Psoriasis and depression often occur together for me, due to obvious reasons. With severe psoriasis, I am constantly thinking about my treatments and therapy. If my skin is doing well, then I worry about when treatments might become ineffective, and what side effects I might be sustaining because of them.
If my skin is broken out or flaring, then I struggle with the discomforts of itching; inflexible, broken, and thick plaques; insomnia; social anxiety and self-consciousness; and pervasive negativity. These dynamics produce background anxiety and can lead to depressive symptoms.
But could there also be a biological link between psoriasis and depression? Adam Friedman, MD, associate professor of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, DC, makes a case in his blog “The Psoriasis-Depression Connection Probably Isn’t Just in Your Head” that inflammation could contribute to the depression often seen in psoriasis patients:
There is more to this story, and just like the many corresponding medical problems associated with psoriasis, depression is also likely a result of the cause of psoriasis: inflammation. The same inflammatory signals and molecules that create the skin lesions, joint pain, and increased risk for possibly every medical problem we know of can also cross the blood-brain barrier and impact a person’s mental and emotional state. The very same immune signals that are the foundation of psoriatic disease may in fact activate the brain circuitry that mediates various negative behavioral responses such as depression.
It’s thought-provoking that depression could at least be partly due to inflammation. Whatever the cause or origin, depression is clearly a comorbidity of psoriasis.
Running Out of Options
When I look back on my experience with psoriasis, I can think of different times when I felt particularly depressed, stressed, and anxious. I think of the time in 1989 when I went to the Psoriasis Research Institute, Palo Alto’s daycare clinic for a six week treatment program. Each weekday, for six hours a day, I underwent anthralin paste and UVB treatments. Or I think of the time when I broke out uncontrollably over Christmas break during my third year at the University of California in Davis before starting methotrexate therapy. But the worst I’ve felt physically and emotionally, by far, was the end of 2004 into the beginning of 2005.
During that time, many new biologics became available. I started taking the first FDA-approved biologic about a week after it arrived. I then switched to another biologic after about 16 weeks of my skin getting worse and worse on the first one. Every 12 to 16 weeks, I tried a new medication or therapy, including hydroxyurea, CellCept (mycophenolate mofetil), narrowband UVB phototherapy, Soriatane (acitretin), and methotrexate. Each time, my condition spread while increasing in severity.
By November 2004, I was 95 percent covered, with no part of my skin untouched. I also sported a deep ultraviolet light burn that took three weeks to heal.
I felt totally exasperated with my condition — ready to quit my job and throw in the towel. At the lowest moment, I sobbed for half an evening, with my dear wife and children taking turns trying to comfort me. I kept thinking about how limited I had become with my weakening health. I tried just about everything, and nothing worked. I lamented at how I had such a wonderful family but felt so useless to them.
I felt like I had run out of options. I didn’t want to deal with psoriasis anymore, but I knew I could not get away from this body with a broken immune system. I felt trapped and lost.
After many consultations with my dermatologist, he referred me to the University of California San Francisco Medical Center’s Psoriasis and Skin Treatment Center, where I found some hope. I started taking cyclosporine, a systemic medication, which began to clear the psoriasis a couple of months later. During this time, and in the years since, I learned to deal with the depression that comes with psoriasis.
Treating the Psoriasis
The most obvious way for me to overcome depression with psoriasis was for the condition to improve. If my psoriasis improves, then the inflammation and emotional triggers associated with it naturally improve, too. That’s what happened when I finally found an effective treatment.
In the midst of difficult treatment cycles, I try to tell myself never to give up hope, to be willing to try something new, and to be open-minded. I know myself enough to know that I get in trouble when I become negative and think that nothing will ever change (except perhaps for the worse).
Knowing This, Too, Shall Pass
Having been through some really tough flares, I dwell on the fact that psoriasis will recede at some point in the future. I just need to take things day-by-day, moment-by-moment. If I think too far ahead, I get easily overwhelmed.
Drawing from past experience tells me that whatever I’m going through won’t last forever. It’s become a mantra of mine that this, too, shall pass.
Reaching Out
Taking initiative to reach out to others who encourage and pray for me also lifts my mood in the lowest moments. Knowing I’m not alone strengthens my spirit and resolve, so writing my blog and talking to others with psoriasis or other chronic conditions improves my mental outlook.
More recently, I’ve become involved in both my local Northern California psoriasis community and the psoriasis blogger community at large. Those connections take some effort and energy, but become an incredible source of strength for me.
Slowing Down
I even once took a month-long leave from work, partly due to work stress, and partly due to psoriasis. At first I felt like a failure, but then I realized I needed the time to discover how I arrived at such a low state.
I started seeing a therapist during that break, who helped me work through my depression. The depressive episode slowly lifted. I began to feel a bit more energy, and to feel more hopeful. In the meantime, I listened to my health providers, who told me to exercise regularly, get out into nature, and get exposure to sunlight each day.
I know I have to slow down my life periodically and regularly by taking downtime from work, sleeping in more, saying “no” to nonessential activities, taking walks with my wife and dog, and so on.
Finding Inner Strength
Finally, the physical discomfort and mental burden that psoriasis brings has led me to explore the inner life and spirituality. I pray and meditate on Bible verses regularly (even more so when I am flaring or anxious), and seek to find calm and peace from within.
I believe that as long as I have severe psoriasis, I will be prone to depressive episodes. Thus, I focus on managing and coping the best I can to avoid falling too far down emotionally and mentally.
Definitely see your healthcare provider if you feel you have symptoms of depression that concern you. Also, check out this Everyday Health article on “11 Ways to Fight Depression When You Have Psoriasis.”
PHOTO CREDIT: Yenpitsu Nemoto/Getty Images