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Mental health and inflammatory bowel disease

Mental health and inflammatory bowel disease

Mental health and inflammatory bowel disease

Having a chronic health condition such as inflammatory bowel disease (IBD) can contribute to poor mental health because of the impact it can have on your daily life. People living with Crohn’s disease or ulcerative colitis are more likely to have depression or other mental health problems than the general population.1,2

You may have a lot of physical symptoms with inflammatory bowel disease, but it is important to ensure you also look after your mental well-being.

44% of people living with IBD reported experiencing depression because of it3*

– IBDrelief IBD Quality of Life Survey

What is good mental health?

Good mental health is not just the absence of mental disorders. It is defined as a state of well-being in which you can:

  • feel confident and have positive self-esteem
  • feel and express many emotions
  • build and maintain healthy relationships
  • interact with the world around you
  • manage life stresses
  • be resilient during times of change and uncertainty

Good mental health is a critical component of health and a means for us to connect with others, function in the best way and enjoy life. It goes beyond simply not having a mental health condition.

A smiling person with IBD, showing positive mental health

Inflammatory bowel disease and your mental health

Living with long-term conditions such as Crohn’s disease and ulcerative colitis can cause you to experience a range of emotions, from worry and sadness to anger and frustration. These feelings are all normal and it is natural to feel like you may be struggling to cope. It is important that you give yourself space to accept your feelings and understand that they will not last forever.

For some people, negative feelings can be overwhelming and make managing your condition more difficult.

You are more likely to experience mental health problems at specific times such as:

  • when you first receive your diagnosis
  • when you have a flare-up and symptoms return again
  • after you have had surgery – especially if you have a stoma
  • experiencing side effects of medication
  • experiencing invisible symptoms like fatigue and pain

What is depression?

Depression is a clinical condition that goes beyond just ‘being sad’. Possible signs and symptoms are:4,5

  • A continuous low mood that persists for weeks or more combined with a loss of interest in activities you usually enjoy
  • Feelings of emptiness, guilt, and low self-esteem
  • Anxiety, with excessive and distressing worry
  • Physical symptoms such as changes to sleep and appetite, and a lack of energy
  • Increased irritability
  • Difficulty making decisions
  • Avoidance of social contact

Symptoms are very individual and can be complex. They can impact your performance at work, your relationships, and your quality of life.5

IBD and depression

Being diagnosed with and living with IBD can be very challenging. You may notice an impact on your mental health immediately following diagnosis, during a flare, after surgery, or living with ongoing ‘invisible’ symptoms such as fatigue or pain.1

Mental health and medications

Some medications may cause depressive side effects – for example, steroids can cause extreme mood swings.1,6

If you are suffering pain and disability because of your IBD, you are more likely to become depressed, which in turn can make your symptoms worse and trigger a relapse.1

How to look after your mental health

1. Learning to live well with IBD

Coming to terms with your IBD can take some time, and it is very normal to go through a period of adjustment as you acclimatise to your new way of living.

You can explore Living Well to find out more about how to continue as normally as possible and how you can keep yourself well:

  • There are very few quick fixes when it comes to mental health, but regular exercise can help. Moving your body whenever you are able can help you feel better, help you sleep and reduce the intensity of your emotions7
  • Although there is no singular ‘magic bullet’ diet, dietary modification is being explored as a method of managing IBD.8 Explore the practical changes you can make to your nutrition
  • Concerns about drinking alcohol are common among IBD patients. Find information about drinking alcohol with IBD
  • Quitting smoking is one of the best things you can do to improve your health. Explore the association between smoking and your IBD here
2. Talk about your condition

A problem shared is a problem halved. Whether it’s loved ones who want to know how you’re feeling or professionals who have the skills and expertise to work through your emotions, talking to people can be an excellent way to get both emotional and practical support. 

However, many people with IBD, particularly those who have been recently diagnosed, struggle to talk about their condition. In Talking about your IBD, you can find resources to help you get started, and information about what support family and friends can give you.

3. Find a community of people who understand what you’re going through

It can be easy to prioritise your physical symptoms, but it's always important to remember that coping with a long-term condition can have a big impact on your mental health too.

But you are not alone. Crohn’s & Colitis UK supports patients living with IBD and if you’d like to talk, you can use their confidential Helpline Service.

Their team can provide up-to-date, evidence-based information across a range of subjects, including your mental health, to help you:

  • look after your mental wellbeing
  • recognise common mental health conditions
  • get you the help you need

Call the Crohn’s & Colitis UK helpline team on 0300 222 5700, email helpline@crohnsandcolitis.org.uk or use their LiveChat.

You may also want to join the Crohn’s & Colitis UK Forum. This closed-group community on Facebook is for everyone affected by Crohn's or colitis. You can share your experiences and receive support from others.

Visit Crohn’s & Colitis UK Helpline service for more information.

4. Look into other forms of support:
  • Samaritans: If you’re feeling emotionally vulnerable, Samaritans are available to call 24 hours a day, 7 days a week, on 116 123.
  • Mind: If you’re looking for advice and support to empower you or anyone you know experiencing a mental health problem, Mind has lots of resources on their website. Local Mind groups provide mental health services in local communities across England and Wales. You can also call their helpline on 0300 123 3393, 9am to 6pm, Monday to Friday (except for bank holidays) or email info@mind.org.uk.
  • Shout: If you want support via text, text SHOUT to 85258. This is a free 24/7 confidential text service.

If you have thoughts of suicide or harming yourself, tell someone you trust, call the NHS on 111 or go to your nearest A&E.

5. Getting help

It can be difficult to start a conversation about your personal feelings with your GP – someone you may not know – and it can be especially hard when you’re not feeling yourself. But it’s a good first step to getting the support and treatment that might help you.

Here are some things to consider:

  • Be honest
  • Use words and phrases that feel natural to you – there is no ‘wrong’ way to explain your experience – and don’t be afraid to use emotive language
  • Try not to feel as though your problems are unimportant or small – everyone deserves help, and your GP is there to support you. Depression is one of the most common problems your GP will see in their practice.

*IBDrelief patient survey data from 167 respondents with IBD in the UK.3

  1. CCUK. Mental health and wellbeing. https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/living-with-crohns-or-colitis/mental-health-and-wellbeing. Accessed October 2023.
  2. Crohn’s & Colitis Foundation. www.crohnscolitisfoundation.org/mental-health/depression-anxiety. Accessed October 2023.
  3. IBDrelief. Impact of IBD on physical and emotional health: Findings from an IBDrelief survey. Available at www.ibdrelief.com/impact-of-ibd-on-physical-and-emotional-health. Accessed October 2023.
  4. NICE. Depression in adults with a chronic physical health problem: recognition and management [CG91]. https://www.nice.org.uk/guidance/cg91/chapter/Context. Accessed October 2023.
  5. NHS. Symptoms – Clinical depression. https://www.nhs.uk/mental-health/conditions/clinical-depression/. Accessed October 2023.
  6. NHS. Steroids. https://www.nhs.uk/conditions/steroids/. Accessed October 2023.
  7. Sharma A, et al. Exercise for mental health. Prim Care Companion J Clin Psychiatry. 2006;8(2):106.
  8. Zangara MT, et al. Impact of Diet on Inflammatory Bowel Disease Symptoms: An Adolescent Viewpoint. Crohn's & Colitis 360. 2020;2(4):otaa084.

© NICE 2009 Depression in adults with a chronic physical health problem: recognition and management. Available from https://www.nice.org.uk/guidance/cg91/chapter/Context. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.