OCD, Depression, And Irritable Bowel Syndrome

Hello all –

a highly unpleasant, uncomfortable and socially embarrassing co-morbidity (side-disorder) of OCD and depressive illnesses can be: irritable bowel syndrome, or irritable bowel disorder (IBS, and IBD, respectively).

It can be felt as abdominal pressure or even pain, and a constant feeling of gas being relocated (mind: it’s not the same as when your stomach is empty and makes noises). Sometime it feels like breaking wind could help resolve the problems, but that isn’t the case, far from that. Other people may suffer from diarrhoea overmuch and very frequently.

Irritating noises are often a problem in social situations, like in: attending a lecture, or sitting in a full cinema  where a quite silent movie is playing. People with IBD tend to put strain on their abdominal muscles to avoid the noises and the movement of the gas – it’s a kind of reflex that leads to extra stress.

In a previous post, I wrote something on the HPA axis, the hypothalamo-pituitary-adrenal axis, that is overactive in situations of continued stress and may eventually produce depression through a chain of neurobiological events.

Biologists also speak of the brain-gut axis, in stress and depression. There is a complicated link between stress, depression, anxiety, and inflammatory as well as auto-immune events. I already wrote about OCD and the possibility that childhood infections are the ultimate cause of auto-immune reactions against one’s own basal ganglia, which in turn is a hallmark of OCD.

IBD is associated with the so-called ‘leaky gut-syndrome’. The lining of the gut is not as tight and protective as it should be. As a result, antibodies are formed against colonic bacteria. This process causes inflammation, and elevated levels of cytokines (messenger molecules of the immune system) that are harmful in increased quantities.

So: processes that are meant to be protective can become problematic in themselves, just as is the case with that overactive HPA-axis.

What can we learn from this?

  • We pay a price for being enormously complex organisms. Many, many protective systems are at work in us simultaneously. They are in a delicate, fragile balance in healthy persons. When this balance gets disturbed by protective measures against a (possible) threat, very unpleasant side effects may occur.
  • A disturbed balance can elicit a vicious circle. Take IBD. If that plagues you on a daily basis, and hampers your social life, perhaps even makes you nearly housebound, you will no doubt suffer from continuous stress and frustation. In turn, that stress overactivates the HPA-axis. The result can be (extra high) depression. That can lead to the production of more cytokines; which aggravate IBD.
  • We should not perceive our brain as some self-contained system that is some thinking, feeling, and planning unit within our skulls, and is ‘carried around in the world’ by our body. Brain and body are inseparable; and the concept of ‘psychosomatic illnesses’ only gained weight from recent neurobiological research.
  • The preferred medication for OCD and depression nowadays is the ‘specific serotonin reuptake inhibitor’, or SSRI; or a variation thereof (think: Prozac, think: Paroxetine, think: Citalopram). The SSRI significantly reduces IBD. This effect adds to the validity of the models that there are for the brain-gut axis and the HPA-axis. That is because when stress and low mood are relieved, and cytokine levels are restored to normal values, inflammatory processes decrease in activity, and the leaky gut can gain in strength.

Update, 5:02 PM CET: I just found a very intriguing recent observation: left-handed people do suffer from IBD significantly more than do right-handers; and they are later satiated with food. I hope to clarify the implications of these strange correlations at some point in the near future.


4 responses to “OCD, Depression, And Irritable Bowel Syndrome

  1. It is such a relief to see theory and known facts matched to the events I have experienced in recent years. I had assumed that changing my work and home life in an attempt to minimise the stressful situations were the reasons for improvements in the IBS occurences, but taking SSRIs for OCD will also have helped it seems. This combination of medication and reduced anxiety has greatly improved things for me, but both OCD and IBS flare up together during ‘difficult’ days – too coincidental not to be closely linked. Every piece of the jigsaw helps in understanding the brains control.

  2. Hi Daisy –

    thanks for your nice and encouraging comment. It is my experience that most GPs don’t know specifics about the HPA-axis and the brain-gut axis. That is why patients often feel neglected or belittled when they address such intimate and socially embarrassing disorders as IBD.

    OCD and depression, and inflammatory processes such as in the gut area, exert reciprocal (mutually influencing) effects on each other. And if something is not in equilibrium in the brain (as is the case in mood and anxiety disorders), wholly different body systems may get affected too. Which in turn causes additional stress, which stress causes additional depression.

    That is why I emphasized the term ‘psychosomatic illnesses’ here – these are very real. Neurologists and psychiatrists in the days of old (say, the early 20th century) did have an intuitive grasp of this fact, but could not properly schematize it – neuroscience barely existed. That is why they met with skepticism and resistance. All this has thankfully changed.

  3. I am really suffering at night after I fall asleep. I will wake up and automatically feel like I need to have a bowel movement and yet I can’t. it’s very supcetting and depressing. after that I am up and down until I finally give up and get out of bed

    • Hello Susan –

      I am sorry to hear this. If I may ask: what is the nature of your bowel problems? Could you tell me if, and how they express themselves during daytime? And if they are related to a potential amount of stress you experience? I myself had the most trouble in awkward social situations (e.g. in a work & research meeting when I was a student. The more I was afraid of audible movements setting in, the higher the chance was that they actually did set in – this again points to the weird link between our fears and the bodily responses we have.)

      You can contact me in private at: cuthbert.foliott(at)gmail.com.

      Best, Frank.

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