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How Are Psoriasis and Depression Linked?

Medically Reviewed by Stephanie S. Gardner, MD on July 11, 2021

If you have psoriasis, you already know that it is more than just a skin condition.  Beyond the effects psoriasis can have on your body, it can wreak havoc on your emotions and mental well-being.  In fact, the same processes in your body that form plaques also can change the levels of brain chemicals that affect your mood.

If you find yourself feeling 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.

When you are depressed, it 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 symptoms can be obvious to others. 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, some people may 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.

Psoriasis and Anxiety

Along with depression, having psoriasis will raise your chances of having anxiety. Studies have found that people with psoriasis are 31% more likely to have anxiety than people without psoriasis.

Much like with depression, anxiety may stem from how much psoriasis affects the way you look. The more severe your condition, the more likely you are to have social anxiety, especially if your appearance is an important part of your sense of self-worth. This anxiety may cause you to avoid social situations and make you feel lonely and isolated. 

Anxiety can often trigger a flare and worsen your symptoms. This can make you even more anxious and set up a cycle of emotional upset and flares. Even worse, it can affect your psoriasis treatment so that it takes longer to work.

To break this cycle, it’s important to make your mental health as much of a priority as your treatments for psoriasis itself. It can help to learn and practice stress management skills, such as relaxation and breathing techniques, visual imagery, or activities such as yoga, tai chi, or meditation.

Treatment for Psoriasis and Depression

Don't ignore any signs of depression or anxiety. 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 guselkumab (Tremfya) and ixekizumab (Taltz), also can help with symptoms of depression. And there's evidence that some antidepressant drugs can help with psoriasis. In studies, escitalopram (Lexapro) and paroxetine (Paxil) eased both depression and psoriasis symptoms.

A technique called cognitive behavioral therapy (CBT) can be 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

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."

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

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News release, American Academy of Dermatology, August 2015.

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Archives of Dermatology: “Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy.”

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