Irritable bowel syndrome (IBS) and depression
The discomfort, inconvenience and pain from IBS can also affect a person's mental health, with around three out of four people with IBS experiencing depression at some stage, and half having the unease and worry of generalised anxiety disorder or GAD.
Depression can also play a part in worsening of IBS symptoms.
How IBS and depression work together
Some people are so worried that their IBS symptoms will flare up that they avoid going to going to work, school or social functions. This fear may make them physically withdraw from social life. They may lose interest in activities they once enjoyed. They may feel restless or irritable. All these are symptoms of depression.
Or, the feeling of despair caused by depression may influence the way people cope with their IBS. They may feel too tired or hopeless to bother changing their diet to ease IBS symptoms. In the dark cloud of depression, people may think they can't treat IBS-related constipation or diarrhoea effectively.
People with IBS also seem to be more sensitive to emotional stress. People who are stressed often are also more aware of pain and discomfort. IBS with depression can be a frustrating, often painful cycle.
Breaking the IBS, depression cycle with treatment
Antidepressants are used to treat both depression and the symptoms of IBS.
Antidepressants may be prescribed to help reduce abdominal pain and cramping associated with IBS.
However, they're used in different ways for each condition, so it's important talk with your doctor to establish if you are depressed.
Treating depression when you have IBS
Some antidepressants can worsen certain IBS symptoms, so it's important to get the right medication for your symptoms.
Older antidepressants (called the tricyclic antidepressants mentioned above) can cause constipation, along with drowsiness and dry mouth. If you suffer IBS-related constipation, these may not be right for you.
Newer antidepressants (called selective serotonin reuptake inhibitors, or SSRIs) can cause diarrhoea, along with loss of appetite and nausea. If you suffer IBS-related diarrhoea, these may not be right for you.
Make sure you tell your doctor whether you have IBS-related constipation or diarrhoea before deciding on a treatment for depression.
Turning to talk therapy for depression
Traditional psychotherapy and cognitive behavioural therapy (CBT) may also help with depression. Traditional psychotherapy involves talking with a therapist to work out conflicts and understand your feelings.
People who are particularly stressed may benefit from stress counselling or cognitive behavioural therapy. This therapy teaches people how to recognise negative and distorted thoughts and replace them with positive, more realistic thoughts.
One caveat: some studies have found that while behavioural therapy eased many IBS symptoms, it had no effect on constipation or frequent stomach aches.
Other treatment options
Along with medical treatment or therapy, there are many other steps you can take to help ease depression if you have IBS. Some people find that stress management techniques help them cope with life better. Regular exercise helps some people recover from depression. So does a good diet for IBS, getting enough sleep, and taking time to do something enjoyable each day.
The NHS also suggests relaxation techniques, such as meditation, breathing exercises, yoga or Tai Chi.
Finding an organisation to help with IBS or help with depression may be beneficial.