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Comorbidity between depression and inflammatory bowel disease explained by immune-inflammatory, oxidative, and nitrosative stress; tryptophan catabolite; and gut–brain pathways

Published online by Cambridge University Press:  26 August 2015

Marta Martin-Subero*
Department of Psychiatry, Hospital Universitari Germans Trias I Pujol, Badalona, Spain Department of Psychiatry, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
George Anderson
Department of Psychiatry, CRC, Glasgow, UK
Buranee Kanchanatawan
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Michael Berk
Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia School of Medicine, Deakin University, Geelong, Victoria, Australia Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia Barwon Health and the Geelong Clinic, Swanston Centre, Geelong, Victoria, Australia
Michael Maes
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand School of Medicine, Deakin University, Geelong, Victoria, Australia Department of Psychiatry, Health Sciences Center, Londrina State University, University Hospital, Londrina, Paraná, Brazil
*Address for correspondence: Marta Martin-Subero, Department of Psychiatry, Hospital Universitari Germans Trias I Pujol, Badalona, Spain (Email:


The nature of depression has recently been reconceptualized, being conceived as the clinical expression of activated immune-inflammatory, oxidative, and nitrosative stress (IO&NS) pathways, including tryptophan catabolite (TRYCAT), autoimmune, and gut–brain pathways. IO&NS pathways are similarly integral to the pathogenesis of inflammatory bowel disease (IBD). The increased depression prevalence in IBD associates with a lower quality of life and increased morbidity in IBD, highlighting the role of depression in modulating the pathophysiology of IBD.This review covers data within such a wider conceptualization that better explains the heightened co-occurrence of IBD and depression. Common IO&NS underpinning between both disorders is evidenced by increased pro-inflammatory cytokine levels, eg, interleukin-1 (IL-1) and tumor necrosis factor-α, IL-6 trans-signalling; Th-1- and Th-17-like responses; neopterin and soluble IL-2 receptor levels; positive acute phase reactants (haptoglobin and C-reactive protein); lowered levels of negative acute phase reactants (albumin, transferrin, zinc) and anti-inflammatory cytokines (IL-10 and transforming growth factor-β); increased O&NS with damage to lipids, proteinsm and DNA; increased production of nitric oxide (NO) and inducible NO synthase; lowered plasma tryptophan but increased TRYCAT levels; autoimmune responses; and increased bacterial translocation. As such, heightened IO&NS processes in depression overlap with the biological underpinnings of IBD, potentially explaining their increased co-occurrence. This supports the perspective that there is a spectrum of IO&NS disorders that includes depression, both as an emergent comorbidity and as a contributor to IO&NS processes. Such a frame of reference has treatment implications for IBD when “comorbid” with depression.

Review Articles
© Cambridge University Press 2015 

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M.B. is supported by a NHMRC Senior Principal Research Fellowship 1059660. M.M. wants to thank the Fundación Española de Psiquiatría y Salud Mental.


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