Mental health interventions may improve inflammatory bowel disease

New research suggests that mental health interventions like therapy may help improve symptoms of inflammatory bowel disease. Copyright Crezalyn Nerona Uratsuji/Getty Images
A new meta-analysis suggests that mental health interventions may improve symptoms associated with inflammatory bowel disease (IBD).
The researchers tracked biomarkers of IBD to reach their conclusion.
The findings show psychological therapy was highly effective at reducing IBD symptoms.
A new meta-analysis — study of studies — from New King’s College in London reinforces existing knowledge of the brain-gut axis that links mental health to the development and behavior of inflammatory bowel disease (IBD).
The findings show that improving depression and anxiety symptoms in people with IBD reduces the severity of the condition by statistically significant amounts.
Mental health therapy interventions, in particular, were most successful at alleviating the inflammation associated with IBD.
Antidepressants and exercise also resulted in improvements, though smaller.
Rather than relying on self-reporting of IBD symptoms, the researchers tracked levels of two biomarkers commonly associated with IBD inflammation: calprotectin and C-reactive protein (CRP).
After searching five medical databases for relevant studies, the authors of the study analyzed data from 28 random, controlled trials involving 1,789 participants. Where biomarker data existed, it was incorporated in the study’s analysis.
The study is published in eBioMedicine.
What’s the link between IBD and mental health?
The new study builds on existing evidence establishing a confirm the connection between IBD and mental health.
The study’s first author, PhD student Natasha Seaton, a PhD student at King’s College, cited several statistics from a 2021 study:
“Depression and anxiety are common in people with IBD. 25% percent of people with IBD have clinical levels of depression, 32% have clinical levels of anxiety. These rates rise to 39% and 58%, respectively, when disease is active and inflammation levels are higher.”
“If you take a snapshot of IBD patients at one time period, it seems as though some inflammatory markers are associated with anxiety [or] depression symptoms,” Seaton told Medical News Today.
Dr. Tine Jess of the Center For Molecular Prediction Of Inflammatory Bowel Disease, told MNT: “There are several mechanistic links between mental health and intestinal inflammation, including vagal nerve signaling, systemic inflammatory markers and the gut microbiome.” Dr. Jess was not involved with the present study.
Dr. Rudolph Bedford, a gastroenterologist with Saint John’s Physician Partners in Santa Monica, CA, not involved with the research, said that a poor psychological state can increase pro-inflammatory cytokines.
“We also see this with gut dysbiosis, or bacterial overgrowth,” Dr. Bedford told MNT.
“These things change the signaling of the brain, and also of the potential inflammatory cytokines. [With] inflammatory bowel disease, it goes back and forth between the two,” he added.
Psychological interventions outperformed antidepressants in improving IBD symptoms.
“We know that the brain can regulate some of the activity of the immune system and of our gut, so an improvement in mood may be linked to brain activity which could reduce inflammation,” Seaton explained.
Better mental health is known to strengthen one’s immune system, she said, noting that people with IBD become “able to manage their physical health better, for example, more physical exercise, better diet, improved sleep quality, [and they are] more likely to take prescribed medication.”
“Psychological therapies may equip people with skills — e.g., CBT techniques, mindfulness practices, stress management strategies — that would empower them to manage their IBD better, leading to improved physical health,” Seaton noted.
The researchers of the present study tracked fecal calprotectin and CRP, two biomarkers of IBD, to draw their conclusions.
“Fecal calprotectin and CRP are used as measures of intestinal and systemic inflammation, and hence reflect disease activity in patients with IBD,” Dr. Jess explained.
Both biomarkers can help physicians objectively determine whether a person with IBD is experiencing a flareup or if they are currently in remission, Seaton said.
Bedford added they are valuable indicators that a patient’s treatment for IBD is or isn’t working.
“If you have a normal calprotectin, then you pretty much know there’s no inflammation in the colon, the same thing goes for the CRP — if it’s normal, then you know your treatment is working,” he said.
“This systematic review and meta-analysis shows that psychological interventions which address mood outcomes have a beneficial effect on both intestinal and systemic inflammation, which I think may still come as a surprise to many people,” Dr. Jess noted.
Dr. Bedford pointed out that, “Not everybody with mood swings, depression, or anxiety develops inflammatory bowel disease. The same thing goes the other way — not everybody with inflammatory bowel disease has depression or anxiety,” he said.
Dr. Bedford said in his practice they often refer IBD patients for psychological counseling.
“We find that their inflammatory bowel disease improves when their anxiety and their depression improves or is mitigated in some way,” he said.
What to know about inflammatory bowel syndrome
IBD is often confused with IBS, irritable bowel syndrome, but IBS does not involve inflammation.
“IBD is an inflammatory, autoimmune condition, whereby debilitating symptoms — pain, fatigue, incontinence, diarrhea — are caused by inflammation in the gastrointestinal tract,” Seaton explained.
IBD is the collective name given to three inflammatory bowel conditions:
Crohn’s disease, which affects any part of the gastrointestinal tract from the mouth all the way to the anus.
Ulcerative colitis, which affects any area in the large intestine.
Indeterminate colitis inflammatory bowel disease, which contains features of both Crohn’s disease and ulcerative colitis.
There is some indication that Crohn’s is hereditary since it tends to be experienced by multiple family members, and disproportionately strikes the Jewish population.
––Robby Berman