How Are Psoriasis and Depression Linked?

Psoriasis is more than just a skin condition. The red, scaly patches on your skin can make you feel embarrassed, anxious, and depressed. And the same processes in your body that form plaques also can change the levels of brain chemicals that affect your mood.

If you feel down day after day, talk to your doctor. There are ways to treat both depression and psoriasis that can help clear up your skin and boost your mood.

Psoriasis and Depression

People with psoriasis are twice as likely to be depressed as those who don't have it. Even if your psoriasis symptoms are mild, you still have a higher risk. In one study, nearly 20% of people with psoriasis had some form of depression.

Being depressed can keep you from sticking with your treatment plan. That can make both your psoriasis and your depression worse.

There are several reasons for the link between psoriasis and depression:

Psoriasis can be embarrassing. The most obvious reason psoriasis makes you feel down is what it does to your skin. The red, scaly patches can be hard to hide, especially in the summer.

People around you might treat you differently because they don't understand what psoriasis is or they think it's contagious. Surveys show that 1 in 5 people with psoriasis have faced rejection and felt unwelcome at times because of their condition.

Psoriasis is uncomfortable. Psoriasis plaques itch, burn, crack, and bleed. Up to 42% of people with psoriasis also have the swollen, painful joints of psoriatic arthritis. Living with these uncomfortable symptoms can make you more likely to be depressed.

Psoriasis affects your brain chemicals. With psoriasis, your immune cells release substances called cytokines. These make skin cells grow out of control and form scaly plaques. They also change levels of chemicals in your brain that affect your mood. A cytokine called TNF-alpha may affect brain chemicals like serotonin in a way that could lead to depression.

Signs You're Depressed

Feeling blue once in a while doesn't mean you're depressed. But you might be depressed if you:

  • Feel hopeless, worthless, empty, angry, or irritable
  • Sleep more than usual or have trouble sleeping
  • Have lost interest in activities you once loved, including sex, sports, and hobbies
  • Have no appetite or feel hungrier than usual
  • Have no energy
  • Can't concentrate or pay attention
  • Have trouble going to work or school

If you've had thoughts of death or suicide, get medical help right away.

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Treatment for Psoriasis and Depression

Don't ignore any signs of depression. It can affect your quality of life. See your doctor about ways to help you feel better.

For example, some drugs doctors use to treat psoriasis -- like adalimumab (Humira), etanercept (Enbrel), or ustekinumab (Stelara) -- also can help with symptoms of depression. And there's evidence that some antidepressant drugs can help with psoriasis. In studies, paroxetine (Paxil) and escitalopram (Lexapro) eased both depression and psoriasis symptoms.

A technique called cognitive behavioral therapy (CBT) is another way to manage the feelings psoriasis can bring on. CBT helps you change the negative thoughts that make you depressed. And mind-body techniques like meditation also can help you control your negative emotions.

WebMD Medical Reference Reviewed by Debra Jaliman, MD on 2/, 017

Sources

SOURCES:

American Council on Science and Health: "Psoriasis Causes Depression, And Here's Why."

Archives of Dermatology: "The risk of depression, anxiety and suicidality in patients with psoriasis: A population-based cohort study."

Arthritis Foundation: "How Common is Psoriatic Arthritis in People with Psoriasis?"

British Journal of Dermatology: "A cognitive-behavioural symptom management programme as an adjunct in psoriasis therapy."

Cytokine: "Cytokines in psoriasis."

Expert Opinion on Pharmacotherapy: "Impact and management of depression in psoriasis patients."

JAMA Dermatology: "Psoriasis and the risk of depression in the US Population: National Health and Nutrition Examination Survey 2009-2012."

Journal of the European Academy of Dermatology and Venereology: "Effect of biologics on depressive symptoms in patients with psoriasis: a systematic review."

Mayo Clinic: "Depression (major depressive disorder): Symptoms."

National Psoriasis Foundation: "Mind and Body Therapies," "The link between psoriatic disease and mental illness."

Neuroscience: "Inflammatory cytokines in depression: Neurobiological mechanisms and therapeutic implications."

News release, American Academy of Dermatology, August 2015.

The Journal of Investigative Dermatology: "The psychological burden of skin diseases: A cross-sectional multicenter study among dermatological out-patients in 13 European countries."

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