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.