Mental health problems also commonly overlap with ulcerative colitis, although it’s less clear that they develop as a direct result of the disease. Instead, many people may be somehow predisposed to both conditions. But there’s no question that living with ulcerative colitis brings challenges that can lead to negative thoughts, which may exacerbate symptoms of depression or anxiety in people with these conditions. It’s important to note, though, that there’s no evidence showing that stress, tension, or anxiety causes ulcerative colitis. But these factors can have a major impact on how you experience and cope with the disease, notes the Crohn’s and Colitis Foundation.

How Common Are Mental Health Issues With Ulcerative Colitis?

It’s difficult to know exactly how common mental health issues are in people with ulcerative colitis. Some people with ulcerative colitis may not report psychological stress to their doctors, since they assume it’s a normal part of the illness or don’t want to show weakness. Even when psychological issues are reported, this may not lead to a definitive diagnosis of anxiety or depression. But a few studies have tried to estimate the prevalence of mental disorders in ulcerative colitis. According to an article published in October 2017 in the Canadian Journal of Gastroenterology and Hepatology, the rate of anxiety and depression in patients with inflammatory bowel disease (IBD) may be as high as 21 percent and 26 percent, respectively. In another study, published in 2015 in the Permanente Journal, researchers found that 82 percent of people with ulcerative colitis were also diagnosed with a mental disorder, compared with 54 percent of the general study population. These disorders were more likely to be diagnosed before ulcerative colitis than after it, especially in women. Not everyone with ulcerative colitis has the same risk of mental health issues. According to a study published in the journal Inflammatory Bowel Diseases, factors associated with anxiety in ulcerative colitis include:

Severe diseaseActive flaresNot taking treatment as prescribedBeing disabled or unemployedHaving a low income

Factors associated with depression include:

Older ageActive flaresBeing disabled or unemployedHaving a low income

A 2020 study published in the journal Quality of Life Research looked specifically at the mental health of teens and young adults ages 14 to 25 living with IBD. The results showed more severe disease was linked to poorer mental health. In addition, feelings of embarrassment about their condition increased the risk of depression, anxiety, and loneliness.

How Mental Health and Ulcerative Colitis Interact

The links between ulcerative colitis and mental health disorders are complex, with each potentially having an impact on the other in several different ways. A study published in May 2019 in the Journal of Clinical Medicine found that the risk of depression and anxiety increases after a diagnosis of IBD. Living with a chronic disease comes with many challenges, and in some people with ulcerative colitis, being diagnosed can bring about feelings of frustration or sadness, and cause them to become withdrawn. Other people may be worried about specific aspects of the condition, such as having bouts of gas, diarrhea, or pain in a social situation or public place. This can directly bring about anxiety or lead them to become isolated, which may in turn cause feelings of loneliness and despair and contribute to depression. But as noted in a review paper published in the journal Gastroenterology Research and Practice, there’s evidence that both depression and anxiety are more common in people who later develop ulcerative colitis than in the general population. This link seems to be strongest when the mental health conditions are diagnosed only a short time before ulcerative colitis. These findings suggest that both mental health disorders and ulcerative colitis may have common risk factors, and that depression and anxiety may even contribute to ulcerative colitis. The risk of anxiety also rises after a diagnosis of ulcerative colitis, though, which indicates that, in many people, the disease may contribute to anxiety. It’s not just your risk of developing ulcerative colitis that may be affected by depression and anxiety. In a study published in June 2016 in the journal Clinical Gastroenterology and Hepatology, researchers found that depression was associated with a greater incidence of flares in ulcerative colitis. Anxiety was also associated with less time between flares, along with greater use of steroids in people with ulcerative colitis.

There are a number of potential scientific explanations for the links seen between ulcerative colitis and mental health disorders. Psychological stress has been shown to increase the permeability of the intestines — how easy it is for nutrients and other particles to pass through. This can reduce the effectiveness of the mucosal lining as a barrier to various harmful substances. There’s also evidence that stress can change the activity of cytokines, molecules in the immune system that may play a role in the onset of ulcerative colitis and its associated inflammation. Inflammatory cytokines may also play a role in the onset of mental health issues, contributing to anxiety when their levels go up due to intestinal inflammation, according to a review published in March 2015 in Clinical and Experimental Gastroenterology. A 2017 case study shed some further light on the connection among inflammation, UC, and mental health disorders. The paper documents the case of a 56-year-old man with a history of major depressive disorder. Doctors treated him with antidepressants, but he saw no improvement in his symptoms. Later, the patient was diagnosed with ulcerative colitis and received treatment to reduce inflammation. Subsequently, his mood improved and he had fewer thoughts of suicide. Additionally, taking steroids to treat symptoms of ulcerative colitis can also have psychological effects, contributing to feelings of stress and anxiety. Finally, anxiety can result in stronger perception of symptoms of ulcerative colitis — which can, in turn, further increase psychological distress.

Recognizing and Treating Mental Health Issues

The following symptoms can indicate anxiety and depression in people with ulcerative colitis:

A spell of sudden fear or panicFrequent nerves or anxious feelings for six monthsFeeling anxious or uncomfortable around other peopleRecurring dreams or nightmares about traumatic eventsAvoiding reminders of traumatic eventsFeeling down, hopeless, or uninterested in doing things for two weeks

If you experience any of these symptoms, it’s important to discuss them with your primary care doctor or gastroenterologist. According to the Crohn’s and Colitis Foundation, not everyone with a negative emotional response to ulcerative colitis will require a psychiatric consultation. Healthcare professionals that you already see may be able to provide the emotional support you need. But if you’re experiencing severe emotional difficulties or feel like you need to try new ways to cope with the disease, you may benefit from seeing a psychologist or psychiatrist. It’s important to find a therapist who is familiar with ulcerative colitis, since it’s helpful to know about the disease’s symptoms, complications, and drug treatments when deciding how to address mental health issues. Your gastroenterologist or primary care doctor can help you find the right therapist based on your symptoms and the type of treatment you’re looking for. Treatments that you may decide to try with your therapist include:

Psychotherapy (talk therapy)Relaxation trainingMedication

Additional reporting by Ashley Welch.