Does Psoriasis Lead to Depression?

Psoriasis and depression can occur on their own, but when a person has psoriasis, their risk of developing depression is higher. Depression is also linked to psoriatic arthritis (PsA), an inflammatory form of arthritis connected to psoriasis but classified as a separate disorder.

While psoriasis is a skin disorder that causes plaques and scales to build up on the skin, psoriatic arthritis causes inflammation within the joints and spine, leading to joint pain, swelling, and stiffness. Both psoriatic arthritis and psoriasis can lead to depression, which is a mood disorder marked by symptoms such as chronic sadness and a lack of interest.

This article will discuss the connection between psoriasis and depression, including potential causes and triggers, symptoms, treatment, and coping. 

Likelihood of Depression Increases

Psoriasis, psoriatic arthritis, and depression are all common disorders. Research showed that roughly 7.6 million adults in the United States have psoriasis. Psoriatic arthritis also affects a large number of people, roughly one million U.S. adults. Of those with psoriasis, about 30% will also experience psoriatic arthritis.

According to the Anxiety and Depression Association of America, depression is one of the leading causes of disability in young adults and affects more than 16 million American adults.

Although the average age that depression begins is 32 years old, it can occur at any age, and adolescents under 18 are shown to have high rates of depression. It’s estimated that roughly 3.2 million people between 12 and 17 experience major depressive episodes.

Research also showed that people who have psoriasis are close to 1.5 times more likely to develop depression. According to one review, roughly one in three people with psoriatic arthritis also have depression.

Women are more likely than men to experience depression if they have psoriasis or psoriatic arthritis.

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.

The underlying causes of depression are not always obvious. However, several things can contribute to depression in people with psoriasis.

Inflammation

Researchers have found the same inflammatory processes that cause psoriasis may also contribute to depression. For example, one report found ongoing inflammation—as a result of elevated cytokines, including IL-1 and IL-6—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. Researchers found that 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 months. And it is possible that 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 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, such as cortisol and adrenaline, 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 shown a connection between low vitamin D and depression.

Researchers report 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, 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
• Thoughts of suicide, or suicide attempts

Depression may also manifest in physical symptoms such as:

• Aches, pains, headaches, and cramps that don’t go away
• Digestive problems that don’t resolve, even with treatment

Treatment and Coping

There are several different treatments and coping strategies to help you manage psoriasis and 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 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, vitamin D supplements may help. Research suggests that 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 study looking at the association between taking biologics and taking antidepressants in people with PsA or psoriasis found that before using biologics, about 20% of the study participants were taking antidepressants. After two years of taking biologics, there was a 40% reduction in antidepressant use. 

Stress Management

Stress is a major contributor to psoriasis flare-ups and depression. Things you can do to manage stress include:

• Take time each day to destress. Try meditation or simple breathing exercises.
• 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. Set 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 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 manage stress.

Antidepressants

Ask your healthcare provider if you need medication to manage depressive symptoms. Antidepressant 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.

Summary

Research has shown that psoriasis increases your risk of developing depression. This may be a result of the inflammation caused by psoriasis, vitamin D deficiency, social avoidance, stress, and embarrassment. To cope with depression linked to psoriasis, keeping your condition under control, joining support groups, managing stress, and taking antidepressants can help relieve depressive symptoms.

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 in your life may tell you that 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 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 stay healthy and in control. They can also help ease your psoriasis symptoms.