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The Link Between IBS and Depression

What Is Depression?

Depression is an illness characterized by a persistent low mood or loss of interest or pleasure accompanied by a variety of other symptoms that interfere with a person’s ability to function and enjoy life.1 Symptoms of depression may include:

  • Changes in appetite and weight
  • Difficulty concentrating
  • Difficulty falling asleep and/or difficulty staying asleep
  • Feelings of hopelessness, low self-esteem, excessive guilt, and pessimism
  • Lack of energy and motivation
  • Social isolation
  • Suicidal ideation and attempts

There are several depressive orders with different features, including:1

  • Disruptive mood dysregulation disorder
  • Postpartum depression
  • Dysthymic disorder
  • Premenstrual dysphoric disorder (PMDD)

Overlap of IBS and Depression

The most commonly diagnosed psychiatric disorder in IBS patients is depression. Researchers reviewed six studies and found that depression levels were significantly higher in IBS patients compared to healthy individuals.2 These numbers are higher than the rates of depression seen in patients who have inflammatory bowel disease (IBD) or in healthy individuals.

Why would IBS patients be at higher risk for depression? Researchers have been looking for answers. One area of inquiry has to do with early childhood trauma. Prevalence rates for childhood sexual and/or emotional abuse in IBS patients range widely, with some estimates as high as 50%.3 Experiencing such trauma also puts a person at risk for the development of a mood disorder such as depression.

IBS researchers have also been looking at the role that the neurotransmitter serotonin plays in both disorders. Serotonin is involved in many of the functions of digestion and plays a key role in communication between our brains and our guts.4 Serotonin levels are also associated with depression symptoms although the mechanism behind this relationship is not fully understood. Thus, problems with the body’s regulation of serotonin may be behind the overlap.

Another good question is whether having IBS can cause depression. A large 12- year study did find that having IBS at the beginning of the study was associated with higher levels of anxiety and depression at the end of the study.5 However, the inverse was also true. Individuals who had higher levels of anxiety and depression at the beginning of the study were at a greater risk for the development of IBS by the end of the study. The study researchers conclude that dysfunction behind both disorders can occur in either direction, i.e. from the brain to the gut or from the gut to the brain.

What to Do if You Have Both

Although having two disorders at the same time can certainly be filed under the “life is not fair” category, there is a bit of a silver lining. What is good for one disorder may also prove helpful for the other disorder. You may find this particularly in the area of prescription medication.

Although it is considered an off-label use, antidepressants are frequently prescribed to IBS patients due to their beneficial effects on pain and gut functioning. It is thought that this helpful effect is due to the effect of the antidepressant on serotonin and other neurotransmitters.

Tricyclic antidepressants are a class of antidepressants that slow down the intestinal tract, possibly making them the better choice for patients who have diarrhea-predominant irritable bowel syndrome (IBS-D).

Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of antidepressants that are thought to only target serotonin, resulting in less unwanted side effects, including constipation. Thus, a person who has constipation-predominant irritable bowel syndrome (IBS-C) may be better served to have his/her depression addressed by medication from this class.

Another avenue to consider is the use of cognitive-behavioral therapy (CBT). CBT has strong research support in helping to relieve the symptoms of both depression and IBS

Why Antidepressants Are Used for IBS

You might be wondering why your doctor would prescribe an antidepressant for your irritable bowel syndrome (IBS) if you are not depressed. Or, perhaps like many IBS sufferers, you do suffer from depression or anxiety alongside your IBS, so the idea makes a little more sense, but you are curious as to what effects an antidepressant might have on your IBS symptoms.

The following overview will answer the question of why antidepressants are sometimes used as a treatment for IBS and educate you as to the types of antidepressants that are commonly prescribed to IBS patients.

Antidepressants and IBS

Although medications in this class are labeled as antidepressants, they have effects that go beyond stabilizing a depressed mood. Antidepressants have been shown to reduce anxiety and pain sensations while having positive effects on the digestive system.1

Physicians may prescribe an antidepressant to an IBS patient, but this is considered an “off-label” use of the drug, as no antidepressant has received FDA approval as an IBS treatment. However, the American College of Gastroenterology, after an extensive research review, concluded that there is enough research support on the effectiveness of two classes of drugs⁠—TCAs and SSRIs⁠—to recommend their use in treating IBS.

