Chronic Illness & Anxiety: A Chicken & Egg Scenario

Anxiety and depression are prevalent for those who suffer from chronic illness. In fact, one study found that 40% of Inflammatory Bowel Disease (IBD) patients had abnormal anxiety levels and this drastically increases to 80% when the patient is in a flare-up . With chronic illness typically, there is a feeling of loss of control over your own life which can in turn cause stress, anxiety and depression.

Chicken or Egg?

I was diagnosed with IBD 9 years ago and while I have learned to (mostly) manage the symptoms of my disease over time, I have yet to master the feelings of worry and anxiety. After having a bowel resection surgery, I have been in clinical remission but not without its bumps along the way. The fear of the unknown can do a number on one’s mental health. The possibility of a flare-up always lives in the back of my mind. I can remember the countless visits to the hospital, procedures, medications, and extreme pain. I was barely able to take care of myself, and now that I have children, I worry that if I were to have a flare-up, I wouldn’t be able to take care of them or participate in their lives in a meaningful way.

I know that having a chronic illness has increased my anxiety levels, but does stress and anxiety exasperate my symptoms? Research shows that stress can worsen symptoms and cause a relapse of remission. From WebMD “When someone is under stress, the body gears up for a fight-or-flight response by secreting certain hormones, including adrenalin, as well as molecules called cytokines. They stimulate the immune system, which triggers inflammation. In people whose ulcerative colitis is in remission, this sets the stage for the return of their symptoms, known as a flare-up.” This is something I’ve experienced and heard from talking to fellow chronic illness sufferers. Lack of quality sleep and environmental stressors have often caused a revival of symptoms which can be a slippery slope to a full-on flare.

Anxiety definition (from Merriam-Webster):
an abnormal and overwhelming sense of apprehension and fear often marked by physical signs (such as tension, sweating, and increased pulse rate), by doubt concerning the reality and nature of the threat, and by self-doubt about one’s capacity to cope with it.

Stress definition (from Merriam-Webster):
constraining force or influence: such a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
Anxiety = Fear

When speaking about Generalized Anxiety Disorder it is often associated with people who have irrational fears or worry for no reason. When talking about sufferers from chronic illness, often the anxiety is derived from perceived AND real fears. From my experience, my anxiety stems from a fear of a past trauma reoccurring. Fear of pain, a flare-up, of being out with no access to bathrooms. Fear of foods and eating, procedures, fear of damage caused by long term use of medications (i.e. Remicade can cause an increase in cancer). Fear of missing work, fear that people don’t understand, fear of drug/procedure costs and benefits coverage. This can be scary stuff and can plague your thoughts even when in remission.

From diagnosis to remission the fear still exists, it just changes in size and scope. A newly diagnosed patient can go through stages of grieving and without having the tools to manage the illness it can be very scary. Fast forward to remission, chronic illness has many layers and can be unpredictable. No matter how much you’ve done to manage your illness, there is still a possibility you can have a relapse. The feeling of helplessness can trigger depression, but on the flip-side depression can slow recovery. This begets a vicious cycle which can be hard to get under control.

Coping Physically and Mentally

Patients must cope with not just the disease itself but the mental health side effects of it. While I believe I’ve received excellent care from my Gastroenterologist, he deals with only clinical IBD symptoms so often the mental health aspect of the disease gets overlooked. It is important to bring up your emotional health to your doctor when suffering from a chronic illness despite the perceived stigma. Having that aspect under control could potentially help with physical symptoms. Anxiety and chronic illness can be a chicken and egg scenario where consideration must be given to both to have a holistic treatment plan.

Strategies for Coping With Anxiety:

Find your support: whether that be a close friend, family member, a fellow patient, or support group like Lyfebulb, knowing you aren’t in this alone makes a world of difference.

Don’t assume the worst: challenge those negative thoughts! Remember that you have survived thus far, and all those experiences make you stronger.

Try yoga, meditation, or deep-breathing:  Research has shown this to be an effective complementary therapy for patients with IBD.

Seek counseling – an impartial third party can help instill coping techniques

SOURCES: [Sharma P, Poojary G, Dwivedi SN, Deepak KK. Effect of Yoga-Based Intervention in Patients with Inflammatory Bowel Disease. Int J Yoga Therap. 2015;25(1):101-12. doi: 10.17761/1531-2054-25.1.101. ]
Cannabis is an increasingly popular therapy for IBD with cannabidiol (CBD) showing promise as an anti-inflammatory and tetrahydrocannabinol (THC) as a pain reducer and sleep-aid. [Ahmed W, Katz S. Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2016;12(11):668-679.]

– Krystal Laferriere, Lyfebulb Ambassador (Instagram @xtra_ordinary_girl )

Diabetes and Depression

Diabetes and depression is a topic I feel strongly about, but also one that is not easy to discuss. Many people with diabetes and relatives to those with diabetes do not want to acknowledge the psychological issues one can have when living with diabetes. These issues are not only related to the fact that diabetes is a chronic disease, that one has to inject insulin to survive, and that one has to modify diet, exercise, relationships etc etc.

In fact, John McManamy, author of “Living well with depression and bipolar disorder” says that a Kaiser Permanente study of some 1,680 subjects found that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84% of people with diabetes reported a higher rate of earlier depressive episodes. He goes on to say that a 2004 Johns Hopkins study tracking 11,615 initially non-diabetic adults aged 48–67 over six years found that ‘depressive symptoms predicted incident Type 2 diabetes. Women, in particular are at greater risk, according to other studies; and another study shows that this risk, among both men and women, persists even after controlling weight, caloric intake, smoking, and economic factors.

It has clearly been shown that depression is higher in people living with diabetes, and that this differs from other chronic disease. It is also clear that the depressive tendencies people struggle with are exacerbated by volatility in blood sugar, and can be reduced when control is improved. I recognize this, since I know that when I was “high” I felt tired, lethargic and often hopeless. This would lead to thoughts not moving fast enough, and frustration with my own capacity as a thinker. I would be sad about small things and be emotional about events that otherwise did not bother me. The worst part of depression triggered by blood sugar volatility is the feeling of loss of control and the vicious circle triggering poor management of diabetes which makes both the physical problems and the psychological issues worse!

My recommendation is as always to try to stay in control and when you do slip, ask for help! Being alone with your disease is the worst, and the concept of peer-to-peer mentoring helps, especially with more emotional issues than with medical and physical details. It is hard for a doctor or a nurse to understand the sense of hopelessness, fear of complications and the loss of control that we feel at times when living with diabetes. This is when a friend who also has the disease can help you tremendously by bringing you up in your mood, and down from the rollercoaster of sugar.

My other piece of advice is to reduce the simple carbs in your diet– it really helps you control the volatility. As you may have seen in children without diabetes, their mood is seriously affected by high sugar meals, and the subsequent crash is hard on parents and caretakers.

Lastly, exercise creates a natural surge in anti-depressive hormones such as serotonin and endorphins so adding exercise to your daily regimen will reduce the risk of depression.

I had a pancreas transplant in 2010, and since then my HbA1c has been normal with few glucose excursions. My mood and my energy levels have improved dramatically, but yet, when I eat a carb-loaded meal (rarely!) I do feel a high in the beginning, but then I dip and I lose my mojo. I feel lost and without control. I may have solved the sugar highs, but I am still vulnerable to lows in sugar and that is still my trigger for also feeling low in my mood.

Sugar is evil and I hope that in the future children will not be fed high-sugar meals and handed candy as rewards – it kills, mutilates and makes you sad!

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