Does depression and stress worsen Crohn's Disease?

"Brain-Gut Interaction in Inflammatory Bowel Diseases" in Gastroenterology (2012)
"Increasingly knowledge gained from animal models exploring the brain-gut axis has provided potential insight into the management of human IBD. Depression and stress may both result from active IBD but may also play a role in triggering or magnifying symptoms in patients with IBD. The important symptoms of pain and fatigue, frequently reported by patients with IBD (163) are impacted by a patient’s mental health. Completely abrogating the inflammatory state may not eliminate these symptoms (164,165). The placebo response in IBD is further evidence that IBD can be modulated by the patient’s perception of events external to their intrinsic disease (166-168). While a number of factors may contribute to the placebo response in IBD treatment trials, the potential of the subjects’ own expectations and response to the practitioner underscores the importance of cognition and patient experience in effecting clinical responses. In the past 15 years there has been a successful emergence of treatment strategies impacting on immune mediators such as TNF-α and α4 related integrins that direct lymphocyte trafficking. The next decade will see the emergence of other therapies that will modulate other effector mechanisms of immunoinflammation. Therapies that modulate neural control of inflammation and mental health (which may impact on both psychoneural inflammation as well as well symptom perception) should not be overlooked. While these newer therapies are developed and studied there remains a need to study older available and often cheaper therapies. Rigorous studies of antidepressant pharmacotherapies as well as behavioural therapies are warranted. Since not all instances of active symptoms are accompanied by objective measures of inflammation in IBD, an assessment of both the antiinflammatory effects as well as the symptom reduction effects is warranted. There are groups around the world that have incorporated biopsychosocial approaches to IBD management already (108,169). We anticipate that these approaches will become standards of care as emerging evidence solidifies the importance of the brain-gut axis in orchestrating the inflammation and symptoms of IBD."