Why my Mental Health is So Much Worse When Flaring

Mental health is something we're talking a lot about at the moment. Thankfully, we've come some way in banishing the stigma around mental health conditions and have begun to recognize just how much they can impact our lives. Yet still, we rarely discuss this in relation to our disease.

I've always struggled with anxiety to an extent-and wrote about my battle with health anxiety previously. However, I've never thought to really track the patterns of my mental health and whether it's directly related to my disease activity.

That's until I came across a study that looked at the risk of anxiety in IBD patients. It was fascinating to consider that issues like anxiety are more closely linked to our flare-ups than we realized. For example, the study showed that when we're in remission, between 29-35% of IBD patients have anxiety. Yet, when we're flaring, this rises to a huge 80%.¹ That's a huge increase!

Why might our mental health worsen in a flare?

There are many reasons this might be. Of course, flaring is naturally stressful and would increase our risk of anxiety. But other reasons might include...

• Malnutrition from flaring.
• Side effects of steroid medication.
• Changes of gut bacteria (interestingly, we are learning more about the connection between the bacteria and our mental health).
• High levels of inflammation in the body or the body being under stress.

We won't know for certain, but what's more important is that we actually start talking more with our doctors about it! At the moment, when we're flaring, our doctors might talk to us about increasing our nutrition, considering a liquid diet and taking it easy. But very rarely are we asked how we're actually feeling and given support to deal with the emotional side of it all.

Why doctors need to do more

The study notes that it is clear that being able to diagnose and treat anxiety should now be part of medical care for IBD patients.  But also notes that at the moment, doctors have very little training in this area. And herein lies the issue.

Since being diagnosed five years ago, I have definitely become more anxious. At first, this manifested itself as health anxiety after beginning Remicade and worrying about its symptoms. At the time, nobody explained that both the medication I was on and the disease I was battling could be causing the anxiety. I was made to believe it was a separate issue altogether and encouraged to start a course of antidepressants with very little discussion.

I appreciate that doctors might not consider themselves an 'expert' in this every time every time I go to see my doctor, I get asked the same questions. I'm asked to discuss my pain, discuss my bowel movements, discuss my energy levels and discuss my other extraintestinal manifestations. How difficult would it be to asked to discuss my mental health too? To allow my doctor, at the very least, to keep track of this and refer to a relevant specialist.

By making this part of our consultations, it would also send an important message that mental health issues ARE a part of living with Inflammatory Bowel Disease; and that we should treat them as seriously as we would any other symptom. It would encourage patients themselves to take time to monitor their mental health and give them courage to speak out.

The benefits for newly diagnosed patients

This is even more so the case with patients who are newly diagnosed; who can feel extremely overwhelmed and isolated. In fact, I personally believe (mental health issues or not) a session with a therapist or counsellor should be mandatory to help them come to terms with a lifelong diagnosis. This would establish that from the onset, managing mental health with IBD is just as vital as our physical health.

I'd love to hear your thoughts on this-is your mental health connected to your IBD? Have you noticed a pattern? Do you wish you'd been more supported when first diagnosed?