Not a week goes by where we don’t hear from someone about gastrointestinal issues and chronic pain along with substance abuse, anxiety or depression. Over time, it has become clear that the connection between mental health and gut health is solid.
ENS and CNS – The ties that bind
The intricate ties between the brain and the gut have been well established. The enteric nervous system (ENS), beginning with the esophagus and traveling the entire length of the GI system, uses the same type of neurons and neurotransmitters as the central nervous system (CNS.) Because of this close connection, many experts refer to the gut as a “second brain.”
This “second brain” – in concert with the brain in our head – plays an important role both in our bodies and in our mental health. Researchers studying depressive and other neuro conditions are beginning to look at what is happening in a person’s gut. Likewise, researchers who are investigating GI conditions are now looking into brain function as part of their research.
In addition, we know that there is a significant connection between the ENS and behavioral response to addictive drugs. Drugs have an impact on the gut microbiome, and the microbiome in turn affects behavioral response. Additionally, we know that anxiety and depression are frequently co-occurring with drug use. For these reasons, gut health is emerging as an important factor to consider when dealing with substance use disorders.
Physical Symptoms, Mental Health Issues
When someone is suffering from GI complaints, but there is no medical explanation, it is called “Functional GI Symptoms.” This doesn’t mean the symptoms aren’t real – it means the answer lies beyond a medical cause.
It is well known that there are several types of stomach problems associated with anxiety. These include:
- Indigestion (even on an empty stomach)
- Gas and bloating
- Stomach pain
Numerous studies show a correlation between anxiety, depression, and functional GI symptoms. Studies have shown that people with at least one GI symptom are more likely to have anxiety and depression than those who do not suffer from GI symptoms.
In addition to the stomach problems listed above, other unexplained physical complaints can be associated with anxiety and depression. Fatigue, headache, dizziness, and musculoskeletal pains are are more commonly reported in those with anxiety and/or depression.
The two most common conditions known to be related to anxiety are Irritable Bowel Syndrome (IBS) and Gastroesophageal reflux disease (GERD.) Anyone diagnosed with either of these conditions, or those with Functional GI symptoms, can benefit from working with a behavioral health specialist along with their doctor.
Severe GI symptoms need a medical evaluation
Even with known anxiety, any severe symptoms should be evaluated by your doctor. Dangerous symptoms requiring evaluation include:
- Blood in stool
- Feeling bloated or full after eating very little
- Black, tarry, and foul-smelling bowel movements
- Persistent low-grade fever
- Unexplained weight loss
Immediate care is required with the following symptoms:
- Chest, neck, shoulder, or jaw pain
- Disorientation or confusion
- High fever
- Inability to have a bowel movement
- Moderate to severe rectal bleeding
- Significantly increased OR decreased heart rate
- Severe abdominal pain
- Severe diarrhea lasting more than one day
- Vomiting blood (this may look like ground coffee)
What to do
Once medical issues are ruled out and symptoms are determined to be related to anxiety and/or depression, there are many effective treatments available. The best approach is to treat the anxiety/depression at the same time as treating the GI symptoms. Medication can be helpful for both and you should discuss the possibility with your providers. Therapy can help you to develop healthy ways of dealing with stress and anxiety.
Anxiety is treatable – Depression is treatable – Substance use disorder is treatable. No one should suffer unnecessarily. If you or a loved one is struggling with any of this, there is help available.