The Connection Between Psoriasis and Depression

Causes, Symptoms, Treatment, and Coping

In This Article

Psoriasis is an inflammatory skin condition where skin cells build up and form scales and itchy, dry, and painful patches. There is no cure for psoriasis, but disease symptoms are treatable and manageable.

In addition to affecting the skin, psoriasis can affect a person’s mental health. Research shows people with psoriasis are more likely to develop depression. This is because psoriasis has a major impact on mental health and well-being due to numerous factors, including stress of living with the condition, inflammation, pain, and fatigue. 

Here is what you need to lnow about the connection between psoriasis and depression, including potential causes and triggers, symptoms, treatment, and coping. 

Connection Prevalence

According to a 2014 report in the American Journal of Preventive Medicine, psoriasis affects nearly 7 million American adults. The report’s authors further note people with psoriasis report more mental distress and are about 1.5 times more likely to report mild to severe depression than others without psoriasis.  

The severity of psoriasis is not a deciding factor when to comes to risk of developing depression, this according to a 2016 study in JAMA Dermatology. In fact, the risk is not significantly different in people with limited psoriasis versus those with severe disease. 

A study reported by the Indian Journal of Psychological Medicine in 2015 aimed to determine the effect living with psoriasis had. The researchers specifically wanted to measure the prevalence of anxiety and depression in people with psoriasis and determine the part disease severity and quality of life played. The 90 psoriasis patients were assessed over a one-year period. Researches used a psoriasis area and severity index to determine the severity of psoriasis and a perceived stress scale to screen for depression, anxiety, and stress. Quality of life was also measured.

Of the 90 study participants, 71 (78.9%) reported they were depressed and 69 or (76.7%) had anxiety. Fifty-one were living with significant stress. The researchers determined severity and duration of psoriasis had a strong effect on depression, anxiety, and stress. Further, disease severity had a negative effect on social relationships and other aspects of quality of life. Quality of life was worse for people who lived with both psoriasis and a mood disorder, this in comparison to those with psoriasis alone.

A study reported in 2015 in the British Journal of Dermatology investigated the risk of depression in American women with psoriasis and psoriatic arthritis (PsA). PsA is a type of inflammatory arthritis that affects some people with psoriasis. The researchers found the risk for depression was higher in the women with psoriasis, this in comparison to women without the condition. The risk was even higher in women who also had PsA.

Causes and Triggers

Psoriasis is a disease that comes with social and behavioral elements. That means the answer is not as simple as saying someone is depressed because of the appearance of their skin. Most of the time, the underlying causes of depression are not always obvious. However, there are several things can contribute to depression in people with psoriasis. 

Factors that may contribute to depression in people with psoriasis may include: 

Inflammation

Researchers have found the same inflammatory processes that cause psoriasis may also contribute to depression. For example, one 2017 report in the Journal of European Academy of Dermatology and Venereology reported on how ongoing inflammation—as a result of elevated cytokines—is a likely culprit of the physiological and biochemical changes that drive depression and other mood disorders. Cytokines are proteins involved in the inflammatory process.

Discomfort

Psoriasis is an uncomfortable condition. It causes the skin to itch, burn, crack, and bleed. Living with uncomfortable and painful symptoms can make anyone depressed. 

Embarrassment

It is not usual for people who live with psoriasis to feel embarrassed when they look at their skin. One 2017 targeted review in Seminars in Arthritis and Rheumatism finds the visibility of psoriasis can result in “poor psychological function” in people with the condition, “causing embarrassment, self-consciousness, and depression,” and feelings of “rejection, shame, and guilt.”

It is not easy to hide red, scaly patches, especially in the warmer weather months. And it is possible people will treat you differently because they don’t know what psoriasis is, or they think you may be contagious. 

Social Avoidance

Sometimes, people with psoriasis—especially during periods of flare (high disease activity)—tend to be more socially withdrawn. The lack of social interaction and support many promote depressive symptoms and/or make them worse. 

Stress

Because psoriasis causes emotional stress, it may trigger depression as well as a cycle of psoriasis flares. When a person is stressed, their brain releases certain chemical messages, some of which also affect immune cells. Immune cells may then increase inflammatory cytokines to the brain, causing more inflammation and depression. The process becomes a vicious cycle where stress induces inflammation and inflammation causes more stress. 

Low Vitamin D

Studies have shown that people with psoriasis may have low levels of vitamin D. Research has also a connection between low vitamin D and depression. One 2017 report in the journal Neuropsychiatry reports that while low vitamin D is not the main cause of depression, it is one of many contributing factors. Therefore, low vitamin D, in conjunction with other psoriasis factors, may increase a person’s risk for psoriasis-related depression. 

