At a glance
- Anxiety, low mood and tiredness are common with IBD. They are not a weakness, and they are not your fault.
- Tell your IBD team if you feel worried, low or worn out. Ask them to check for inflammation and for low iron or vitamins.
- Getting your IBD under control often helps your energy and mood too.
- Talk therapy, such as CBT, can ease anxiety and low mood. In Ontario, adults can refer themselves to free CBT-based care through Ontario Structured Psychotherapy.
- Keep moving, even gently, and protect your sleep with a regular bedtime.
- Connect with others who have IBD. Crohn's and Colitis Canada has free peer support for adults.
- If you think about suicide, call or text 9-8-8, any time, day or night. If you are in danger now, call 9-1-1.
You are not alone
Living with IBD is hard. The symptoms can be unpredictable. Trips to the bathroom, tests, and medicines take time and energy. It makes sense that many people feel worried, down or worn out.
These feelings are very common:
About 1 in 3
About 1 in 4
About 1 in 2
During a flare, these are even more common. About half have anxiety, and about 1 in 3 have depression. Fatigue affects about 7 in 10 people during a flare. It can last even when IBD is calm. More than half of people with IBD have poor sleep.
These are real health problems. They are not a sign of weakness. You can get help for them, just like for your bowel.
Why it happens
The gut and the brain are linked, and the link goes both ways. Inflammation in the gut can affect mood and energy. Stress and low mood can make bowel symptoms feel worse.
Many things can add to tiredness and low mood:
- Active inflammation. A flare uses up the body’s energy.
- Anemia. This means low red blood cells, often from low iron. It is common in IBD and causes tiredness and shortness of breath.
- Low vitamins. Crohn’s disease in the small bowel, or past surgery, can lower vitamin B12. Your team may check this and other vitamins.
- Poor sleep. Night-time trips to the toilet, pain, worry and some medicines, like prednisone, can all disturb sleep.
- Pain. Ongoing pain is tiring and wears down mood.
- Less activity. When you feel unwell, you move less. Over time, this lowers your energy and strength.
- Life stress. Missing work or school, money worries and changes in your social life all take a toll.
What helps
1. Talk to your IBD team
Tell your team how you feel. It is part of your IBD care, not a side issue. Experts advise that IBD teams ask about anxiety and depression.
Your team can:
- Check for inflammation, with blood and stool tests or a scan. Getting IBD under control often helps energy and mood.
- Check for low iron and vitamins. Iron pills or an iron drip can help if you are low.
- Review your medicines, in case one is affecting your sleep or mood.
2. Talk therapy
Talk therapy can ease anxiety and low mood in people with IBD. Cognitive behavioural therapy (CBT) helps you notice unhelpful thought patterns and change them. Mindfulness and relaxation can also help. These therapies help you feel better. They do not treat the inflammation itself, so keep taking your IBD medicine.
Some people have belly pain, bloating or bowel changes even when their IBD is calm. Gut-focused talk therapies, like CBT for the gut or gut-directed hypnotherapy, can help with this. IBD experts suggested them in 2026.
In Ontario, adults can get free CBT-based help through the Ontario Structured Psychotherapy program. You can refer yourself. Your family doctor can also refer you.
3. Medicine for mood
Sometimes, medicine for depression or anxiety is the right choice. Small studies in IBD show that antidepressants can improve low mood. Your family doctor or IBD team can talk with you about this.
4. Daily habits that build energy
- Move a little every day. A short walk is a good start. Build up slowly. Rest when you need to, but try not to stop moving.
- Protect your sleep. Go to bed and get up at the same times. Keep screens out of bed. Avoid caffeine late in the day.
- Pace yourself. Plan your busiest tasks for when you have the most energy. Break big jobs into small steps.
- Eat regular meals. Your body needs fuel to heal.
- Limit alcohol, which harms sleep and mood.
5. Connect with others
Talking with someone who understands IBD can help a lot. Crohn’s and Colitis Canada offers free peer support online for adults 18 and over, one-to-one or in groups. Volunteers live with IBD or care for someone who does.
Let family and friends know how you feel. Tell them what helps you.
Signs to tell your team about
- You feel low, hopeless or empty most days for 2 weeks or more.
- You have lost interest in things you used to enjoy.
- Worry is hard to control or stops you doing things.
- You are so tired that you cannot work, study or care for your family.
- You avoid going out because of your bowel.
Help right now
If you are thinking about suicide, or worried about someone else:
- Call or text 9-8-8, the Suicide Crisis Helpline. It is free and open 24 hours a day, every day.
- Call 9-1-1 or go to the nearest emergency department if you or someone else is in danger now.
Other free help, any time, day or night:
- Kids Help Phone, for children, teens and young adults: call 1-800-668-6868, or text CONNECT to 686868.
- Hope for Wellness Help Line, for Indigenous people: call 1-855-242-3310, or chat online.
- ConnexOntario, to find mental health and addiction services in Ontario: call 1-866-531-2600.
You do not have to wait until things are at their worst to reach out.
Did stress cause my IBD?
