It's not uncommon for people with celiac disease or gluten sensitivity to report depression as one of their symptoms.
Many studies have documented a link between symptoms of depression and celiac disease — even in people who have been following the gluten-free diet for a long time. Some researchers have speculated that depression in celiacs may simply stem from having a chronic health problem, in the same way people with chronic health issues such as arthritis and diabetes tend to get depressed.
However, there's some evidence that depression in people with celiac disease is connected to changes in the brain -- potentially changes that are triggered because intestinal damage precludes absorption of certain nutrients that are important for brain function. And although following a gluten-free diet appears to help, it doesn't always alleviate depression symptoms entirely.
Meanwhile, depression also is one of the more common symptoms of non-celiac gluten sensitivity, a newly-recognized condition that involves a different immune system reaction to gluten ingestion than celiac disease. A recent study found higher levels of depression among people with gluten sensitivity who underwent a gluten challenge, but the authors couldn't explain why this occurred.
Depression Common in Celiac Disease
It's not clear why these links exist, although some researchers speculate that malnutrition resulting from malabsorption of nutrients plays a major role.
For example, the vitamins folic acid and B-6 both play a role in mood and neurotransmitter health, and many newly diagnosed celiacs are deficient in those nutrients. In fact, at least one study has shown that supplementing vitamin B-6 can improve symptoms of mood in people with celiac.
However, other researchers — specifically, Dr. Rodney Ford, author of The Gluten Syndrome — have hypothesized that gluten exerts a direct depressive influence on your brain chemistry, independent of malabsorption resulting from intestinal damage. Dr. Ford believes gluten is responsible for depression both in people with celiac and in people with non-celiac gluten sensitivity. In fact, his hypothesis of a direct effect would explain why so many people — both celiac and gluten-sensitive — experience short, predictable bouts of depression whenever they've been glutened, even if they didn't ingest enough gluten to cause lasting intestinal damage.
Regardless of the reason, though, research is clear that diagnosed celiacs — both adults and children — show high levels of depression. In fact, one recent study involving women with celiac disease found that 37% suffered from clinical depression, and another involving celiac children found depression rates ranging from more than 8% in boys to nearly 14% in girls.
Suicide Rate Also Higher Among Celiacs
One particularly troubling study published in 2011 indicates that the suicide rate among celiacs is higher than the rate in the general population.
Researchers in Sweden looked at more than 29,000 people who were diagnosed with biopsy-proven celiac disease between 1969 and 2007, and found 54 of them had committed suicide, indicating a suicide rate that's moderately higher than that in the general population. Individuals with intestinal damage that wasn't bad enough to qualify for a celiac diagnosis also had a moderately higher rate of suicide, although people with latent celiac disease did not.
The researchers did not indicate why they thought the suicide risk among celiacs was higher, but they did say the problem merits attention from physicians treating celiac patients.
Depression Lessens As Diet Gets Stricter
A strict gluten-free diet with absolutely no cheating may represent the key to keeping your mood elevated if you do get depression from gluten exposure.
A study released in late 2011 from researchers at Penn State found that women who stuck with their diet more strictly had fewer depressive symptoms, although all celiac women studied suffered from higher rates of depression than the general population.
This finding follows what I've experienced myself and heard anecdotally from numerous people with celiac disease and gluten sensitivity: We frequently feel as if a cloud has been lifted from our mood once we get off gluten permanently, and many of us experience recurrent bouts with depressive symptoms when we accidentally ingest gluten.
In fact, I've heard from several people that they feel incredibly depressed, weepy and even suicidal if they've been badly glutened, only to have those feelings dissipate quickly — frequently within a few hours — as the glutening seems to wear off.
The Penn State researchers said they intend to continue studying celiac disease and depression in an effort to determine whether the celiac disease actually causes the depression, along with symptoms of stress and eating disorders (which they also found in the women studied). Perhaps they'll help to determine why depression is such a pervasive problem in people with celiac disease.
In the meantime, though, if you suffer from depression or suicidal thoughts, please get help. Here are some resources you can use:
• If you're having suicidal thoughts, call 911 immediately or call the National Suicide Prevention Lifeline at 800-273-8255. You also can visit the National Suicide Prevention Lifeline online.
• If you're suffering from persistent depression despite following the gluten-free diet, talk to your doctor about getting a referral to a mental health expert. In some cases, medication may help alleviate your depression. See About.com's excellent site on depression for more information on your options.
• If you notice a pattern of depressive feelings following accidental gluten ingestion, it may help to get more gluten out of your diet. The tiny amount of gluten in "gluten-free" processed foods is a common culprit; see my article on why you can eat gluten-free and still get gluten symptoms for more information.
Addolorato G. et al. Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scandinavian Journal of Gastroenterology. 2001 May;36(5):502-6.
Addolorato G. et al. Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive illness?. Hepatogastroenterology. 1996 Nov-Dec;43(12):1513-7.
Arigo D. et al. Psychiatric comorbidities in women with Celiac Disease. Chronic Illness. 2011 Sept. 20 (Epub ahead of print).
Dickerson F. et al. Markers of gluten sensitivity and celiac disease in recent-onset psychosis and multi-episode schizophrenia. Biological Psychiatry. 2010 Jul 1;68(1):100-4. Epub 2010 May 14.
Ford R. The Gluten Syndrome: A Neurological Disease. Medical Hypotheses. 2009 Sep;73(3):438-40.
Hallert C. et al. Reversal of psychopathology in adult coeliac disease with the aid of pyridoxine (vitamin B6). Scandinavian Journal of Gastroenterology. 1983 Mar;18(2):299-304.
Ludvigsson J. et al. Increased suicide risk in coeliac disease--a Swedish nationwide cohort study. Digestive and Liver Disease. 2011 Aug;43(8):616-22.
Mazzone L. et al. Compliant gluten-free children with celiac disease: an evaluation of psychological distress. BMC Pediatrics. 2011. Published online May 27, 2011.
Penn State news release. Women with celiac disease suffer from depression, disordered eating. Dec. 26, 2011.