Signs of Depression

Most everyone feels sad, lonely, or depressed from time to time. In fact, these feelings are normal reactions to loss, struggles, or hurt feelings. But it is when these feelings become overwhelming, last for long periods of time, cause physical symptoms, or keep you from leading a normal and active life, that they become a concern. 

Untreated depression may get worse and last for months or even years. It may lead to physical pain or suicidal thoughts. Therefore, it is important to recognize the symptoms early on. Unfortunately, only about half of the people who suffer from depression worldwide ever receive a diagnosis or treatment, this according to the World Health Organization.

Signs you may be depressed include: 

  • Extreme fatigue
  • Cognitive problems, such as trouble with concentration, making decisions, and remembering details
  • Feelings of guilt, worthlessness, and helplessness
  • Feeling hopeless
  • Irritability and restlessness
  • Sleeping problems, including trouble falling asleep, early wakefulness, or sleeping too much
  • Overeating or appetite loss
  • Loss of interest in activities once enjoyed
  • Persistent sadness, anxiety, or emptiness
  • Aches, pains, headaches, and cramps that don’t go away
  • Digestive problems that don’t resolve even with treatment
  • Thoughts of suicide or suicide attempts

You shouldn’t ignore any of the signs or symptoms of depression because they can negatively affect your quality of life. Make an appointment with your doctor to find out how you can feel better. 

Treatment and Coping

There are several different treatments and coping strategies to help you manage psoriasis depression.  

Talk Therapy

Psychotherapy, also called talk therapy, is one way to get help for depression. It involves talking to a trained mental health professional who can help you determine the causes of your depression and what you can do to feel better.

Support Groups

Talking to others with psoriasis can help you get emotional support from someone who understands what you are going through. Support groups can help you to share experiences with others also living with psoriasis. You can find support groups online and in person. 

Lean on Loved Ones

If you are feeling lousy, spending time and talking to a loved one may be helpful in managing feelings related to living with psoriasis. People with psoriasis who get support from loved ones are more likely to feel better and less likely to have depression. 

Vitamin D Supplements

If low vitamin D is contributing to depressive symptoms, psoriasis, or both, it is possible vitamin D supplements may help. According to a 2015 study reported in the International Journal of Dermatology, taking vitamin D supplements and applying skin creams containing vitamin D can reduce severity of psoriasis symptoms. If psoriasis severity is lessened, a person’s risk for depression may be reduced and their stress alleviated.  

Biologic Therapy

Biologics may reduce the risk of depression and help improve depressive symptoms. A 2016 study reported in the journal Medicine looked at the effects of biologics on depression in people with PsA or psoriasis. Before using biologics, about 20% of the study participants were taking anti-depressants. After two years of taking biologics, there was a 40% reduction in anti-depressant use. 

Stress Management

Stress is a major contributor to psoriasis flare-ups and depression. There are things you can do to manage stress including:

  • Taking time each day to destress. Try meditation or simple breathing exercises.
  • Try to think positive thoughts at bedtime. Feeling stressed and worried at night can make you feel stressed and fatigued the next day. You can also practice counteracting pessimistic thoughts with positive ones. 
  • Relax your muscles. Stress can cause muscles to get tense, but you can loosen them and refresh your body by stretching, going for a walk, or taking a warm shower.
  • Take a break. Downtime can help get your mind off stress. Try listening to your favorite music, praying, doing yoga, or spending time in nature.
  • Make time for hobbies. Try setting time aside for the things you enjoy doing, such as reading, playing golf, watching a movie, etc. Do at least one thing you enjoy daily. You don’t even have to do it for a long period—15 to 20 minutes is enough time to help you to relax.
  • Be kind to yourself. Sometimes, you just have to accept there are things out of your control. Stop thinking and stressing so much. And don’t forget to laugh, as this goes a long way in helping you to manage stress. 

Anti-Depressant Medications

Ask your doctor if you need medication to manage depressive symptoms. Anti-depressant medications are helpful because they work by increasing the levels of serotonin in the brain. Serotonin is a brain chemical responsible for feelings of well-being and happiness.

A Word From Verywell

Psoriasis is a long-term disease with no cure. It is likely to make you feel like you are not in control of your life. Some people you in your life may tell you just have to learn to live with all the aspects of the conditions, but that is not necessarily true. There are plenty of treatment options to clear your skin clear and keep you feeling good. When your symptoms are improved, so is your mood. You will also feel better about yourself and life in general. 

But medication is not the only option you have for feeling better. Make sure you are eating healthy, managing your weight, getting enough sleep, staying active and not smoking or drinking alcohol in excess. All these things can help you to stay healthy and in control. They can also help ease your psoriasis symptoms. 

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