Upstate News

April 25, 1999
Darryl Geddes 315 464-4828

University Hospital physicians look for link between irritable bowel syndrome and depression

Physicians at University Hospital of the State University of New York (SUNY) Health Science Center at Syracuse are surveying patients to determine whether sufferers of irritable bowel syndrome may also experience symptoms of depression and or other psychiatric disorders.

The survey was developed by psychiatrist Prakash S. Masand, M.D. and gastroenterologist David S. Kaplan, M.D. Both are also professors at the SUNY Health Science Center.

“This interview will help diagnose psychiatric disorders that may play a role in gastrointestinal disorders,” Dr. Masand said. “In order to effectively treat the bowel disease, you need to treat the depression.”

The interview evolved from research led by Drs. Masand and Kaplan and others who in a series of published studies found a high rate of irritable bowel syndrome among patients with psychiatric disorders.

Twenty to 60 percent of patients with psychiatric disorders such as panic disorder, major depression, schizophrenia and dysthymia (chronic depression) have the digestive disorder as well. The percentages vary depending on the type of psychiatric disorder.

Furthermore, when looking at the general population without psychiatric disorders, fewer than 5 percent have irritable bowel syndrome. And, when looking at patients who seek treatment for irritable bowel syndrome, 70 percent to 90 percent also have psychiatric disorders, most commonly depression.

Dr. Masand believes that an abnormality of the chemical serotonin may be the link between the two disorders. Many antidepressants boost serotonin, which is directly related to how good a person feels. Serotonin also inhibits gastric secretion and stimulates smooth muscle, necessary for healthy digestion and elimination.

In addition to asking questions regarding personal health, such as whether one smokes or experiences chest pain or constipation, the survey asks patients to say whether they experienced any of 48 different symptoms over the last four weeks. Symptoms include:

  • constant worry
  • fear of losing control
  • frequent crying or weepin
  • frequent thoughts of death or suicide
  • worthless feelings
  • excessive feelings of guilt
  • frequent negative thinking
  • fear of going crazy

“Saying that one experiences any of these symptoms is not a diagnosis that one suffers from a psychiatric disorder, but it is certainly an indication that treatment for only irritable bowel may not be all that is needed,” Dr. Kaplan said.

Symptoms of irritable bowel syndrome include constipation, diarrhea, alternating constipation and diarrhea, abdominal pain relieved by a bowel movement and night waking for a bowel movement.

Symptoms of depression include feelings of sadness, loneliness, despair, low self-esteem and self-reproach along with signs such as loss of appetite, insomnia and withdrawal from social contact.

New treatments like fluvoxamine (Lurox), fluoxetine (Prozac) and citalopram (Celexa) are also being studied to treat symptoms of irritable bowel syndrome.

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