Recent studies have shown higher rates of depression in people with celiac disease. But, how much stock can we actually put into these studies? Are they a fair or accurate assessment? For starters, research is limited, and as it is with most findings in psychological studies, doctors wonder if there could be a combination of issues at play.
I was fortunate enough to speak with Dr. Mi-Young Ryee from Children’s National Health System about her thoughts on the topic. She had a lot of helpful reflections to share about links between celiac disease and mental health conditions.
Celiac Disease and Mental Health
In Dr. Ryee’s experience, there have been some cases where doctors have thought of depression as one of the possible symptoms of celiac disease. There has been research that has linked patients with the biological markers of celiac disease to patients diagnosed with depression. Findings have also linked celiac disease to other psychiatric symptoms such as anxiety and ADHD. But again, Dr. Ryee questions if there could be other factors that influence the research results. For instance, some of her patients had their symptoms improve once they changed their diet to follow a gluten-free lifestyle; however, that was not the case with all. If celiac disease was truly the only link, wouldn’t they all potentially improve by following a gluten-free diet?
Dr. Ryee has seen a connection between how being diagnosed with a chronic disease such as celiac disease can affect an individual’s mental health. Many patients experience stumping symptoms that lead to lengthy periods of being evaluated and/or misdiagnosed, which can be very stressful. By the time these individuals are finally diagnosed with celiac disease, depression could be an unfortunate consequence. People may also have trouble adjusting to living with a chronic disease. Much of their mental health may depend on how they handle the new limitations in their day-to-day life and social experiences, and/or if they have a strong support system.
Many patients go through a grieving process of sorts after being diagnosed with celiac disease because they visualize having to give up many of their favorite foods or food-oriented traditions. They are also overwhelmed by the idea of navigating social experiences and being forced to speak up about their dietary needs. While many patients are relieved to finally have a correct celiac disease diagnosis, they still experience emotional distress about how the diagnosis will affect their life going forward. Dr. Ryee says she finds this to be another triggering time for patients and a potential piece of the puzzle to explain the link between celiac disease and depression.
Additionally, people with depression and celiac disease can experience similar symptoms such as brain fog, malaise, weight loss and anxiety. A medical connection could be a possibility; however, Dr. Ryee stresses that more research needs to be done to continue looking at the mechanisms of how celiac disease is linked to mental health conditions.
Why Study the Link between Celiac Disease and Mental Health Conditions
Dr. Ryee feels studying the possible links between celiac disease and mental health conditions will help to promote:
>> Education about Celiac Disease
It is vital for mental health care professionals to educate themselves about all the possible effects of celiac disease, including depression and other mental health conditions.
>> Better Collaboration between Mental Health Providers and Other Health Care Professionals
Assumption is the worst enemy. When a patient comes in describing an issue or symptoms without a diagnosed cause, the worst thing a mental health professional can do is assume the primary care doctor has already run all the necessary tests. If mental health providers have educated themselves about celiac disease, they can consider it in their own differential diagnostic picture. Then if it hasn’t been assessed, they can encourage families to pursue an evaluation when appropriate. Also, if mental health providers have a better understanding of celiac disease they can provide more tailored treatment to address celiac-disease specific needs.
The same is true for primary care doctors. It is important they understand that psychological symptoms can often be a piece of the puzzle. Bringing in a mental health professional to work together in a complementary way will hopefully only lead to a more thorough diagnosis sooner.
>> Less of a Social Stigma to Working with Mental Health Professionals
It is starting to become more socially accepted to see a therapist; however, we still have a ways to go. More strides can hopefully begin in the referral process. If a primary care doctor gets to a point where they are not finding a physical cause for symptoms and wants to explore the psychological component, the delivery of that information is key. That one conversation can dictate the entire dynamic of how the patient will perceive the referral. They might already be on the defensive and the doctor explaining their reasoning and presenting this option in an understanding receptive manner can completely assuage that. For instance, an emphasis on the mind-body connection (versus all psych or all medical) can help families be more receptive to mental health care.
Educating Health Care Professionals
To better educate mental health providers and other health care professionals Dr. Ryee and her team at Children’s National have joined forces with the Celiac Disease Foundation to launch the Celiac Disease and Gluten-Related Conditions Psychological Health Training Program. There were two live continuing education programs in 2016, one in February in Washington DC and a second in Los Angeles in April. The sessions were live streamed and made available via the web to encourage practitioners from around the world to participate.
It is amazing the strides the medical community continues to make in research and the more they collaborate between fields and share knowledge and insight, the more discoveries will be made. As the old saying goes: two minds are always better than one. By examining how your psychological health affects your physical health, you will only get a more comprehensive picture of your overall well-being. In the end, don’t we all wish for a sound mind and sound body? I know I do!
By Joyana Peters McMahon