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Depression and Celiac Disease

 

What is Depression?
Depression is a treatable medical illness marked by changes in mood, thought and behavior. It is not a character flaw or a sign of personal weakness. It is more than just feeling "down in the dumps" or "blue" for a few days, as these feelings persist and interfere with everyday life. The difference between "normal" feelings of sadness and the feelings caused by clinical depression are mainly:

  • How intense the mood is
  • How long the mood lasts
  • How much it interferes with daily life

Depression can run in families and a person can have an episode of depression at any age. In addition, depression is estimated to affect more than 21% of women , making it twice as common in women as in men.

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Celiac Disease and Depression
According to various studies, there is a possible linkage between brain functions and malabsorption.

  • One study conducted by Addolorato et al., reported that depression was present in a higher percentage of celiac patients. They found that one year of gluten-free diet failed significantly to affect depressive symptoms. The presence of depression after introduction of the gluten-free diet could be related to the reduction in quality of life in celiac patients. The non-regression of depression after introducing the diet could suggest that these patients need psychological support.
  • Another study found that celiac disease increased a patient's risk of subsequent depression. Moreover, patients with celiac disease were 1.8 times as likely to develop subsequent depression as those without the gastrointestinal disorder. Also, prior depression increased the risk of celiac disease at odds ratios of 2.3. The investigators suggested, in the Journal of Affective Disorders, that this increased risk might be due to increased screening for the condition among patients with mood disorder compared to healthy individuals.
  • Ludvigsson and colleagues suggested that the positive association between celiac disease and subsequent depression might be due to "malnutrition or active bowel inflammation in individuals with celiac disease." For example, folate deficiency is implicated in both celiac disease and depression. The team noted that red cell folate levels were significantly lower in people with depression than those with bipolar disorder, potentially explaining why celiac disease is associated with subsequent depression but not bipolar disorder. Tryptophan levels, which were reduced in patients with celiac disease and those with depression, might also explain the association between the conditions.
  • According to Mayo Clinic psychiatrist Daniel Hall-Flavin, M.D., doctors have long known of the relationship between low levels of vitamin B-12 and depression. Vitamin B-12 and other B vitamins, such as folate, play a role in the production of certain neurotransmitters, which are important in regulating mood and other brain functions. However, it is less clear whether vitamin B-12 deficiency may be the cause or the result of depression. Poor nutrition is one cause of vitamin B-12 deficiency. But poor nutrition may also be a consequence of depression. People who are depressed may lose interest in eating or make less healthy food choices, which may lead to vitamin B-12 deficiency.

Some studies attribute the relationship between celiac disease and depression to the psychological weight of having a chronic disease with a restrictive diet, sudden lifestyle changes or dietary compliance. Moreover, poor absorption of vitamins and minerals can make the celiac disease patient feel sick and depression can be a side effect of not having an adequate balance of nutrients. All these factors can affect mood and emotions. For some patients following a strict gluten-free diet is sufficient, while for others, counseling, psychological support and pharmacological treatment is helpful.

Causes of Depression
A combination of genetic, psychological, and environmental factors can cause depression. The cells of the brain, also known as neurons, communicate with each other using special chemical compounds called “neurotransmitters.” When someone is depressed, there is a chemical imbalance in the neurotransmitters. Since the brain controls the whole body, people with depression may also have aches and pains that cannot be linked to any other condition. The direct causes of the illness are unclear, however it is known that body chemistry can bring on a depressive disorder, due to experiencing a traumatic event, hormonal changes, altered health habits, the presence of another illness or substance abuse.

Types of Depression

  • Major depressive disorder: People who have a major depressive disorder have had at least one major depressive episode (five or more symptoms for at least a two-week period). For some people, this disorder is recurrent, which means they may experience episodes once a month, once a year or several times throughout their lives.
  • Dysthymia: A low-level state of depressed mood that last for more than two years in adults (or one year in children) and a person has not been symptom-free for more than two months at a time. The depressed state of dysthymia is not as severe as with major depression, but can be just as disabling.
  • Postpartum depression is a type of depression that affects 10-15% of all new mothers.

A particular form of depression called seasonal affective disorder (SAD) is caused by seasonal shifts in daylight hours.

What are the symptoms of depression?

  • Prolonged sadness or unexplained crying
  • Significant changes in appetite and sleep patterns
  • Irritability, anger, worry, agitation, anxiety
  • Indifference
  • Loss of energy, persistent lethargy
  • Feelings of guilt, worthlessness
  • Inability to concentrate, indecisiveness
  • Inability to take pleasure in former interests, social withdrawal
  • Unexplained aches and pains
  • Thoughts of death or suicide

Treatment
When talking to your doctor about depression, keep in mind that it's important for him or her to address any underlying physical conditions — such as vitamin B-12 deficiency, thyroid disease or certain types of anemia — that may be contributing to depression. Treatment of these underlying conditions may improve depression. However, if depression persists after successful treatment of the underlying condition, your doctor may recommend treatment that specifically targets your depression, such as antidepressants or psychotherapy.

References

  • Addolorato G, et al. Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive illness? Hepatogastroenterology. 1996 Nov-Dec; 43(12):1513-7
  • Addolorato G. et al.  Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scandinavian Journal of Gastroenterology. 36(5):502-6, 2001 May.
  • Depression and Bipolar Support Alliance.
  • Fera T. et al. Affective disorders and quality of life in adult coeliac disease patients on a gluten-free diet. European Journal of Gastroenterology & Hepatology. 2003 Dec; 15(12):1287-92.
  • MedLine Plus

Do you or a family member suffer from this disease? You may have celiac disease, find ouy now, take our celiac disease symptoms checklist.

 

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