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

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. Key points Depression and anxiety are common comorbidities in inflammatory bowel disease (IBD), but the prevalence varies across studies owing to heterogeneity in study populations and assessment tools for depression and anxiety. The relationship between IBD and depression and anxiety seems to be bidirectional. The mechanisms behind the relationship between IBD and depression and anxiety include increased pro-inflammatory cytokines, vagal nerve signalling, gut dysbiosis and changes in brain signalling and morphology. Antidepressants and behavioural therapies show not only effectiveness in the treatment of depression and anxiety but might also alleviate IBD symptoms or decrease the risk of relapse, although evidence is still limited.