The symptoms of ulcerative colitis can affect mental and physical health, causing distress.

Ulcerative colitis is a chronic inflammatory bowel condition that causes ulceration and inflammation of the lining of the large intestine. Researchers continue to look into the two-way connection between ulcerative colitis and depression and anxiety.

Below, we explore the links between ulcerative colitis and mental health conditions and which strategies and treatments can help.

The gut-brain connection
The link between the gut and the central nervous system is called the gut-brain axis. Gastrointestinal muscle and mucosa are controlled by nerve signals, and the gut likewise communicates back to the central nervous system.

More recently, research has found that the gut microbiome can affect brain signals, activating areas of the brain that regulate emotions.

People with ulcerative colitis are more likely than others to experience anxiety or depression. As one-third of people with inflammatory bowel disease experience symptoms of anxiety, and a quarter experience symptoms of depression.

Concerns about the timing and extent of ulcerative colitis symptoms may be a source of anxiety and stress, and evidence indicates that anxiety and stress can, in turn, cause inflammatory bowel diseases such as ulcerative colitis to flare up.

For this reason, it can be important to receive treatment for the physiological and psychological effects of ulcerative colitis.

The Crohn’s & Colitis Foundation also notes that people with this condition may be more likely than others to:

feel overwhelmed
be “in denial” about the effects on their health
have a poor self-image
have dependent behaviours
In a 2015 study of participants with ulcerative colitis and a mental health disorder, researchers found that mood disorders were more likely to precede ulcerative colitis than the other way around.

In a 2017 study, researchers found that around 30% of people recently diagnosed with an inflammatory bowel disease also experienced anxiety or depression. They recommend that doctors screen and monitor for signs of these conditions.

In a 2012 review, researchers confirmed that both anxiety and depression can worsen ulcerative colitis symptoms. In a study 4 years later, researchers found similar results and noted that people with depression had a greater recurrence of flare-ups.

Exploring the two-way link between the brain and the gut helps health experts understand that addressing mental health conditions can help reduce digestive symptoms of ulcerative colitis.

How to manage depression and anxiety
The Crohn’s & Colitis Foundation highlights two main treatments for depression: cognitive behavioural therapy (CBT) and prescribed antidepressant medication.

CBT involves working with a psychologist to identify harmful or unhelpful thought patterns and behaviours.

People with ulcerative colitis may also benefit from the following ways to ease anxiety and stress:

Other forms of psychotherapy. A psychologist or counsellor can help a person understand the sources of their anxiety and find effective treatment strategies.
Relaxation techniques. Breathing exercises, meditation, yoga, tai chi, and other relaxation techniques interrupt the body’s stress response.
Support groups. Meeting, virtually or in person, with others who face the same mental and physical health issues can help, as can building a network of supportive family members, friends, and healthcare professionals.

How to manage pain and fatigue
Pain and fatigue are common symptoms of ulcerative colitis. They can each cause distress, and a range of strategies and treatments can help.

A doctor’s first approach is to reduce these symptoms by managing the underlying condition. They may also prescribe acetaminophen (Tylenol) to ease the pain. Unlike nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen is not associated with an increased risk of ulcerative colitis flare-ups.

It may also be worth noting that a 2018 systemic review did not find conclusive evidence that NSAIDs increased the risk of flare-ups.

Doctors sometimes prescribe anticonvulsants to ease nerve pain, though there is very limited evidence that these drugs can address the pain when it relates to bowel symptoms.

Doctors also prescribe antidepressants to people with irritable bowel syndrome as an “adjuvant analgesic,” a drug not only intended to relieve pain but used for that purpose.

Meanwhile, fatigue affects 42–47%Trusted Source of people with ulcerative colitis. Treatment to reduce the inflammation can help with fatigue, as can drugs called immunomodulators and amino salicylates.

To manage pain and fatigue, the Crohn’s & Colitis Foundation also recommends:

mind and body exercises, such as yoga and meditation
medical cannabis
physical therapy
light exercise
Coping strategies to improve mental health
To support and enhance mental wellbeing while dealing with ulcerative colitis, a person might try:

eating healthy, nourishing food that does not cause digestive upset
limiting the consumption of alcohol and caffeine
exercising regularly
trying to get plenty of sleep each night
practicing relaxation techniques such as deep breathing exercises or yoga
using supplements, if a doctor recommends it
The following techniques may also help reduce anxiety and depression:

setting achievable goals, by starting small and working up to larger goals
establishing a daily routine
challenging negative thoughts or self-doubts as they arise
accepting that not everything can be controlled
celebrating best efforts, not perfect achievements
learning about and managing triggers
Having social support can also help. People may benefit from:

making time for a fun activity or an enjoyable social interaction each day
taking on new responsibilities, such as by volunteering
talking to a trusted friend or family member or another supportive person
Talking to healthcare professionals
Let a trusted healthcare professional know about any symptoms of depression or anxiety. They may prescribe medication or make a referral to a therapist.

Some general signs and symptoms of depression may include:

finding little or no pleasure in activities that were once enjoyable
having feelings of worthlessness that are excessive
having a consistently low mood
moving or talking more slowly than usual
having less energy than usual
having trouble sitting still
having trouble sleeping
experiencing persistent headaches
having thoughts of suicide or death
Anxiety may manifest as:

numbness or tingling sensations
hot flashes, sweating, shaking, or cold chills
difficulty breathing
discomfort or pain in the chest or throat
nausea or abdominal discomfort
aches and pains
restlessness, irritability, and hypersensitivity
dizziness, light-headedness, or faintness
worrying about death or a loss of control
feeling disconnected from one’s self
difficulty sleeping
Mental health resources
A person can start by speaking with a trusted healthcare professional, who can recommend support groups, psychologists, and other helpful resources.

To find mental health support and resources, a person can also contact the Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-662-HELP (4357).

In addition, the Rome Foundation provides a directory of therapists who specialize in helping people with gastric conditions.

Takeaway
A person with ulcerative colitis may be more likely than others to develop depression, anxiety, or both — and these issues can make ulcerative colitis symptoms worse.

Managing the physical and psychological aspects of the condition can alleviate the symptoms, and there are several effective medical and holistic approaches.

A doctor can provide resources, treatment, and guidance, and trusted family members, friends, and support groups can also help.

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