Irritable Bowel Syndrome, Anxiety, and Depression: What Are the Links?

Irritable bowel syndrome (IBS) is a common and potentially disabling functional gastrointestinaldisorder characterized by abdominal pain and altered bowel patterns. A significant amount of clinicaland research data suggest the importance of the brain-gut interaction in IBS. This review examines theobserved high prevalence of psychiatric disorders in patients with IBS. The published literature indicatesthat fewer than half of individuals with IBS seek treatment for it. Of those who do, 50% to 90%have psychiatric disorders, including panic disorder, generalized anxiety disorder, social phobia,posttraumatic stress disorder, and major depression, while those who do not seek treatment tend to bepsychologically normal. Both physiologic and psychosocial variables appear to play important rolesin the development and maintenance of IBS. Recent information suggests that the association of IBSand psychiatric disorders may be more fundamental than was previously believed. A brain-gut modelfor IBS is presented, and the role of traumatic stress and corticotropin-releasing factor as modulatorsof the brain-gut loop is discussed. Finally, the rationale for the use of psychotropic agents in the treatmentof IBS with or without psychiatric symptoms is presented.