IBS and Depression: Spectrum of the Same Diseases

IBS and depression are considered two different illnesses. However, there is a close link between the two diseases.

When depression affects primarily your thoughts and social life, you go to a psychiatrist who gives you a diagnosis of “Major Depressive Disorder“, “Anxiety Disorder“, or “Phobic disorder” and so on.

Similarly, when depression affects your musculoskeletal system, you go to physicians and rheumatologists who give you the label of “Fibromyalgia” or “Chronic Fatigue Syndrome“.

Similarly, if you develop symptoms in your groin and pelvic area because of depression, your gynecologist will label you with “Chronic Pelvic Pain Syndrome“.

Likewise, when depression affects your tummy (gastrointestinal system) and you feel bloated, and have diarrhea, constipation, gases, and abdominal pain, your gastroenterologist gives you the diagnosis of IBS (Irritable Bowel Syndrome).

But what is common with all the above diagnoses? Antidepressants! 😯 All these diseases are treated with antidepressants.

For the sake of discussion, I am quoting studies here to see the link between IBS and Depression. But I personally believe IBS is a form of depression. 

IBS is basically “Depressed and Irritable Gut“.

IBS and Depression

IBS is a disorder related to the Gastrointestinal tract in which there are symptoms such as:

Severe stomach cramps

• Abdominal bloating
• Diarrhea
• Constipation
• Gas
• Pain
• Depression

It is a state of mental illness that affects the way one feels, thinks, interacts, etc. It makes you lose your interest in daily life activities and causes a feeling of sadness in you. This affects your response and approach toward life.

IBS and Depression

IBS and depression have a strong connection between them. One suffering from Irritable Bowel Syndrome has many chances to suffer from depression and anxiety.

Majority of people suffering from IBS get into depression sooner or later. According to research, almost one-third of IBS victims suffer from depression, which makes up nearly 30% [Ref].

IBS causing depression

In patients suffering from IBS, it is observed that apart from effects caused by IBS physically, it also affects one’s ability to think, feel, talk, interact, etc.

You do not feel comfortable going out and socially interacting with people because of feeling uncomfortable with your gut movements, bloating, and gases.

Stomach pain, diarrhea, and constipation may cut you off from people and make you socially inactive, and indulge you in depression.

You may feel abnormal and different from others, becoming the leading cause of anxiety.

• Does serotonin affect both?

There is a clear influence of IBS and anxiety on each other. Serotonin which is a neurotransmitter is thought to have the main role in the link between IBS and depression.

In addition, both depression and IBS are treated with serotonin reuptake inhibitors (SSRIs). although OTC medications like Buscopan and antacids help too, most people ultimately need SSRIs.

This is especially true for patients who have long-standing symptoms which are not responsive to other remedies.

• Gut and brain interaction:

In some people, depression and anxiety can result in IBS as it affects your hormonal release, digestive functions, secretions, etc.

So studies prove that there is a very strong connection between your GIT and your brain. This connection is due to the link between the digestive system and the nervous system.

The Gastrointestinal tract has more than 500 million neurons that carry messages via the vagus nerve and may affect your behavior as well as your psychological condition.

The research was conducted on mice to know the exact connection between the brain and the gut. In this investigation, stress was applied to mice from an external environment, and then their GI conditions were examined.

Scientists were surprised to find out that the stress led to changes like bacteria in its intestine causing a depressive state [Ref].

• Does trauma have any effect?

Some researchers have found a strong connection between IBS and trauma or severe depression.

In a study, 74% of the patients suffering from IBS vs 59% of those without IBS had a history of childhood trauma.

This could be either physical or emotional such as an accident, death of loved ones, sexual assault, etc. So any emotional or physical damage of such an extent can lead to IBS [Ref].

Treatment of IBS and Depression:

IBS treatment is usually symptomatic. People who have predominant constipation get the most relief from medications that have a laxative effect. These include:

• Senna
• Psyllium husk
• Isphaghula husk
• Miralax
• Dulcolax

Newer drugs that have proven to be safe and more effective in the treatment of IBS with predominant constipation are:

• Linzess (Linaclotide)
• Lubiprostone (Amitiza)
• Plecanatide (Trulance)
• Tegaserod

People also get relief from medications that relieve intestinal spasms like Hyoscine, Mebeverine, Buscopan, and antibiotics/ antiseptics like Rifaximin (Xifaxin).

However, symptomatic treatment is usually combined with drugs that relieve stress such as antidepressants (SSRIs) and anxiolytics.

One drug commonly used is Librium. It contains Clidinium and chlordiazepoxide. It relieves stress and relaxes smooth muscles as well.

• Antidepressants

Antidepressants can be very effective in treating IBS. They reduce both depression and relieve abdominal cramps as they maintain serotonin levels which maintain a link between IBS and depression. Some antidepressants most commonly used are:

• Tricyclic antidepressants e.g Nortriptyline and Amitriptyline
• Selective serotonin reuptake inhibitors e.g Citalopram and Paroxetine

TCAs (Tricyclic antidepressants) are used in patients with IBS and predominant symptoms of diarrhea while SSRIs can be used to treat both especially IBS with Constipation.

Paroxetine is a potent SSRI that is found effective by most patients with IBS and depression. Sertraline has the added benefit of relieving constipation as well.

Among all the antidepressants, Zoloft (Sertraline) is likely associated with constipation.

• Diet:

Diet plays a key role in the treatment of the majority of diseases, it also plays a very significant role in curing both IBS and depression.

Many foods trigger symptoms of IBS and simultaneously increase depression. So having a diet that avoids such foods prevents you from both.

A diet having low short-chain carbs and polyols or FODMAP is suggested which relieves IBS and helps you improve your way of living.

• Psychotherapy

Psychotherapy is proven to be very effective in treating IBS and depression simultaneously. Many other forms of psychotherapy such as hypnotherapy are also widely accepted in which hypnosis is done to improve the focus and mental state of a patient.

In Conclusion:

IBS and Depression are two diseases with similar manifestations. I believe they are the same diseases manifesting differently.

Both patients with IBS and depression get relief by following a healthy schedule, exercising, a low FODMAP diet, and antidepressants.