Is there such a thing as a Crohn's-friendly antidepressant?

My mental health and IBD have always been closely intertwined. Like many people with Crohn's, I worry. I worry that I'm never going to feel well. I worry that when I am well, It's going to be pulled under my feet by a sudden flare. And of course, as a new mom, I worry about my son; whether I can take care of him, how I can do my best for him and even the statistics around passing on my condition.

Anxiety and panicking about my health

Being a mother has made me more determined than ever to get my anxiety under control. I love motherhood but I can still find myself panicking about my health, caught in 'what if...' cycles and worrying about the future; I decided several months ago that along with the counseling I regularly undertake, I would try to tackle things head-on with antidepressants.

Medications and counseling for mental health

And of course, my first google search term was 'anti-depressants and Crohn's' and I was surprised to see that some evidence supports that taking antidepressants could actually be beneficial for IBD.¹ Perhaps because if our mental health is better, our physical health is better? So I can't deny a small part of me was excited to try and tackle my mental health and perhaps unwittingly uncover a solution for my IBD along the way (for some reason, I remain an optimist!). The first few days I felt incredibly tired. But it passed. But what didn't pass is the constant feeling of urgency, frequent toilet trips...even to the point of accidents and stomach pain. 'This can sometimes happen in about 10% of patients,' my GP replied. And, of course, I am always that 10%. Why couldn't I be the 10% that ended up with perfect skin or bundles of energy? It was easy to blame my Crohn's for this but the symptoms seemed to occur within minutes of taking the medication most days and I'd had enough.

Next stop with Sertraline (also called Zoloft). The doctor said this was particularly helpful for postnatal mental health but again might cause stomach issues. 'You just need to try to get through them....' he added. But I'm impatient. I have spent my life trying to get through stomach issues but when my Crohn's is relatively stable, I just don't have the energy for more stomach issues. In fact, I found these worse for GI issues and the pain awful; especially since my IBD doesn't usually cause pain. I lasted two weeks before I gave in. I know I should have tried longer and that my mental health is important, but it was stopping me from leaving the house as my gut was becoming so temperamental.

For a few months, I decided I could cope with counseling alone but recently found that my worrying and checking behaviors (with health anxiety, I check my body for signs of illness) returned. This time it was Mirtazapine (sometimes called Remeron). My doctor said this could cause constipation (music to my ears!) but weight gain which is why he'd left it until last as I was a young female. I know most people are bothered by weight gain but as someone who has always been underweight, other than when pregnant and postpartum, it was low on my priorities and I'm not sure why my doctor didn't ask me about this; rather than assuming because I was a young woman that my weight was my priority. My priority is to feel well and to spend much of the day off the toilet. Could this help?

Nothing ever feels easy with Crohn's disease

I'm on day 5 and I'm not sure. I feel like I've been hit by a truck with fatigue on another scale. I had a few days of going to the toilet only once a day (what sorcery is this?) due to the constipation side of things but whilst this pleasant side effect seems to be departing, the tiredness isn't.

There seem to be lots of suggestions antidepressants can help with IBD, at least, according to my specialist, it can help deal with the strain a chronic condition our mental health has on us. But I feel I already have a condition that causes me to have many side effects AND take medication for my physical health that comes with a bunch more. Do I have the energy to invest in my mental health by adding more side effects to my list? Or do I accept that I am just a worrier and accept that worrying is better than the side effects medication brings? It is a tricky one and like every question that comes with Crohn's disease, nothing ever feels easy.