxetine.

lss said:

I have Crohn's - diagnosed at age 50 (2008), suffered w/depression and anxiety most of my life. I have been on Humira for 2 years and last May was told I was in remission. 2 weeks later, saw a rheumatologist who said I had fibromyalgia. Since January, I've had bad depression, anxiety, extreme fatigue, diarrhea, gut pains, low grade fever, and now occasionally notice gas passing from my vagina.

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This sounds like you are having flare-type symptoms - the low grade fever indicates your body is fighting something - inflammation, infection etc.....

The gas passing from your vagina may be from a fistula - if you are not noticing any stool passing, it may be a very small one. This should be investigated further, if it progresses and enlarges, you may end up with infections.

I had a colonoscopy, upper endoscopy and MRI back in late March and my GI showed me pictures and said he thought my lower stomach looked like it had a granuloma (sp?) type of surface (biopsies reveal nothing), and that I had multiple diverticuli throughout, and did not see any fistula per se, but said I might need a pelvic MRI. Then I finally get a brief, terse letter stating I might need to see a surgeon. This has not helped my depression or anxiety - the not knowing and a Dr. who seems to be dismissive and is very arrogant and rude (I need to fire him, but need to get through this flare first, right?)

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If you are not happy with your doctor, there isn't really a need to wait until you get through a flare - if he isn't treating you appropriately, according to your symptoms, you may not get things under control, and end up doing further damage by waiting. It is ALWAYS a good idea to get a second, or even thrird opinion - you can do that without leaving your current doctor. If he isn't ok with that, I wouldn't keep him anyway!

I saw my Psych meds Dr. yesterday and she explained that Crohn's CAN cause depression b/c of the effect of the inflammation on our brain.

I asked if it is possible that my anti-depressant medication might not be fully effective if I am not absorbing because of scaring in my ileum and/or constant diarrhea, and/or not digesting food properly.

Is there any medical opinion out there about digesting and full utilization of any kind of drug we take orally and whether it can be counted on to work if you have absorption problems or constant diarrhea?

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As ngng stated, Crohns' doesn't cause inflammation on the brain - maybe what the psyche doctor meant was that the inflammation in the body can have an effect on the brain....the disease itself wouldn't necessarily cause depression either, rather it is more likely the symptoms of the disease bring out depression. As far as malabsorption, YES - just like with food, if you are not absorbing things properly, it is possible for medications to not be as effective, as they are expelled from the body before they can be absorbed. This holds true for birth control too!

I think my doc meant that inflammation/auto immune diseases can cause inflammatory problems everywhere, including the brain. That our depression isn't just b/c this crohn's is a pain in the butt (pun intended) and we feel bad for ourselves.

here is an article from the web - abstract below:

Mounting evidence indicates that inflammation may play a significant role in the development of depression. Patients with depression exhibit increased inflammatory markers, and administration of cytokines and other inflammatory stimuli can induce depressive symptoms. Mechanisms by which cytokines access the brain and influence neurotransmitter systems relevant to depression have also been described, as have preliminary findings indicating that antagonizing inflammatory pathways may improve depressive symptoms. One primary source of inflammation in depression appears to be adiposity. Adipose tissue is a rich source of inflammatory factors including adipokines, chemokines, and cytokines, and a bidirectional relationship between adiposity and depression has been revealed. Adiposity is associated with the development of depression, and depression is associated with adiposity, reflecting a potentional vicious cycle between these two conditions which appears to center around inflammation. Treatments targeting this vicious cycle may be especially relevant for the treatment and prevention of depression as well as its multiple comorbid disorders such as cardiovascular disease, diabetes, and cancer, all of which have also been associated with both depression and inflammation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181969/

thanks for this:
As far as malabsorption, YES - just like with food, if you are not absorbing things properly, it is possible for medications to not be as effective, as they are expelled from the body before they can be absorbed.

how do you know if you're not absorbing things? I guess another question for the dear doctor. I'm about 30 pounds overweight, so I think my body is at least able to absorb fat!

I know inflammation from IBD can aggravate other areas such as our joints which is a common extra intestinal manifestation. The joints pain is not the same as arthritis though because it does not create lasting damage, it is just painful and can get swollen.

You could have an MR of the brain to see if there is inflammation there but it may be an unnecessary test since I never heard of that happening and also the treatment would likely be the same, anti-TNF's and immunosuppresives to treat your overall disease.