Psoriasis and Depression: What’s the Connection?
Medically reviewed by Brendan Camp, MD
Psoriasis is a chronic autoimmune skin condition that often comes with mental health concerns, including depression. This connection is partially a result of lower self-esteem due to the skin's appearance or location of the psoriasis lesions.
Furthermore, the same processes in the body that form plaques can also change the levels of brain chemicals that affect your mood.
People with psoriasis are 1.5 times more likely to have symptoms of depression than people who don't have psoriasis.
In this article, learn more about the link between psoriasis and depression.
Reproduced with permission from ©DermNet and ©Te Whatu Ora Waikatowww.dermnetnz.org 2023.
Understanding the Link Between Psoriasis and Depression
Scientists believe that there is a bidirectional relationship between psoriasis and depression. This means that psoriasis can worsen depression, and depression can also contribute to psoriasis.
Many people with psoriasis feel stigmatized by their skin's appearance, and this affects their mental health. Research shows that the more visible the psoriasis lesions—namely, in areas such as the head, neck, arms, and hands—the greater the impact on mental health. People with lesions in those locations and the genital region have higher levels of depression symptoms.
There is also a biological connection between psoriasis and depression. Researchers have linked both depression and psoriasis to high levels of inflammation.
How Likely Is the Risk of Depression With Psoriasis?
People with psoriasis have a 1.5 times are at increased risk of developing depression than the general population.
Studies have found that between 10% and 62% of people with psoriasis have depression. However, having psoriasis does not mean you will develop depression.
Signs of Depression
Depression is more than just being sad. The signs of depression are emotional, physical, social, and beyond.
Below are some common depression symptoms:
Changes in appetite
Continuous sadness, guilt, or low mood
Irritability
Lack of energy or fatigue
Losing interest in previously enjoyed activities
Low self-esteem
Sleeping too much or too little
Social withdrawal
Speaking or moving slowly
Knowing these signs can help you identify if you are experiencing depression related to your psoriasis.
Related: Can Stress Cause Psoriasis Flare-Ups?
Psoriasis and Anxiety
As with psoriasis and depression, there is also a link between psoriasis and anxiety due to social and biological factors. Between 20% and 50% of people with psoriasis experience anxiety symptoms, which is higher than the rate among people who don't have psoriasis.
Scientists believe this link is bidirectional, meaning that psoriasis may lead to anxiety, and anxiety can also trigger psoriasis flares.
Treatment for Psoriasis and Depression
Some research has shown that psoriasis treatments can improve both psoriasis and depression symptoms.
Biologics
Research shows that anti-inflammatory biologic therapies treat psoriasis and reduce depression symptoms simultaneously. These drugs are derived from living organisms and are delivered either by injection or infusion. Examples include:
TNF-a inhibitors: Humira (adalimumab) and Cimzia (certolizumab)
IL-12/23 antagonists: Stelara (ustekinumab)
IL-23 antagonist: Skyrizi (risankizumab) and Tremfaya (guselkumab)
IL-17 inhibitors: Taltz (ixekizumab) and Cosentyx (secukinumab)
Psychotherapy
Psychotherapy is a standard treatment for depression, but there is increasing evidence that psychotherapy can also be beneficial for treating psoriasis symptoms, likely due to the bidirectional relationship between the two conditions.
Antidepressants
Researchers have found that antidepressants—medications used to treat depression—also have anti-inflammatory properties.
Multiple studies have found that antidepressant use—specifically monoamine oxidase inhibitors (MAOIs), Wellbutrin (bupropion), and selective serotonin reuptake inhibitors (SSRIs)—was associated with reduced Psoriasis Area and Severity Index (PASI) scores. However, the studies are of varying sizes and quality.
Conversely, one 2023 study found the SSRI antidepressant Prozac (fluoxetine) was associated with inducing psoriasis.
This is an emerging area of research, and there is still a lot to learn about the interplay between antidepressants and psoriasis. Speak to a healthcare provider about any new medications prescribed and discuss their possible side effects and complications.
Managing Your Mental Health With Psoriasis
Physical and mental health are closely related, and the connection between psoriasis and depression is a good example of this.
If you have psoriasis, it's important to tend to your mental health as well as your physical symptoms. Below are some tips for managing your mental health with psoriasis.
Identify How Psoriasis Affects You
No two people experience psoriasis in the same way. Take some time to identify how your psoriasis affects you. Some questions to ask yourself are:
What are my psoriasis triggers?
Am I managing my triggers well, or does it feel overwhelming?
Where does my psoriasis typically occur, and how does it make me feel?
Has psoriasis impacted my self-esteem? How so?
What are my current struggles or successes with my psoriasis?
Understanding your psoriasis better can help you identify links between it and your mental health.
Aim for 8 Hours of Sleep
Experts recommend getting eight hours of sleep each night, especially for people with psoriasis; however, this is a bit easier said than done. Both depression and psoriasis are linked to sleep problems.
Your sleep may benefit if the medications for your psoriasis and depression have the carryover effect of helping you sleep better. If not, practicing nightly sleep hygiene habits, such as the following, may help:
Going to bed and waking up at the same time every day
Not looking at electronic screens close to bedtime
Avoiding caffeine, nicotine, and alcohol
Setting up your bedroom to be conducive to sleep, such as regarding temperature and light
Prioritize Exercise
Regular exercise can benefit your mental health, especially the conditions of depression and anxiety. Exercise is also highly regarded as a way to prevent or improve psoriasis flares.
However, people with psoriasis may face barriers to exercise, including from painful physical symptoms or being self-conscious of their visible lesions in public places like parks or gyms. Fortunately, there are many ways to exercise, and some may suit your comfort level more so than others. Examples include:
At-home workout videos
Cycling outdoors, at a gym, or at home
Gentle stretching
Lifting weights at home or in a gym
Pilates
Qigong
Running outdoors or on a treadmill
Swimming
Tai chi
Walking
Yoga
Related: Health Complications of Psoriasis
Add Other Healthy Activities
Many healthy activities can help you manage your mental health with psoriasis. The American Academy of Dermatology (AAD) Association recommends the following healthy habits for people with psoriasis:
Eat a healthy and balanced diet.
Exercise regularly.
Keep up with your healthcare appointments and treatment.
Limit alcohol consumption.
Maintain a healthy weight.
Quit smoking.
Challenge Unhelpful Beliefs
People with psoriasis often feel stigmatized due to their lesions. If you notice unhelpful thoughts arising, try challenging them when they occur. Psoriasis is chronic but treatable, and there is hope. Every human body is different, and each person has their insecurities.
Talk About Your Concerns
It's important to talk about your concerns, whether they relate to how psoriasis makes you feel or the mental health symptoms you're experiencing.
Mainstream guidance is that healthcare providers should screen everyone with psoriasis for depression, anxiety, and suicidal ideation (preoccupation with suicide). In addition to talking to your providers, it can also help to be open with your loved ones about your struggles.
Summary
People with psoriasis are at higher risk of developing depression. These two conditions influence each other and share social and biological mechanisms. It is crucial to keep up with your psoriasis and depression treatments to manage both conditions.
Read the original article on Verywell Health.
