This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Researchers analysed the impact of treatments for depression, anxiety and distress (including talking therapy, antidepressants, and exercise) on inflammation levels in people with inflammatory bowel disease (IBD).
They found that:
- overall, interventions to improve mood also reduced inflammation
- psychological therapies reduced inflammation more than antidepressants or exercise.
The researchers suggest that talking therapies could improve the physical and mental health of people with IBD.
For more information on IBD, visit the NHS website.
Do mood interventions reduce inflammation in people with IBD?
More than 500,000 people in the UK have an inflammatory bowel disease (IBD), which means their immune system attacks their gut and causes painful sores (ulcers) and inflammation. IBD includes Crohn's disease (inflammation can be anywhere in the gut, from mouth to bottom) or ulcerative colitis (inflammation is in the large bowel only). Symptoms include severe stomach pain and diarrhoea.
IBD is a long-term condition, but medications that dampen the immune response can improve symptoms.
People with IBD are more likely than others to have mood disorders such as depression and anxiety. Up to 1 in 4 (25%) people with IBD have depression and up to 6 in 10 (58%) have anxiety. Patient charity Crohn’s and Colitis UK suggest that people with IBD and mental health issues benefit from psychological support. However, its 2021 report stated that few (2%) IBD specialist teams have sufficient access to psychologists.
Previous studies have linked depression and anxiety to worse outcomes for people with IBD, including flares and hospital admissions. But interventions to improve mood (including exercise and therapy) have not been reliably shown to reduce inflammation. This study therefore brought together existing evidence on the impact on inflammation of interventions to improve mood in people with IBD.
What’s new?
The analysis included 28 randomised controlled trials, involving 1,789 adults with inflammatory bowel disease (IBD). Most studies (20) trialled psychological therapies (including talking therapy, mindfulness, and cognitive behavioural therapy or CBT); a few investigated antidepressants (3) or exercise (5).
Each trial compared an intervention with a control group. For example, psychological therapy was compared with usual care, antidepressants with placebo, and exercise with no exercise. Results from the trials were pooled; the control group was made up of the various control groups in different studies.
The study found that, compared with control groups, interventions to improve mood:
- reduced inflammation overall (18% reduction in inflammation markers)
- markedly reduced inflammation markers relevant to IBD (40% reduction in C-Reactive Protein which guides treatment decisions; 35% reduction in faecal calprotectin).
Interventions were most effective at reducing inflammation when they:
- had led to the greatest improvements in mental health
- aimed primarily to improve mood (rather than to reduce pain or fatigue, for example)
- were psychological treatments rather than antidepressants or exercise.
Why is this important?
The analysis showed that interventions for mood reduce inflammation in people with inflammatory bowel disease (IBD). Psychological support appeared to improve people’s physical as well as mental health. The researchers hope the findings will encourage clinicians and policymakers to prioritise psychological interventions as part of IBD treatment.
Many medications for IBD are costly and have side effects. For example, infliximab costs £12,584 per year. By contrast, an eight-week course of face-to-face CBT costs approximately £480 - £800 (waiting lists can be long). This study suggests that psychological therapies to improve mood could add benefit to treatment with medicines, and reduce costs for the NHS.
The researchers caution that some data were not reported adequately, and some studies were not directly comparable. Age, sex, and other factors may have also had an effect.
What’s next?
The researchers propose 2 explanations for their findings that may work independently or together. Improved mood could change brain activity and in turn alter immune and gut activity. Alternatively, people with better mental health may be more able to look after their physical health (exercising more and eating a healthier diet, for example), thus reducing inflammation. The researchers aim to test these possible explanations in an ongoing study.
The research team is testing a digital CBT therapy designed for people with inflammatory bowel disease (IBD). This intervention showed positive results in an early study. If effective, it could be delivered as part of routine care in the future.
You may be interested to read
This is a summary of: Seaton N, and others. Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease?: a systematic review and meta-analysis. eBioMedicine 2024; 100: 104910.
An article about the study by the NIHR and the Independent; infographics about the study on Instagram.
An article about the CBT tool for people with inflammatory bowel disease.
Information on taking part in NIHR research on inflammatory bowel disease.
Funding: This study was funded by the NIHR Maudsley Biomedical Research Centre.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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