• Anxiety and depression are two mental health conditions that commonly affect people of all ages who have eosinophilic esophagitis (EoE).
• Causes of anxiety and depression include stigmas surrounding EoE, fear of social interaction and embarrassment, and side effects of treatments.
• Anxiety and depression associated with EoE may be managed through talk therapy, medication, and the support of family and friends

Eosinophilic esophagitis is a chronic disease caused by a buildup of eosinophils — immune cells that cause inflammation in the esophagus (throat). Often, people think only of the physical symptoms associated with a disease. However, chronic conditions can also have a large impact on a person’s mental health. Many people living with EoE also have mental health conditions (sometimes called psychiatric disorders), such as anxiety or depression. If you have EoE, recognizing the symptoms of these conditions and learning how to cope can help improve your overall quality of life.

Mental Health Conditions and EoE

Eosinophilic esophagitis is mainly associated with physical symptoms that affect the esophagus and gastrointestinal tract (stomach and intestines), including:

• Food impaction (food stuck in the esophagus)
• Dysphagia (difficulty swallowing)
• Abdominal pain
• Heartburn or reflux (excess stomach acid)
• Strictures (narrowing of the esophagus)

Living with these EoE symptoms can lead to mental health conditions like anxiety and depression. EoE affects 1 in 2,000 people, according to the National Organization for Rare Disorders and can occur at any age, from infancy through adulthood. Studies show that anxiety and depression are more common in children, teens, and adults who have EoE than in the general population.

Mental Health and Adults With EoE

A 2019 review published in the Journal of Asthma and Allergy presented the results of studies on anxiety and depression on EoE. The authors found that in a small study of 34 adults with EoE, 31 percent had at least one mental health or neuropsychiatric condition, such as attention deficit hyperactivity disorder. In addition, 12 percent reported a diagnosis of depression, and 9.3 percent reported having anxiety. Women with EoE also tend to report more depression and anxiety symptoms than men, according to the review authors. Other studies showed that adults with EoE who were diagnosed in childhood are most likely to be affected by mental health conditions. These individuals were more likely than their siblings to experience anxiety or depression.

Mental Health and Children and Teens With EoE

Eosinophilic esophagitis also has negative impacts on the mental health of children and teenagers. Studies show that younger people with EoE are more likely to experience anxiety symptoms than the general population. In the 2019 review, one study found that 19 percent of children and teens aged 11 to 17 with EoE, as well as more than 9 percent of younger children, reported depression and anxiety. A small study with 64 participants also found that 41 percent of children with EoE reported anxiety that was mainly associated with their treatments and symptoms. Depression in young people with EoE is also linked with not following treatment plans, as well as having more stomach pain and sleep problems.

Symptoms of Depression and Anxiety

If you are living with EoE, it’s helpful to be able to recognize and understand the symptoms of mental health conditions. You may be experiencing depression if you notice symptoms like the following persisting for at least two weeks:

• A sad or “empty” feeling
• Feelings of pessimism or hopelessness
• Feelings of worthlessness, helplessness, or guilt
• Fatigue
• Problems with sleeping at night or waking in the morning
• Trouble with memory, concentrating, or making decisions
• Loss of pleasure or interest in hobbies or activities you usually enjoy
• Changes in appetite
• Unexplained changes in weight
• Aches or pains that seem to have no clear cause and don’t improve with treatment
• Thoughts of hurting yourself, suicide, or death

Note: If you or someone you know needs help, you can contact the National Suicide Prevention Lifeline by calling or texting 988 or chatting online.

Generalized anxiety disorder (GAD) is a condition in which feelings of anxiety or dread interfere with day-to-day life. GAD is different from occasionally feeling anxious about a stressful event — instead, the anxiety is ongoing, lasting for months to years. Symptoms of GAD include:

• Having trouble controlling anxious feelings or worry
• Tiring easily
• Experiencing unexplained stomachaches, headaches, or other pain
• Feeling irritable, restless, or on edge
• Sleeping poorly

What Leads to Anxiety and Depression in EoE?