No. Stress does not cause IBD. But stress can make symptoms feel worse, and IBD can cause stress. Looking after your mental health is part of looking after your IBD.
Why am I still tired when my IBD is calm?
Fatigue can last after inflammation settles. Ask your team to check for low iron or vitamins, poor sleep, low mood and other causes. Many of these can be treated. In a 2026 study, a probiotic did not help tiredness when IBD was calm.
Sources for this guide
Sources
- Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2021;6(5):359–70. PMID 33721557 77 studies, 30,118 patients. Anxiety symptoms 32.1%, depression symptoms 25.2%. With active IBD: anxiety 57.6%, depression 38.9%. Links via the gut–brain axis in both directions.
- D'Silva A, Fox DE, Nasser Y, et al. Prevalence and risk factors for fatigue in adults with inflammatory bowel disease: a systematic review with meta-analysis. Clin Gastroenterol Hepatol 2022;20(5):995–1009.e7. PMID 34216824 Fatigue in 47% overall; 72% with active disease and 47% in remission. Main risk factors: poor sleep, anxiety, depression and anemia.
- Barnes A, Mountifield R, Baker J, et al. A systematic review and meta-analysis of the prevalence of poor sleep in inflammatory bowel disease. Sleep Adv 2022;3(1):zpac025. PMID 37193414 Poor sleep in 56% of people with IBD; more common with objectively active disease.
- Alruwaili A, AlQahtani A, Altuwaijri M, et al. Fatigue in inflammatory bowel disease: mechanisms, assessment, and management strategies. Saudi J Gastroenterol 2026;32(5):368–78. PMID 42241139 Stepwise approach: assess and control inflammation, then screen for iron deficiency, other micronutrient deficits, hormone problems, sleep disorders, pain, mood and deconditioning. Advanced therapies can improve fatigue; iron when indicated, exercise, sleep and CBT or mindfulness help.
- Tiles-Sar N, Neuser J, de Sordi D, et al. Psychological interventions for treatment of inflammatory bowel disease. Cochrane Database Syst Rev 2025;4:CD006913. PMID 40243391 In adults, psychotherapy slightly improves quality of life, depression and anxiety (moderate certainty); little or no effect on disease activity.
- Weston F, Carter B, Powell N, Young AH, Moulton CD. Antidepressant treatment in inflammatory bowel disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2024;36(7):850–60. PMID 38625827 About 25% of people with IBD have depressive symptoms. In small good-quality trials, antidepressants improved depression and quality of life.
- Farraye FA, Melmed GY, Lichtenstein GR, et al. ACG Clinical Guideline Update: Preventive Care in Inflammatory Bowel Disease. Am J Gastroenterol 2025;120(7):1447–73. PMID 40701559 Advises screening people with IBD for depression and anxiety as part of routine preventive care.
- 9-8-8: Suicide Crisis Helpline (Canada). Accessed October 2026. Call or text 9-8-8, 24 hours a day, every day. If safety is at risk now, call 9-1-1.
- Ontario Health. Ontario Structured Psychotherapy Program: depression and anxiety-related concerns (accessed October 2026). Free, CBT-based care for adults 18+ with depression, anxiety or stress; self-referral accepted; includes BounceBack coaching and internet CBT.
- Crohn's and Colitis Canada. Online peer support (accessed October 2026). Free online mentoring matched with volunteers who live with IBD or care for someone who does, plus monthly online peer support groups (adults, young adults 18–30, caregivers); 18 and over; mentors do not give medical advice.
- Kids Help Phone (accessed October 2026). Free, confidential, 24/7 support for kids, teens and young adults: call 1-800-668-6868 or text CONNECT to 686868.
- Hope for Wellness Help Line (accessed October 2026). 1-855-242-3310 or online chat, 24/7, for all Indigenous people across Canada.
- ConnexOntario (accessed October 2026). Free, 24/7 help finding mental health, addiction and gambling services in Ontario: 1-866-531-2600, text CONNEX to 247247, or live chat.
- Ma C, Ford AC, Hashash JG, et al. Recommendations for the evaluation and management of inflammatory bowel disease with IBS-like symptoms: a joint Rome Foundation and IOIBD consensus. Gastroenterology 2026;171(3):504–20. PMID 42066865 For pain, bowel changes or bloating when IBD is in remission, appropriate therapies include brain-gut behavioural therapies, psyllium (if no stricture), a short-term low-FODMAP diet and targeted drugs.
- Borren NZ, et al. Microbiome-directed therapy for fatigue in quiescent inflammatory bowel disease: a randomized placebo-controlled trial of multistrain probiotic supplementation. Am J Gastroenterol 2026 (online ahead of print). PMID 42153706 100 people with quiescent IBD and fatigue, 12 weeks: no fatigue in 29.4% on probiotic vs 40.0% on placebo (P=0.34); the probiotic did not relieve fatigue.
- Crohn's and Colitis Canada. Frequently asked questions (accessed October 2026). Stress does not cause IBD but can make symptoms worse.
This guide is for general education. It can't replace advice from your own care team, who know your health history.