Anxiety and Depression in Irritable Bowel Syndrome

Banerjee, Arko; Sarkhel, Sujit; Sarkar, Rajib; Dhali, Gopal Krishna

doi:10.4103/ijpsym.ijpsym_46_17

Cited by 55 publications

(38 citation statements)

References 24 publications

(32 reference statements)

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“…We choose a clinical sample because it maximizes the prevalence of depression. Although the DSM criteria do not require distinguishing between clinical and non-clinical populations, it is possible to speculate that specific clinical problems may bias both the Hamilton Depression Rating Scale (e.g., irritable bowel syndrome) ( 69 , 70 ) and the DSM-5 criteria (e.g., fibromyalgia) ( 71 , 72 ). In addition, the study was done from a sample in Brazil, and some cultural factors could influence the symptoms.…”

Section: Discussionmentioning

confidence: 99%

DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

2018

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Background: Depression diagnosis requires five or more symptoms (Diagnostic and Statistical Manual of Mental Disorders-DSM-5). One of them must be either Depressed mood or Anhedonia, named main criteria. Although the secondary symptoms can be divided into somatic and non-somatic clusters, the DSM-5 identify depression in all or none fashion. In contrast, depression severity is a continuous variable. Therefore, it is commonly assessed with scales such as the Hamilton Depression Rating Scale (HAMD). Previously, we reported that patients with moderate depression (MD) exhibit greater impairments in cardiac-autonomic modulation than severely depressed (SD) patients. However, clinicians usually do not use scales.Objective: To verify whether the DSM-5 symptoms would be able to discriminate SD from MD and MD from non-depressed (ND) subjects.Material and Methods: Depression was diagnosed based on the Structured Clinical Interview for DSM-5® Disorders. The HAMD evaluated depression severity. In depressed subjects, MD and SD were defined considering the HAMD scores. ND was defined considering both the absence of DSM-5 criteria for depression and the HAMD score. Among 782 outpatients, 46 SD were found. MD and ND subjects were randomly sampled to match the demographic variables of the SD group.Results: Discriminant analysis showed that Depressed Mood was the most reliable symptom to discriminate ND from MD. Anhedonia discriminated SD from MD. Among the secondary DSM-5 criteria, the somatic cluster discriminated ND from MD and the non-somatic cluster SD from MD patients.Discussion: The presence of the somatic cluster in MD may indicate decreased vagal tone and/or increased sympathetic tone, leading to higher cardiovascular risk. As SD is associated with the non-somatic cluster, these patients are at risk of committing suicide. The DSM-5 symptoms exhibited by the patient may help the choice of adequate pharmacological treatment. This would avoid the use of antidepressants that unnecessarily increase cardiac risk in MD. When the symptom cluster suggests SD, the treatment must focus on the prevention of suicide.Conclusions: Depression severity may be inferred based on the DSM-5 criteria. The presence of the Anhedonia main criterium accompanied by non-somatic criteria indicate SD. The Depressive Mood criterium followed by somatic criteria suggest MD.

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Section: Discussionmentioning

confidence: 99%

DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

2018

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“…[89][90][91] Psychological distress, here defined as the presence of anxiety or depression, is common in IBS. 22,40,41,68 Patients with concurrent anxiety and depression, have more severe symptoms from the GI tract, [92][93][94][95] and visceral hypersensitivity is common. 37,[96][97][98] Psychological distress in IBS is associated with the severity of somatic symptoms, 69,99 lower quality of life, 95,100 and alterations in ANS function, 101 colonic motility, 102,103 and immune function, 104,105 as well as changes in the composition of gut flora.…”

