Psoriasis, Depression, and Inflammatory Overlap: A Review

Abstract

Psoriasis has an enormous impact on patients' lives and is frequently associated with depression. Depression in psoriasis may be attributed, at least in part, to elevated proinflammatory cytokines rather than the psychosocial impact of psoriasis itself. Biologics that target inflammatory cytokines treat the clinical manifestations of psoriasis, but may also play a role in reducing associated depression. Multiple biologics have decreased symptoms of depression during clinical trials in psoriasis; however, these studies used a variety of depression screening tools, which limits comparison. Furthermore, it is difficult to distinguish whether improved depression is the result of the direct anti-inflammatory effect of the biologic, or the indirect effect of improved psoriasis leading to better psychological status. Future studies evaluating depression in patients with psoriasis could benefit from a standardized depression screening tool to mitigate discrepancies and facilitate comparison across treatment types. Here, we highlight the inflammatory overlap between psoriasis and depression by examining the pathophysiology of depression, and reviewing psoriasis clinical studies that assessed depression as an outcome measure.

Depression Symptoms Predict Worse Clinical Response to Etanercept Treatment in Psoriasis Patients

“…Many clinical characteristics of psoriasis patients are reported to be correlated with psychological disorders, including depression, anxiety, and others [1, 4, 11, 14]. Partially in line with previous studies, our study demonstrated that female gender, long disease duration, and high PASI score were positively associated with depression symptoms, and female gender, large psoriasis-affected BSA, and high PASI score were positively associated with anxiety symptoms in psoriasis patients.…”

Differential effects of secukinumab vs. ustekinumab for treatment of psoriasis on quality of life, work productivity and activity impairment: a structural equation modelling analysis

“…We explored whether a psychological variable such as depression could play a role in explaining some of these relationships, following recent findings of an increased likelihood of depressive symptoms or clinical depression among patients with psoriasis. These may be explained in part by the systemic inflammatory responses of psoriasis that increase the risk of brain inflammation . The only psychological variable available from the CLEAR study is the single item from the EuroQol‐5D (EQ‐5D) that asks about the extent to which the patient feels anxious or depressed today.…”

“…These may be explained in part by the systemic inflammatory responses of psoriasis that increase the risk of brain inflammation. 4,27,28 The only psychological variable available from the CLEAR study is the single item from the EuroQol-5D (EQ-5D) that asks about the extent to which the patient feels anxious or depressed today. As an example, the results of the models of the WPAI that included the EQ-5D anxiety/depression variable showed that improvements in pain Direct effects are depicted as an arrow emanating from an independent variable leading and pointing to a dependent variable (outcome).…”

“…The appearance and lifelong, chronic nature of psoriasis result in considerable burden to patients, such as sleep impairment, depressive symptoms, negative self‐esteem and reduced work productivity . Assessment of psoriasis severity and response to treatment in clinical trials is typically made using the Psoriasis Area and Severity Index (PASI) .…”

Childhood trauma: a risk for major depression in patients with psoriasis

“…Medical diseases may be components of the complex pathway that determine the emergence of depression [29]. Depression may merge with expression of dermatological disorders, as some severe skin diseases have an enormous impact on the quality of sufferers' lives [30,31]. Various studies suggested that depression is significantly more prevalent among patients with skin disorders [32].…”