Depressed With Psoriasis? You’re Not Alone

When you hear the word “psoriasis,” you probably think about its effects on skin. But the condition can also have an impact on mental health, and in some cases, lead to depression.

“Psoriasis is more than just a dermatological issue, and it has profound psychological and emotional impacts,” says Zishan Khan, MD, a psychiatrist with Mindpath Health in Frisco, Texas.

Many people with psoriasis also experience varying levels of psychological distress from the condition.

While social factors like self-esteem issues or embarrassment over how psoriasis physically looks can worsen mental health issues, research suggests other factors can contribute to depression as well.

Inflammation

As in the case with many autoimmune diseases, one of the primary causes of psoriasis is inflammation. With psoriasis, the lack of regulation within the immune system that leads to inflammation can also play a role in the development of depression.

“This is one reason why individuals with psoriasis and other inflammatory conditions may have higher rates of depression and anxiety,” Khan says.

Physical Discomfort

Reduced Self-Esteem and Isolation

A skin condition like psoriasis can lead to social withdrawal, Khan says. This is particularly true when affected areas are highly visible.

Hannah Kopelman, DO, a dermatologist with Kopelman Aesthetic Surgery and Kopelman Hair Restoration in New York City, says this is often the case with psoriasis, which commonly affects the scalp, elbows, arms, and knees.

Some with psoriasis feel concern about how the public or loved ones will react to their skin’s appearance. “One of the most common things with psoriasis is that people don’t want to leave their house because they’re depressed by their skin manifestations,” Dr. Kopelman says.

This impact on self-esteem can lead to social avoidance. “The social withdrawal, avoidance of intimate relationships, and anxiety about public perception can lead to feelings of loneliness, which is a significant risk factor for depression,” Khan says.

“Low self-esteem is common in individuals with psoriasis, particularly if they have experienced bullying, comments about their appearance, or rejection due to their condition,” he says.

Co-occurring Conditions

Because psoriatic arthritis has the potential to affect mobility, this can further contribute to social isolation and make someone less likely to engage in things that them bring joy, Kopelman says.

• Cardiovascular disease
• Hypertension
• Anxiety and depression
• Type 2 diabetes
• Chronic obstructive pulmonary disease (COPD)
• Cancer
• Metabolic syndrome
• Obesity
• Inflammatory bowel disease (IBD)

Navigating additional health concerns alongside a visible skin condition can prove overwhelming. This can ultimately lead to worsening depression.

Kopelman says depending on the severity of your psoriasis, you may need to routinely take medication, especially during an active flare-up.

If you’ve experienced depression, you know that sometimes the simplest of tasks can feel difficult, so keeping up with routine can feel impossible. This means that during a depressive episode, the need to stay on top of psoriasis treatment can make daily life even more challenging.

While depression itself may not worsen psoriatic symptoms, taking medication and attending therapy won’t completely eliminate them. The anticipation of these symptoms and the challenges they bring can also lead to stress.

Khan says, “There is a significant psychological burden that comes with having a chronic condition. The unpredictability of flare-ups and the lifelong nature of the disease further lead to feelings of helplessness and frustration.”

It’s important to recognize the signs of depression, especially if it’s affecting your ability to navigate your regular day-to-day life.

According to Khan, some examples of depressive symptoms include:

• Persistent feelings of sadness or low mood
• Anhedonia, or loss of interest in activities an individual once enjoyed
• Fatigue and low energy
• Changes in appetite and weight
• Sleep disturbances, including insomnia or hypersomnia
• Difficulty concentrating
• Feelings of hopelessness, helplessness, and worthlessness
• Thoughts of self-harm or suicide

When it comes to treatment, there are many options for managing psoriasis and depression. In some cases, one treatment can address both conditions. Try the following.

Consider Therapy and Take Steps to Reduce Stress

Khan says techniques such as meditation and deep breathing can be helpful in managing emotional responses alongside therapy for depression. “Support groups and other forms of therapy can also be helpful, since talking to others who understand the condition reduces feelings of isolation,” he says.

Ask Your Doctor About Medication Options

There are also prescription medications that have been effective for psoriasis, depression, or both. Khan says these include:

• Biologics These medications that come from living organisms don’t just target psoriasis, but because they reduce inflammation, could also have secondary effects on depression.

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• Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs can help with depression and anxiety, and adding stability to your overall mental health can help with coping during psoriatic flare-ups.

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• Antidepressants Because antidepressants (not including SSRIs, which are a type of antidepressants as well) can also be anti-inflammatory, they can be helpful in managing both depression and an inflammatory condition like psoriasis.

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Strengthen Social Ties

Concerns about appearance can affect depression risk when they lead to isolation and withdrawal from social interactions. Pain, especially for those with psoriatic arthritis, can also affect someone’s ability to socialize.

Even though social interaction is vital to mental wellness, the combination of depression and psoriatic symptoms can make it hard.

This is especially true if you’ve found yourself struggling to share the impact of your conditions. Khan shared some first steps to navigate these challenges.

• Be open with loved ones. Being honest about how your skin condition affects your life is important when trying to bridge an emotional gap with others. For those without psoriasis or depression, hearing about the impact can make a difference. “It’s important for one to express how psoriasis affects mental health and why emotional support is valuable,” Khan says.
• Lead with education. Sometimes the root of misunderstandings about psoriasis and depression is a lack of knowledge. Share what you’ve learned (either through lived experience or research you may have done) with your loved ones — it could make a difference. “Education is key,” Khan says. “I’m often shocked at how many family members of those with psoriasis fail to understand that it is an autoimmune condition and not a result of poor hygiene or personal failure,” he says.
• Establish boundaries. Unfortunately, not everyone is going to understand or be empathetic to your experience. If you’ve tried open communication with loved ones and it doesn’t go well, it’s okay to center your needs and limit what interaction or conversation looks like. Khan says, “If family members make insensitive comments, it is okay to establish boundaries to protect your emotional well-being and prevent an exacerbation of mental health symptoms.”

Ultimately, being open and encouraging discussion about all aspects of the condition lessens the shame and stigma.

If you’re not yet diagnosed with psoriasis but you have concerns about your skin health or connected conditions, a consultation with a healthcare provider or dermatologist is a great first step.

Whether you’re in the process of being diagnosed or just noticing changes in your mood, a mental health professional can be beneficial. Try connecting with someone who has experience counseling patients who have autoimmune conditions, but ultimately any professional well versed in coping techniques or recommended modalities like CBT or mindfulness could be helpful.

“It’s very important for one to seek help for both psoriasis and depression, as a combined approach,” says Khan. “Addressing both the physical and psychological impacts, can lead to significant improvements in one’s quality of life.”

“I encourage anyone experiencing persistent symptoms of depression that interfere with their daily functioning to consider seeking help from a mental health professional. This is especially important if there are feelings of hopelessness, self-harm, or suicidality that arise — in which case immediate intervention is crucial.”

The Takeaway

• Psoriasis and depression have a two-way relationship because of several potential factors, including inflammation, physical discomfort, and social isolation.
• Inflammation in psoriasis can contribute to neuroinflammation in the brain, which may also play a role in depression.
• The visibility of psoriasis can lead to social withdrawal, low self-esteem, and feelings of isolation, which are major risk factors for depression.
• Therapy and medication, as well as talking with loved ones and strengthening social ties, can help both conditions.