While there has been a great deal of speculation over the years on the importance of emotional factors in inflammatory bowel disease (IBD), it is only in the last decade or so that studies with stronger designs have been available to clarify the nature of this relationship. This review considers recent evidence on the prevalence of anxiety and depressive disorders in IBD, the role of these disorders as a risk factor for IBD onset, the degree to which they affect the course of the IBD, and the contribution of corticosteroid treatment to psychiatric symptom onset. There is evidence that anxiety and depression are more common in patients with IBD and that the symptoms of these conditions are more severe during periods of active disease. The few studies that address the issue of anxiety and depression as risk factors for IBD do not yet provide enough information to support definite conclusions. There is evidence, however, that the course of the disease is worse in depressed patients. Treatment with corticosteroids can induce mood disorders or other psychiatric symptoms. The second part of the review focuses on patient management issues for those with comorbid anxiety or depression. Practical approaches to screening are discussed, and are recommended for routine use in the IBD clinic, especially during periods of active disease. We review evidence-based pharmacological and psychological treatments for anxiety and depression and discuss practical considerations in treating these conditions in the context of IBD to facilitate overall management of the IBD patient.
1Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
2Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
3University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
*Reprints: University of Manitoba, PZ350 — 771 Bannatyne Ave., Winnipeg, Manitoba, Canada R3E 3N4
Received 8 December 2008; Accepted 12 December 2008
Published online 22 January 2009 in Wiley InterScience (www.interscience.wiley.com).
Grant sponsor: Canadian Institutes of Health Research; Grant sponsor: Crohn's and Colitis Foundation of Canada Research Scientist Award.
Conflicts of interest: Lesley Graff, none; John Walker, none; Charles Bernstein: in this past year served on the advisory boards of Axcan Pharma, Abbott Pharmaceuticals Canada, Shire Pharmaceuticals Canada, and has received research support from UCB Canada.