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."

Does Crohn's inflammation worsen depression?

The Link Between Depression and Gastrointestinal Inflammation

Does SAMe reduce Crohn's symptoms?

SAMe:

Why are Crohn's comorbidities important?

"Comorbidity in inflammatory bowel disease" in World J Gastroenterol (2011)

Why is comorbidity important?
Firstly, it is obvious that comorbid conditions cannot be overlooked in a patient with IBD. The existence of comorbidity can significantly change several scenarios of medical practice[2]. (1) Clinical manifestations of IBD and its activity can be altered or confused by associated diseases; (2) Prognosis of IBD will also be influenced; (3) Whenever a patient with significant comorbidity is seen by us, we step outside the realms of medical evidence. As a rule, randomized controlled trials exclude patients with comorbidity, and so their conclusions are not necessarily applicable to such situations; (4) The use of drugs for the treatment of IBD is limited by the increased importance their pharmacologic or collateral effects can have on a person with comorbid conditions; and (5) Frequently, it is more important than ever to set up multidisciplinary teams to empower patient care, or, at least, to assure that channels of collaboration and mutual consultation are as fluid and reliable as possible.
"The comorbid occurrence of other diagnoses in patients with ulcerative colitis and Crohn's disease" in American Journal of Gastroenterology (2001)
"Ulcerative colitis and Crohn's disease showed, in general, similar patterns of comorbidity. Both diseases were associated with similar sets of GI complications, such as intestinal obstruction and stasis, mucosal inflammation and infection, vascular complications, and complications related to fistula and abscess formation. Extraintestinal complications of both IBD involved disorders of the hepatobiliary system, urinary system, and various coagulopathies. Ulcerative colitis alone was found to be associated with Hirschsprung's disease and schizophrenia, whereas Crohn's disease alone was found to be related with osteoporosis and amyloidosis. CONCLUSIONS: No completely unexplained or hitherto undescribed association was revealed. The numerous intestinal and extraintestinal complications associated with IBD serve as a reminder of the systemic nature and the resultant clinical severity of both ulcerative colitis and Crohn's disease."

"Increased Risks of Developing Anxiety and Depression in Young Patients With Crohn's Disease" in Inflammatory Bowel Disease (2011)

"Compared with matched CD-free controls, young patients with CD had significantly greater risks of developing anxiety disorders and depression, were more likely to receive psychotropic treatments, and had significantly greater risks of developing persistent anxiety and depression."

"Increased risk for coronary heart disease, asthma, and connective tissue diseases in inflammatory bowel disease" in Journal of Crohn's and Colitis (2011)
"In addition to many immune-mediated diseases, CHD appeared to be more common in IBD than in control patients, especially in females. The reason is unknown, but chronic inflammation may predispose to atherosclerosis. This finding should encourage more efficacious management of underlying cardiovascular risk factors, and probably also inflammatory activity in IBD."