Specifically, antidepressants have been found to have a positive effect on gut motility and visceral hypersensitivity. It has been hypothesized that the beneficial effects of antidepressants on IBS symptoms are a result of the action of these medications on the neurotransmitters found in the brain and the gut.2

Types of Antidepressants Used in IBS Treatment

Antidepressants used for IBS generally fall into one of the following classes.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants are the elder statesmen of the antidepressants. It has been well-documented that tricyclic antidepressants have anti-pain and gut-slowing qualities, and seem to do this by acting on the neurotransmitters serotonin and norepinephrine. This slowing down of gut motility makes the TCAs better suited for the treatment of diarrhea-predominant IBS (IBS-D).3

Unfortunately, the same action (anticholinergic effect) that results in slowing down the intestinal tract can occasionally lead to side effects, including drowsiness, dry mouth, blurred vision, sexual problems, dizziness, tremors, headache, and weight gain.

TCAs are generally prescribed at lower doses when treating IBS than when used to treat depression.

The following are examples of TCAs that might be prescribed for IBS:

  • Elavil (amitriptyline)
  • Tofranil (imipramine)
  • Norpramin (desipramine)
  • Aventyl, Pamelor, Allegron (nortriptyline)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are medications that were designed to increase the level of the neurotransmitter serotonin in the nervous system, so as to facilitate a beneficial effect on mood. Because only the neurotransmitter serotonin is targeted, SSRIs generally have fewer side effects than the tricyclic antidepressants.4 Common side effects of nausea, diarrhea, anxiety, and headache often lessen as the body adjusts to the medication. The lack of a constipating effect makes the SSRIs a better choice for those who suffer from constipation predominant IBS (IBS-C).

SSRIs may also result in prolonged side effects of sexual difficulties (loss of sex drive and/or difficulty achieving orgasm) and weight gain. It is important to remember that different people react differently and a person may tolerate one type of SSRI better than another. The following are some examples of commonly prescribed SSRIs:

  • Celexa (citalopram)
  • Lexapro (escitalopram oxalate)
  • Prozac (fluoxetine)
  • Paxil (paroxetine)
  • Zoloft (sertraline)

5-HT3 for Depression

Researchers have looked at medications that target specific serotonin receptor sites known as 5-HT3 receptors. The controversial Lotronex falls into this category.

Due to the risk of serious side effects, the FDA has imposed strict limits on the prescription of Lotronex. There is one 5-HT3 antidepressant, Remeron (mirtazapine). Data is limited as to the effectiveness of Remeron for IBS and therefore may be less commonly prescribed to IBS patients.

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Research

Crohn’s & Ulcerative Colitis: Know the Difference?

You’ve had stomach cramps for weeks You’re exhausted and losing weight. And you keep having to run to the bathroom. What’s going on?

It could be an inflammatory bowel disease (IBD). But which one?

There are two: Crohn’s disease and ulcerative colitis. They have a lot in common, including long-term inflammation in your digestive system. But they also have some key differences that affect treatment.

By the way, if you hear some people just say “colitis,” that’s not the same thing. It means inflammation of the colon. With “ulcerative colitis,” you have sores (ulcers) in the lining of your colon, as well as inflammation there.

Shared Symptoms

The symptoms of Crohn’s disease or ulcerative colitis (UC) can be similar. They include:

You might not have all of those symptoms all the time. Both conditions can come and go, switching between flares (when symptoms are worse) and remission (when symptoms ease up or stop).

Crohn’s and ulcerative colitis are most often diagnosed in teenagers and young adults — although they can happen at any age — and tend to run in families.

What Sets Them Apart

There are three key differences:

1. Location.

Ulcerative colitis affects only the large intestine.

But in Crohn’s disease, inflammation can appear anywhere in the digestive tract, from the mouth to the anus.

2. Continuous inflammation.

People with Crohn’s disease often have healthy areas in between inflamed spots. But with ulcerative colitis, there are no healthy areas in between inflamed spots.

3. Which layers are affected.

Because Crohn’s disease affects more of the GI tract, it can cause some problems that doctors don’t usually see in people who have ulcerative colitis. For instance:

  • Mouth sores between the gums and lower lip, or along the sides or bottom of the tongue.
  • Anal tears (fissures), ulcers, infections, or narrowing.

Getting the Right Diagnosis

Since the differences between the two conditions mostly revolve around wherein the digestive system inflammation happens, the best way for a doctor to give you the right diagnosis is to take a look inside.

You might get tests such as:

X-rays can show places where your intestine is blocked or unusually narrow.

Contrast X-rays, for which you’ll swallow a thick, chalky, barium liquid so doctors can see how it moves through your system.

CT scans and MRIs to rule out other conditions that might cause symptoms similar to inflammatory bowel disease.

Endoscopy, in which a doctor uses a tiny camera on a thin tube to see inside your digestive system. Specific types of endoscopy can:

  • Examine the lower part of your large intestines. Your doctor will call this test “sigmoidoscopy.”
  • Look at your entire large intestine. This is a colonoscopy.
  • Check the lining of the esophagusstomach, and duodenum. This is an EGD (esophagogastroduodenoscopy).
  • Additional testing to look at your small intestine using a pill-sized camera. This is often called pill, or capsule, endoscopy.
  • See the bile ducts in the liver and the pancreatic duct. This test is called ERCP (endoscopic retrograde cholangiopancreatography).

