Anxiety and Depression in Pancreatitis: Mechanisms, Assessment, and Treatment.

BACKGROUND: Numerous studies have detailed that patients with pancreatitis frequently experience comorbid anxiety and depression, which may arise from physiological factors or psychosocial influences, and these conditions adversely affect daily functioning and quality of life. However, there is still a lack of reviews on epidemiological and mechanistic studies of anxiety and depression in patients with pancreatitis. SUMMARY: Patients with pancreatitis commonly present with comorbid anxiety and depression, with chronic pancreatitis patients being more susceptible than those with acute pancreatitis. The mechanisms underlying this comorbidity are complex and likely multifactorial. Biological factors encompass inflammation-driven cytokine signalling to the brain, Hypothalamic-Pituitary-Adrenal (HPA) axis hyperactivity, gut microbiome dysbiosis, and altered central nervous system plasticity. Psychosocial factors include the emotional burden of pancreatitis, persistent sleep disturbances, substance abuse, and diminished family and social support. Assessment primarily relies on various types of scales, while treatment encompasses a comprehensive approach involving medication, psychological interventions, and family and social support. KEY MESSAGES: This paper reviews the epidemiological characteristics of anxiety and depression in patients with pancreatitis, explores their biological and psychosocial mechanisms, and summarizes key points for the assessment and treatment of this comorbidity.