A substantial number of people with chronic anxiety or depression also have chronic stomach pain that lowers their quality of life irrespective of whether they have objective findings of gastrointestinal obstruction or disease. Nutritional psychiatrists like Uma Naidoo, M.D., (the author of This is Your Brain on Food) say that in many cases the linkage lies in inflammation of the gut-brain connection. Chronic stress releases adrenalin and cortisol which build up in the blood stream, tissues, and organs. Inflammation caused by chronic stress in the brain or gut can travel in a bi-directional way to the other up and down the vagus nerve. Any person with chronic anxiety/depression should see a psychotherapist and if that person also has chronic abdominal pain, she should see an internist. The internist may or may not refer her for a stomach CT scan or colonoscopy.
A good starting point is to understand the difference between gastritis and dyspepsia. Gastritis is an inflammation of the stomach lining that can be caused by stress, an ulcer, consuming too much alcohol or pain relievers or an infection caused by Helicobacter pylori bacteria. Non-bacterial gastritis is associated with stomach pain, nausea, and vomiting. Gastritis caused by Helibacter pylori is marked by symptoms including bloating, flatulence, diarrhea, constipation, acid reflux, weight loss, severe fatigue, mood swings, and anxiety, depression or both. This particular bacterium can lower serotonin by killing the cells in the lining mucosa of the stomach that release serotonin. Those cells and certain nerve cells in the gastro-intestinal lining produce 90% of the serotonin in the body.
Dyspepsia or indigestion is a condition of the stomach marked by bloating, feeling too full, excess gas, and nausea. Symptoms usually strike right after eating or drinking. Causes include anxiety, depression, gastritis, peptic ulcer, antibiotics, NSAIDs, smoking, stomach cancer, lactose intolerance, eating fried foods, eating too fast, over-consumption of caffeine, alcohol or soda, and for some people eating onions or garlic. Some people with dyspepsia feel better by taking antacids. Some actually feel better by taking a low dose antidepressant. Gastroenterologists distinguish between functional dyspepsia when they cannot find an objective cause such as an ulcer and dyspepsia when they can. Either way the symptoms and accompanying distress are real.
When anxiety and/or depression is associated with acute stomach pain there are self-help measures a person can take in addition to seeing a physician and a psychotherapist. These measures include going on an anti-inflammatory diet such as the one recommended in This is Your Brain on Food; engaging multiple times a day in deep breathing exercises to calm mind and body by activating the parasympathetic nervous system (also known as the rest and digest nervous system); leaving or finding ways to reduce the stress level in a highly stressful job, relationship or living situation; reducing stress by getting massage, exercising (such as daily walking) or both; cutting back on or quitting smoking and alcohol consumption; joining a support group; and spending time in a reclining chair with the head and neck elevated at an angle toward the stomach while listening to calming music or water sounds. Enjoying the company of a pet dog or cat that provides unconditional love will also buffer stress.
