Considering the Bidirectional Pathways Between Depression and IBD: Recommendations for Comprehensive IBD Care.

Because of disease chronicity and required shifts in coping and self-management skills over time, it is not surprising that patients with inflammatory bowel disease (IBD) are at increased risk for mental health issues, including depression. Modern conceptualizations of chronic care recognize that the relationship between depression and disease is bidirectional, with (1) poor health leading to poor self-management just as often as poor self-management leads to poor health and (2) inflammation driving depression and depression driving inflammation. Depression in the setting of IBD has been undertreated in this population in the past and, if it remains as such, will continue to pose a significant risk to the current health care system. In this article, we explore these bidirectional relationships and make recommendations for the assessment and treatment of depression in the context of IBD.