Ronald Prussick, MD, Addresses Depression Trends Among Patients with Psoriatic Disease

Ronald Prussick, MD

Recent research from the National Psoriasis Foundation (NPF) found that 1 in 3 individuals living with psoriatic conditions experience depression. Because stress can trigger psoriatic disease onset and flare-ups, experts in the field have emphasized the importance of screening for, and managing depression in this population.

Ronald Prussick, MD, Dermatologist at the Washington Dermatology Center, George Washington University School of Medicine, and Fellow of the Royal College of Physicians of Canada, elaborated on the impact depression can have on this population and how clinicians can address this with patients going forward.

HCPLive: Can you speak about the relationship between psoriatic disease and depression?

Prussick: Patients with psoriatic disease have systemic inflammation and this inflammation increases the risk of other comorbidities including: cardiovascular disease, non-alcoholic fatty liver disease, and depression. The comorbidity risk generally correlates with the extent of the psoriasis. The more severe the psoriasis, the more risk of having other comorbidities. 

This is because psoriasis severity affects the amount of inflammatory cytokines in the body. It is estimated about a third of psoriasis patients can have depression. Patients with depression can also have a lot of the same increased inflammatory cytokines that psoriasis patients have such as: TNF Alpha, Interleukin 6 and Interleukin 17.

HCPLive: Does effective disease management impact the prevalence of depressive symptoms in patients?

Prussick: We do have data that shows that you can improve depressive symptoms with treatment. There was one paper that was published from the PSOLAR registry, it showed that patients who are treated with Biologics had about a 25% reduced chance of having future depression versus just using traditional systemic therapies or phototherapy.

There is also data that shows that patients with depression have a reduced chance of attaining good skin clearance from TNF-alpha inhibitor treatments. It is thought this is because when you have depression in addition to psoriasis you may have an elevated inflammatory cytokine burden.

HCPLive: What are some ways that depression presents in this population, and how can a clinician assess their patients if they’re unsure?

Prussick: I think its best to ask your psoriasis patient if their mood has really impacted their lives. I ask them what things they would like to do that they can’t do now due to their skin disease or their mental state. You also want to ask about behaviors that might suggest there is an increased risk of depression or anxiety such as: smoking, alcohol abuse, an eating disorder or drug use. I will also ask people about their appetite and if they sleep well at night.

HCPLive: What are the options for intervention when these conditions coexist?

Prussick: Give patients the proper support that they need. We can send them to their primary care doctor or refer to a mental health specialist if needed. Learning coping mechanisms are helpful. I also recommend 30 minutes of daily physical exercise, yoga or meditation. As well, studies show that if we clear the skin we may also improve depressive symptoms, therefore, going on a successful psoriasis treatment may be beneficial.

HCPLive: Is there anything else you wanted to bring attention to?

Prussick: It is also important to know that patients who develop psoriasis at a young age are more vulnerable to developing psychological problems. There was a study out of Sweden which looked at 101 consecutive adult patients with psoriasis and they did personality, anxiety and depression scores on them.

They found that patients who developed psoriasis before the age of 20 or younger had a much higher risk of developing psychological problems later in life. Based on this I think that it is especially important to treat psoriasis aggressively in young patients.

Stress is a known trigger factor for psoriasis and when patients have stress, they produce cortisol. Patients with psoriasis don’t produce as much cortisol as non-psoriasis patients and that can trigger inflammation. When patients with psoriasis get stressed, they should learn how to cope with their stress by using known stress-relieving therapies such as: yoga, meditation and breathing/mindfulness techniques. There are many different ways patients can try to reduce their stress to help prevent their psoriasis from getting triggered. 

For more information visit the National Psoriasis Foundation website https://www.psoriasis.org/.