Psoriasis is probably best known for the scaly red patches it leaves on your skin. Less obvious are the marks it leaves below the surface. The emotional impact of this disease is huge, especially when psoriasis is very visible or covers large areas of your body.
Research shows that people with psoriasis have more mental distress and depression than those without it. The skin flares can be so uncomfortable and unpredictable that some people think about or attempt suicide.
While you're working with a dermatologist to treat your skin, it's important to care for your mental health, too. And if you ever think about hurting yourself, call your doctor, 911, or the suicide hotline (800-273-8255) right away.
Psoriasis and Your Emotions
It can be very stressful to live with psoriasis. Unlike many other conditions, like arthritis or diabetes, psoriasis is a visible disease. Its scaly plaques often form in places like the elbows, knees, scalp, and face -- parts of your body that aren't easy to hide. If you're among the 30% of people with psoriasis who also have psoriatic arthritis, sore joints are part of your life, too.
The skin plaques and other psoriasis symptoms, like itching and pitted nails, can affect your love life, social life, and work. Psoriasis can also wreak havoc with your emotions. Studies show that people with psoriasis are 1½ times more likely to have depression than those without this skin condition.
Inflammation is another piece of the mental health-psoriasis puzzle. Psoriasis is an inflammatory disease. Chronic inflammation is linked to mood disorders like depression. Inflammatory cells affect mood by changing levels of brain chemicals called neurotransmitters.
Living with a chronic inflammatory condition like psoriasis can put you into a loop of emotions and symptoms. Having psoriasis makes you feel stressed and anxious. When you're stressed and anxious, your psoriasis flares more. The flares make you feel even more stressed and anxious. When you're stuck in this cycle, it's hard to get out.
Having depression also makes you less likely to take your psoriasis medicine. When you don't take your medicine, your psoriasis could get worse, and you might have even more depression. That's why it’s important to break these cycles by getting treatment.
Why Psoriasis Affects Suicide Risk
In a survey done by the National Psoriasis Foundation, 87% of people with psoriasis said they felt embarrassed by their condition. Almost 90% were self-conscious about it.
Psoriasis can be a very stigmatizing disease. In one study, nearly 40% of people who weren't familiar with psoriasis said they wouldn't shake hands with someone who had the skin condition. Almost 30% thought psoriasis was contagious. If you're already upset about the way you look, the stigma can make you feel even worse.
Symptoms like itching and joint pain, plus the stigma of living with psoriasis, are reasons why almost 1 in 3 people with psoriasis have major depression. And depression is one of the biggest risks for suicide.
What We Know From Research
A review of studies found that people with psoriasis are nearly 30% more likely to attempt suicide, and 20% more likely to die by suicide, than people without this skin condition. The risk was highest among young people and in those with more severe psoriasis.
The problem is even greater in people with psoriatic arthritis, who have joint pain on top of skin flares. In one study, nearly half of people with psoriatic arthritis had thought about suicide. About 20% had planned suicide, and nearly 10% had attempted it. Along with feeling depressed and anxious, many people in the study said they'd lost the ability to feel pleasure.
Getting Treatment
If skin flares are getting you down, the first thing to do is get on a psoriasis treatment. New medicines called biologics block the reactions in your body that cause psoriasis symptoms. These medicines are very good at clearing your skin and bringing down inflammation.
Treating your psoriasis with a biologic also affects symptoms of depression. In studies, using etanercept (Enbrel) on psoriasis reduced symptoms of depression by nearly 30%, ustekinumab (Stelara) improved depression symptoms by 55%, and adalimumab (Humira) by more than 18%.
A newer biologic drug, brodalumab (Siliq), works very well at clearing the skin and also seems to help with depression and anxiety symptoms in people with psoriasis. But this medicine carries a “black box” warning about a possible increased risk of suicide. Black box warnings on a prescription drug’s label are designed to call attention to serious or life-threatening risks.
Siliq may not be a good fit for you if you've had depression or suicidal thoughts in the past. Because of the risks, the FDA limits access to this drug through a program called Risk Evaluation and Mitigation Strategy (REMS). Doctors who prescribe Siliq must be certified. And people who go on this medication have to sign an agreement before starting it.
If you haven't seen a doctor for your skin condition yet, now is the time to go. It's especially important for people of color to get treated. Although psoriasis isn't as common in Black and Hispanic people as it is in white people, people of color are less likely to see a doctor or to get biologic drugs. Going without treatment could put your mental health at risk.
What You Can Do
Watch for symptoms of depression. Talk to your primary care doctor or a mental health provider if you:
- Feel sad, hopeless, worthless, or empty
- Get angry or cranky more easily than usual
- Feel anxious or restless
- Lose interest in things you once loved
- Sleep too little or too much
- Eat more or less than you did in the past
- Have trouble thinking, concentrating, and remembering
Your doctor can screen you for depression. If you are depressed, talk therapy and possibly antidepressant medications can improve your mood and may also help clear up your skin.
If you've been thinking about suicide, get help right away. Call your doctor, a mental health provider, 911, or the Suicide & Crisis Lifeline at 988. They'll direct you to the care you need.
Part of the sadness surrounding psoriasis comes from feeling like you're the only one with this skin condition. Know that more than 8 million people live with psoriasis in the United States. That's a pretty big tribe.
Organizations like the National Psoriasis Foundation and Talk Psoriasis offer support groups for people with psoriasis. Joining one of these groups, either online or in person, will surround you with people who understand what you're going through. In a support group, you'll learn ways to cope with your condition and be reminded that you're far from alone in this journey.