Section: Psychological Factorsmentioning

confidence: 99%

Cumulative Effect of Psychological Alterations on Gastrointestinal Symptom Severity in Irritable Bowel Syndrome

et al. 2020

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Irritable bowel syndrome (IBS) is a common and multifactorial functional gastrointestinal (GI) disorder characterized by altered gut-brain communication. Due to the complexity of gut-brain interactions, the aim of this thesis was to enhance the understanding of associations between GI symptom severity and measures from multiple levels along the gut-brain axis in IBS patients.In this thesis, various indications of altered gut-brain interactions were demonstrated: I. IBS patients with anxiety or depression reported more severe GI and non-GI symptoms than patients without psychological distress. Visceral hypersensitivity, aberrant function of the autonomic nervous system, GI-specific anxiety, and non-GI somatic symptoms differentiated between patients with and without psychological distress. II. Overall, modest associations were discovered among neurophysiological factors, and between neurophysiological factors and the severity of IBS symptoms. The most important combination of neurophysiology measures for GI symptom severity in IBS patients were extracted through a computerized method and were found to be visceral hypersensitivity and psychological distress. III. Alterations in a wide range of psychological measures were common in IBS. A strong cumulative effect of psychological alterations on the severity of GI symptoms was found. IV. Central sensitization was frequent in IBS patients, but the severity of central sensitization and GI symptoms were only modestly associated in IBS, suggesting that the presence, rather than the level, of central sensitization is of importance for GI symptoms in IBS.In conclusion, the results from this thesis support the current view of IBS being a disorder of gut-brain interaction, where both peripheral and central factors contribute to this multifactorial disease. Complex associations between psychological and neurophysiology measures, and the severity of GI symptoms were demonstrated in the studies included in this thesis.

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“…This persistent low-grade inflammation sends detrimental signals to the brain and adversely affects intestinal physiology [ 4 ]. Traumatic stress, such as early maternal separation, is also associated with development of IBS [ 5 ]. Subjects with IBS exhibit higher depression and anxiety levels compared to those without; 30%–40% of patients with IBS have depression or anxiety disorder as comorbidities [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of red ginseng on gut, microbiota, and brain in a mouse model of post-infectious irritable bowel syndrome

Chun

et al. 2021

Journal of Ginseng Research

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Background Irritable bowel syndrome (IBS), the most common functional gastrointestinal disorder, is characterized by chronic abdominal pain and bowel habit changes. Although diverse complicated etiologies are involved in its pathogenesis, a dysregulated gut–brain axis may be an important factor. Red ginseng (RG), a traditional herbal medicine, is proven to have anti-inflammatory effects and improve brain function; however, these effects have not been investigated in IBS. Methods Three-day intracolonic zymosan injections were used to induce post-infectious human IBS-like symptoms in mice. The animals were randomized to receive either phosphate-buffered saline (CG) or RG (30/100/300 mg/kg) for 10 days. Amitriptyline and sulfasalazine were used as positive controls. Macroscopic scoring was performed on day 4. Visceral pain and anxiety-like behaviors were assessed by colorectal distension and elevated plus maze and open field tests, respectively, on day 10. Next-generation sequencing of gut microbiota was performed, and biomarkers involved in gut–brain axis responses were analyzed. Results Compared to CG, RG significantly decreased the macroscopic score, frequency of visceral pain, and anxiety-like behavior in the IBS mice. These effects were comparable to those after sulfasalazine and amitriptyline treatments. Moreover, RG significantly increased the proliferation of beneficial microbes, including Lactobacillus johnsonii , Lactobacillus reuteri , and Parabacteroides goldsteinii . RG significantly suppressed expression of IL-1β and c-fos in the gut and prefrontal cortex, respectively. Further, it restored the plasma levels of corticosterone to within the normal range, accompanied by an increase in adrenocorticotropic hormone. Conclusion RG may be a potential therapeutic option for the management of human IBS.

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Anxiety and Depression in Irritable Bowel Syndrome

Cited by 55 publications

References 24 publications

DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

Cumulative Effect of Psychological Alterations on Gastrointestinal Symptom Severity in Irritable Bowel Syndrome

Effects of red ginseng on gut, microbiota, and brain in a mouse model of post-infectious irritable bowel syndrome

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