PsoriasisNet Spotlight Article
Psoriasis Increases Risk for Depression Studies Show

Several studies have shown that people living with psoriasis have a higher-than-average risk for depression. To find out why, researchers have been talking with people who have psoriasis. Researchers also have been looking at what happens inside the body to learn if this could be fueling depression. This is what the studies show.

Psoriasis affects quality of life
Researchers have asked via telephone surveys, one-on-one interviews, and questionnaires what it is like living with psoriasis. In each of these studies, the overall conclusion is the same. Having psoriasis significantly affects a person’s quality of life. Here are some thoughts that people shared with researchers:

• Given that psoriasis is a lifelong skin disease that one must deal with daily, staying on an even keel can be a challenge.

• Psoriasis can undermine one’s sense of self and relationships. Some people say they feel ashamed. Others confess that they work hard to hide their psoriasis. One woman admitted that she tries to hide flare-ups from her husband.

• In one study, nearly half (46%) of the people living with psoriasis agreed it would be “the same” or “better” to have diabetes. Among the people who had psoriasis and diabetes, more than three-fourths (87%) said it is “the same” or “better” to have diabetes.

• Another study revealed that some people living with psoriasis said that they would choose a shorter life expectancy to avoid uncontrollable psoriasis.

• Some people said that they often feel like a leper. In one study, more than one-fourth (26%) of those living with psoriasis said that in last month they had encountered someone who avoided touching them.

• Having psoriasis often makes a person feel helpless.

Depression develops when these feelings of helplessness, hopelessness, and worthlessness last for several days — or even months. Depression interferes with normal everyday life. It can make life seem meaningless.

What triggers psoriasis may trigger depression
Feelings may not be the only culprit. In recent years, researchers have discovered that people who have psoriasis or psoriatic arthritis produce too much of a substance called TNF-alpha. Excess TNF-alpha in the body can lead to skin cells growing too quickly. When this happens, psoriasis develops. Excess TNF-alpha also can damage joint tissue and lead to psoriatic arthritis.

Studies are finding that excess TNF-alpha also is associated with depression. In clinical trials, researchers found that patients with psoriasis who saw results when taking medication that blocks TNF-alpha not only had clearer skin. Blocking TNF-alpha also seemed to lift their depression.

The reason that depression lifts is not entirely clear. It could be that blocking the TNF-alpha alleviates the depression. Another possible explanation is that people feel optimistic because they have clearer skin. More studies are needed to find out why the depression lifts.

Depression lifts with help
One thing researchers are sure of is this: Depression is a treatable medical condition. With help, the emptiness, hopelessness, and despair will lift.

How to recognize depression
Most people, even those with severe depression, can get better with treatment. The first step to overcoming depression is to recognize it. The National Institute of Mental Health (NIMH) lists the following as symptoms of depression:

• Feeling sad, anxious, or "empty" for more than a couple of days

• Feelings of hopelessness and/or pessimism

• Feelings of guilt, worthlessness, and/or helplessness

• Irritability, restlessness

• Loss of interest in activities or hobbies once pleasurable, including sex

• Fatigue and decreased energy

• Difficulty concentrating, remembering details and making decisions

• Insomnia, early-morning wakefulness, or excessive sleeping

• Overeating, or appetite loss

• Thoughts of suicide, suicide attempts

• Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

First step often the hardest
While life can seem hopeless, it is possible to change the way you feel. It can be very difficult to take any action when depression hits. The tips on the following page are designed to help you get started:

Psoriasis Action Plan: Dealing with Depression

References:

1. American Academy of Dermatology, “Research Shows Patients With Psoriasis At Increased Risk For Developing Other Serious Medical Conditions.” News release issued May 24, 2008. Available at www.aad.org/media/background/news/Releases/Research_Shows_Patients_With_Psoriasis_At_Increase/. Last accessed November 19, 2009.

2. American Academy of Dermatology Association and Society for Investigative Dermatology. “The Burden of Skin Diseases.” 2005. Available at www.lewin.com/content/publications/april2005skindisease.pdf. Last accessed November 19, 2009.

3. Choi J, Koo JY. “Quality of life issues in psoriasis.” Journal of the American Academy of Dermatology 2003; 49: S57-61.

4. Krueger G, Koo J, Lebwohl M et al. “The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey.” Archives of Dermatology 2001; 137: 280-4.

5. National Institute of Mental Health, “What are the signs and symptoms of depression?” Page last updated September 23, 2009. Available at www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub3. Last accessed November 19, 2009.

6.  Stern RS, Nijsten T, Feldman SR et al. “Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction.” Journal of Investigative Dermatology Symposium Proceedings 2004; 9: 136-9.

7. Van Voorhees AS, Fried R. “Depression and quality of life in psoriasis.” Postgraduate Medicine 2009; 121: 154-61.

8. Wahl AK, Gjengedal E, Hanestad BR. “The bodily suffering of living with severe psoriasis: in-depth interviews with 22 hospitalized patients with psoriasis.” Qualitative Health Research 2002; 12: 250-61.