Many people living with EoE feel stigmas surrounding their condition. This feeling can contribute to mental health conditions and lead to avoiding social situations, such as work, school, or family functions. EoE treatment may also cause stress and anxiety.

Stigma and EoE

When a person believes that stereotypes or negative attitudes about an illness are true in their case, this is called internalized stigma. For people with EoE, this may mean feeling out of place or believing that others avoid them because of their condition. For example, social activities such as dining out with friends or family can be stressful: If you have EoE, you may worry about hiding your condition from others or having a choking episode while eating. These feelings can lead to internalized stigma and symptoms of depression or anxiety.

EoE Treatments

EoE treatments might also be a source of stress. Medications used to treat EoE may come with side effects that can increase stress. Although diet therapy can be useful for treating EoE, this method can be difficult to stick with and create anxiety around mealtimes. If you have EoE, you might worry about having the proper food choices available while eating out, avoiding any foods you’re allergic to, or preparing meals at home. Diet-related anxiety and depression have been found to interfere with people who follow the six-food elimination diet, a common EoE treatment.

Children with EoE also experience anxiety regarding food choices and restrictions. They may be embarrassed or worried about what they eat. Having to use a gastrostomy tube (G-tube) for feedings can also cause anxiety and embarrassment, especially at school.

3 Ways To Cope With Anxiety and Depression

If you’re living with EoE and experiencing depression or anxiety, you’re not alone. Fortunately, these conditions can be managed and treated with help from mental health professionals and your gastroenterologist. Reaching out for help is the first step to getting the treatment you need to improve your quality of life with EoE.

1. Try Talk Therapy and Medication

Psychotherapy, or talk therapy, is one way to help manage mental health conditions. Talk therapy can be provided by a number of professionals, including a licensed therapist, psychiatrist, or psychologist. Psychiatrists are trained medical doctors who can also prescribe medications to treat depression or anxiety, such as antidepressants.

There are many kinds of talk therapy, and your provider will help you choose the best fit for you. Options include cognitive behavioral therapy (CBT) and supportive therapy. CBT teaches people to look for and then change patterns in their thoughts and behaviors that contribute to anxiety or depression. Supportive therapy helps people form their own support system and resources by building self-esteem.

2. Work With Your Gastroenterologist

To help address your EoE symptoms, you can work with your gastroenterologist to find a treatment plan that works for you. Treating the symptoms can help you feel in control of your EoE, which may lessen stress.

Treatment options for EoE include:

• Proton pump inhibitors to reduce stomach acid production
• Esophageal dilation to widen the esophagus
• Topical steroids (corticosteroids) and biologics, such as dupilumab (Dupixent), to treat inflammation
• Dietary therapy to manage food allergies

3. Be Open With Family and Friends About EoE

Someone living with a chronic condition like EoE might feel like family and friends won’t understand. However, being open and talking with supportive people may help. Having social support has been shown to help prevent mental health problems in people with chronic conditions.

Advocating for yourself while living with EoE can also help you avoid stressful situations that may contribute to anxiety or depression. The American Partnership for Eosinophilic Disorders recommends suggesting nonfood- related activities to your friends and family if you have anxiety regarding allergies or eating around others.

Talk to Your Doctors About EoE and Mental Health

Talk to your doctors if you begin noticing new symptoms, whether or not they’re related to the physical or mental and emotional aspects of EoE. It’s important to let both your primary care physician (PCP) and your gastroenterologist know so they can help you manage your symptoms. Your PCP may refer you to a mental health professional who can help you manage anxiety or depression symptoms. You’ll also be able to work with your gastroenterologist to treat your EoE symptoms, which may help address your mental health.

Find Your Team

At myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn more about EoE and share their stories with others who understand life with the condition.

Are you living with anxiety or depression and EoE? What strategies have helped you? Share your experiences in the comments below.