Psoriasis, depression, and suicidality

By Lawrence J. Green, MD

Depression: A comorbidity of psoriasis

Depression should be considered a notable comorbidity in patients with severe psoriasis. The prevalence of depression in patients with psoriasis is 2%-33%. Because of the clinical presentation of severe skin disease over the body, patients are more likely to experience depression, anxiety, or other mental health disorders. There also is a risk for attempted and completed suicides.

“When you have severe skin disease, your immune system is all revved up, there’s inflammation going on in your body, [and] that adds more stress to the body,” reports Lawrence J. Green, MD. “And then you add on people looking at themselves and seeing their skin disease, that even enhances this comorbidity.”

In this video, Dr. Green discusses the prevalence of depression in patients with psoriasis.

How to help psoriasis patients

Developing a strong physician-patient rapport is an important aspect of caring for the whole psoriasis patient, so that patients can deal with the physical as well as psychological impact of their disease.

“We cannot let [patients] get stigmatized. It’s very important to try to give them the answers … so they can be prepared and tell [others], I have an autoinflammatory skin condition, it’s not contagious,” reports Dr. Green. He discusses practical tools to assess if a patient is depressed, and the importance of patient support groups such as the National Psoriasis Foundation. 

Impact of psoriasis treatment on depression

Ultimately, successful treatment leads to a happier patient.
Improvements in symptoms of depression during treatment suggest the potential to improve patients’ psychiatric outcomes with treatment.

However, patients need to be counseled on depression – and suicidal ideation and behavior in particular – when taking the biologic brodalumab in compliance with a Risk Evaluation and Mitigation Strategy (REMS) program, as mandated by the U.S. Food and Drug Administration. Dr. Green discusses the clinical trial results on brodalumab and the REMS program. 

Dr. Green is clinical professor of dermatology, George Washington University, Washington. He is a consultant, investigator, and/or speaker for AbbVie, Amgen, Arcutis Biotherapeutics, Dermavant Sciences, Eli Lilly, Janssen Pharmaceuticals, MC2 Therapeutics, Novartis, Ortho Dermatologics, Sun Pharmaceutical Industries, and UCB. 

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