Despite the way we’re taught in school, the body doesn’t think of itself as divided up into systems. It doesn’t realize it has a nervous system and an endocrine system, a respiratory system and a digestive system. There is really only one system that has to work together to keep you alive. So it’s unsurprising that psychological illness can be related to, or co-morbid with physical disorders that might not seem relevant at first-glance. In fact, the “digestive system” has an enormous effect on the brain and vice-versa. Familiar with the term “hangry”? Well, there’s a reason that being hungry makes you angry at everything else. It’s all entangled.
There’s another system in the body that you may not have heard of that describes this link. It’s called the “enteric nervous system.” Basically, a brain for your gut. This nervous system is a subset of the central nervous system. It’s connected to the brain in your head via nerves like the vagus and pelvic nerves and basically runs the show as far as digesting your food. However, it does more than direct your digestive tract to take your cheeseburger from mouth to toilet. In fact, multiple neurotransmitters associated with mental health are generated by the micro-biome in the gut.
Selective serotonin re-uptake inhibitors, anyone? If this type of medication sounds familiar, then you know the importance of what these neurotransmitters do. Since over 50% of bipolar sufferers are also diagnosed with at least one anxiety disorder, many of us rely on SSRI’s in addition to any mood stabilizers or antipsychotic medications in order to function with bipolar disorder. So it stands to reason that if this link is disrupted in a way that affects mood, we might be a link to gastrointestinal disorders as well.
I happen to be unfortunate enough to have a gastrointestinal disorder called gastroparesis. It’s pretty much what it sounds like. There is nerve damage that causes the muscles in my stomach to either function very slowly or seize according to their pleasure. It causes nausea, vomiting, fatigue, and pain. It also does not help my depression. I was surprised, though, when my doctor prescribed gabapentin to help treat the disorder. Gabapentin is also a mood-stabilizing anticonvulsant and is used in treating bipolar disorder. So, wait. The same drug I’m using for my stomach can also work on my bipolar disorder? Pretty much.
Mine is far from the only example of gut/psychological disorder comorbidity.
Gastritis, and gastroesophageal reflux disease have also been associated with mental illness. In these disorders, mucosa (the slimy tissue) in the digestive tract tends to produce a higher inflammatory response. Now, inflammation is a good thing. It’s part of our immune response to infection and disease, but in cases of chronic stress and illness, like chronic gastritis and GERD, it keepsthe body in that stress response. That bodily stress response can eventually roll over into mental stress response, anxiety, and depression.
It’s not just the upper GI tract that takes part in this cycle. The lower GI tract can have just as much of an impact on health, both mental and physical. Certain antibodies present in higher levels in bipolar patients are also known to be higher in those with Crohn’s Disease. Patients with bipolar disorder may also have an increased risk for gluten sensitivity and celiac disease. Now, I know that the gluten-free movement has been taking hold and is almost now considered as trendy as hula hoops and just as useful, but, it is real and millions of people do suffer from these disorders. Now, it turns out, people with mental illnesses like bipolar disorder and schizophrenia may be at greater risk than the population-at-large. Remember the immune response I mentioned earlier? That plays a role here too. Gluten contains the protein gliadin. When patients with bipolar disorder are exposed to gliadin, there is an increased immune response when compared with the general population. This response is similar to the response seen in celiac disease.
More research is needed to get to the bottom of the chicken and egg problem that bipolar disorder and GI illnesses present. Hopefully the studies will lead to better answers in both areas. In the meantime, a fun fact:
Not only can you see a therapist for your bipolar disorder, but it may help with a GI disorder as well. When you go to a doctor and are diagnosed with any type of disorder, you’re likely to be handed gobs of pamphlets and directions to information on the web to learn all about your new-found friend. Knowing what you’re facing can absolutely help, but seeing a therapist to discuss what you’re going through and how to deal with it can do a whole lot more. It helps to regulate the emotional/mental part of the illness, rather than just treating the symptoms.
It goes back to the example I gave of my particular problem. It’s all intertwined, so you may find help where you least expect it. I think it’s great that the therapies I use for my bipolar disorder can help my gut out too, and the other way around. It’s all in the same body, and we’re all just trying to do the best we can.