Scientists are working to make several blood tests better at helping to diagnose ulcerative colitis and Crohn’s. They check on levels of certain antibodies found in the blood. Two of these are:

  • “pANCA” (perinuclear anti-neutrophil antibodies)
  • “ASCA” (anti-Saccharomyces Cerevisiae antibody)

Most often, people with ulcerative colitis have the pANCA antibody in their blood, and those with Crohn’s disease have ASCA in theirs. But for now, the tests have uncertain accuracy and should only be used in addition to the above testing.

Sometimes, even after all these tests, doctors might not be able to tell which of the two conditions you have. That’s true for 1 in 10 people with IBD. They show signs of both diseases. So they get a diagnosis of “indeterminate colitis,” because it’s not clear which ailment it is.

Finding Your Treatment

Because of the similarities between the conditions, many treatments of ulcerative colitis and Crohn’s disease overlap. These things help for both:

Lifestyle changes. Those include diet tweaks, regular exercise, quitting smoking, and avoiding pain meds called “NSAIDs” (nonsteroidal anti-inflammatory drugs) such as ibuprofen.

Stress management is also key. Stress doesn’t cause IBD, but it can lead to flare-ups. So try to cut down on the things that make you tense, and find ways to relax. Exercise is a great way to do that. So are other healthy things you might enjoy and find meaningful, such as hobbies, meditation, prayer, volunteering, and positive relationships.

Medicines can get the inflammation under control:

“5-ASAs” work on the lining of your GI tract to lower inflammation. They work best in the colon. You might take them to treat an ulcerative colitis flare, or as maintenance, treatment to prevent relapses of the disease.

Steroids curb the immune system to treat ulcerative colitis. Due to side effects, you probably wouldn’t stay on them for a long time.

For severe disease, you may need drugs that work on the immune system. These include:

With the treatments for mild symptoms, almost all — 90% — of ulcerative colitis cases go into remission. If your UC is “refractory,” you may need continuous treatment with steroids.

With Crohn’s disease, complete remission is less common.

Some people eventually need surgery. That includes up to 45% of people with ulcerative colitis and three-quarters of people with Crohn’s.

You and your doctor might talk about an operation if you have severe symptoms that aren’t helped by medications, if you get a blockage in your digestive tract, or if you get a tear or hole in the side of the intestine.

Keep Up With Your Checkups

If you have either condition, you’ll need to keep up with your checkups, even if your symptoms start to ease up.

You may also need to get colonoscopies more often and start them at a younger age. A colonoscopy can check for cancer or polyps that need to come out. Experts recommend that you start these tests within 8 to 10 years of developing UC or Crohn’s symptoms, and then typically every 1 to 3 years after that. Your doctor will tell you a schedule that is best for you.

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Research

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Diet and Lifestyle

SUPPORTING EXAM STRESS and Kids going back to School.

stress

Tests and exams can be a challenging part of school life for children and young people and their parents or carers. But there are ways to ease the stress.

Watch for signs of stress

Children and young people who are stressed may:

  • worry a lot
  • feel tense
  • have headaches and stomach pains
  • not sleep well
  • be irritable
  • lose interest in food or eat more than normal
  • not enjoy activities they previously enjoyed
  • be negative and have a low mood
  • feel hopeless about the future

Having someone to talk to about their work can help. Support from a parent, tutor or study buddy can help young people share their worries and keep things in perspective.

Encourage your child to talk to a member of school staff who they feel is supportive. If you think your child is not coping, it may also be helpful for you to talk to their teachers.

Try to involve your child as much as possible.

Make sure your child eats well 

A balanced diet is vital for your child’s health, and can help them feel well during exam periods.

Some parents find high-fat, high-sugar and high-caffeine foods and drinks, such as energy drinks, cola, sweets, chocolate, burgers and chips, make their children hyperactive, irritable and moody.

Where possible, involve your child in shopping for food and encourage them to choose some healthy snacks.

Read more about healthy eating for teens.

Help your child get enough sleep 

Good sleep improves thinking and concentration. Most teenagers need 8 to 10 hours’ sleep a night. Learn more about how much sleep children need.

Allow half an hour or so for your child to wind down between studying, watching TV or using a computer and going to bed, to help them get a good night’s sleep.

Cramming all night before an exam is usually a bad idea. Sleep will benefit your child far more than a few hours of panicky last-minute study.

Be flexible during exams

Be flexible around exam time. When your child is revising all day, do not worry about household jobs left undone or untidy bedrooms.

