ASSOCIATION BETWEEN BOWEL MOVEMENT DISORDERS AND DEPRESSIVE SYMPTOMS

Abstract

Alterations in intestinal motility—including constipation, diarrhea, and changes in bowel habits—are highly prevalent in the general population and may be associated with psychological manifestations, such as depressive symptoms. In recent decades, understanding of the relationship between the gastrointestinal tract and the central nervous system has expanded through the concept of the gut-brain axis and, subsequently, the recognition of Disorders of Gut-Brain Interaction (DGBI). These disorders involve complex mechanisms related to gastrointestinal motility, visceral hypersensitivity, gut microbiota, immunity, metabolism, and the central processing of visceral stimuli. This article aims to analyze the association between intestinal motility alterations and depressive symptoms, discussing the potential pathophysiological mechanisms involved in this relationship. Recent evidence indicates a particularly consistent association between constipation and depression; however, the nature of this relationship remains predominantly associative, and it is not possible to establish a unidirectional causal link based solely on observational studies. Bidirectional communication between the gut and the brain may involve neural, autonomic, endocrine, immunological, and metabolic pathways, as well as alterations in gut microbiota. Depression, in turn, can modify dietary habits, physical activity, sleep patterns, symptom perception, and autonomic function, thereby contributing to changes in intestinal motility. Consequently, the clinical assessment of patients with persistent changes in bowel habits should consider the possibility of concomitant depressive symptoms, especially when there is a significant impact on quality of life. An integrated approach addressing both gastrointestinal and mental health can contribute to a more comprehensive understanding of these patients.