Staying calm yourself can help. Remember, exams do not last forever.

The Family Lives website has more about coping with exam stress.

Help them study

Make sure your child has somewhere comfortable to study. Ask them how you can support them with their revision.

Help them come up with practical ideas that will help them revise, such as drawing up a revision schedule or getting hold of past papers for practice.

To motivate your child, encourage them to think about their goals in life and see how their revision and exams are related to them.

Talk about exam nerves

Remind your child that it’s normal to feel anxious. Nervousness is a natural reaction to exams. The key is to put these nerves to positive use.

If anxiety is getting in the way rather than helping, encourage your child to practise the activities they’ll be doing on the day of the exam. This will help it feel less scary.

For example, this may involve doing practice papers under exam conditions or seeing the exam hall beforehand. School staff should be able to help with this.

Help your child face their fears and see these activities through, rather than avoiding them.  

Encourage them to think about what they know and the time they’ve already put into studying to help them feel more confident.

Encourage exercise during exams

Exercise can help boost energy levels, clear the mind and relieve stress. It does not matter what it is – walking, cycling, swimming, football and dancing are all effective.

Activities that involve other people can be particularly helpful.

Support group Childline says many children who contact them feel that most pressure at exam time comes from their family.

Listen to your child, give them support and avoid criticism.

Before they go in for a test or exam, be reassuring and positive. Let them know that failing is not the end of the world. If things do not go well they may be able to take the exam again.

After each exam, encourage your child to talk it through with you. Discuss the parts that went well rather than focusing on the questions they found difficult. Then move on and focus on the next test, rather than dwelling on things that cannot be changed.

Make time for treats

With your child, think about rewards for doing revision and getting through each exam.

Rewards do not need to be big or expensive. They can include simple things like making their favourite meal or watching TV.

When the exams are over, help your child celebrate by organising an end-of-exams treat.

When to get help

Some young people feel much better when exams are over, but that’s not the case for all young people.

Get help if your child’s anxiety or low mood is severe, persists and interferes with their everyday life. Seeing a GP is a good place to start.

Some basic rules coming up to exam time

A quiet place to study – A suitable environment to study is important to help concentration levels.

A balanced diet – Good nutrition is essential at any time of year, but especially during exam time. Batch cook some healthy meals and stock up on nutritious snacks. Having some of the student’s favourite dinner to hand is important too.

Omega 3 is essential to fuel the hard-working brain at this time. Keep brain and vision in tip top shape by making sure to top up your good fats daily. Consider taking Cleanmarine® Krill Oil High Strength. It contains 590mg of concentrated, high strength Omega 3 Krill Oil. This concentrated formula of EPA, DHA, Astaxanthin and Choline provides the essential fatty acids required for the normal function of the heart, brain and vision. DHA contributes to the maintenance of normal brain function and vision, the beneficial effect is obtained with a daily intake of 250mg. Also eating 2 – 3 portions of oily fish a week will provides more essential fats for your body. Examples include salmon, mackerel and herring. Easy to cook in steam parcels in the oven with garlic, lemon and oil.

A good night’s sleep – Studying all night may seem like a good idea but if your child doesn’t get enough sleep, they are more likely to forget the information or under perform. When your mind is buzzing with exam questions, quotes and scientific theories, having something to help you switch off, relax and support deep sleep is a must. Try melissa-dreams which contains all-natural ingredients including the herbs lemon balm (Melissa officinalis) and Chamomile in combination with selected B-vitamins, Magnesium and the amino acid L-theanine. Magnesium contributes to a reduction of tiredness and fatigue while vitamins B6 and B12 contribute to the normal function of the nervous system. With no drowsiness or side effects the next day, Melissa Dream helps you to wake up rested and full of energy.

Exercise – Even a 20-minute walk will help your child to relax and destress their mind, this will also help oxygenate the entire body.

Stress is the biggest obstacle to overcome. It’s so important to get enough B vitamins in foods like broccoli. Kale, spinach. Getting your 5-a-day is bound to be the least of your worries as exam time approaches; ironically this is when your nutritional and energy needs are at their highest. Make sure you keep your nutrient and energy levels up with One Nutrition® Organic Power Greens. This is a unique combination of nature’s finest green foods including kale, broccoli, spirulina, wheat grass and barley grass juice powders in a handy capsule or powder to add to your morning smoothie.

Take time out to do something you love such as walking your dog, reading a magazine, chat online to your best friend. Journaling is also therapeutic, to put your thoughts and feelings onto paper. Try family time such as playing a board game to distract your mind from the books for a while.

Don’t forget to celebrate – when the exams are over, go out and celebrate together, hopefully everything will be back to normal by then.

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