Treatment of Psoriasis in Patients with Anxiety and Depression
Clinical Scenario
Psoriasis commonly co-occurs with anxiety and depression. Dermatologists and primary care providers should routinely screen patients with psoriasis for signs and symptoms of both conditions, as their presence directly informs which therapeutic approach is most appropriate.
Comorbidities
In this scenario, anxiety and depression are the defining comorbidities. Their recognition changes the clinical calculus: the chosen psoriasis therapy should be one with evidence of benefit for the psychiatric symptoms as well as the skin disease.
Treatment Approach
Psoriasis-specific therapy — including biologic therapy — is recommended to simultaneously address skin disease and the associated anxiety and depression.
The complete protocol specifies agents, selection guidance, and monitoring parameters. Access it via the button below.
Treatment Goals
The target is a concurrent reduction in anxiety and depression symptoms alongside measurable improvement in skin disease — evidence consistently shows that when psoriasis improves, psychiatric symptoms improve in parallel.
References
DOI: 10.1016/j.jaad.2018.11.058
- Patients with psoriasis should be asked about signs and symptoms of anxiety and depression by their dermatologist or primary care provider.
- Psoriasis-specific therapy is recommended as a measure to improve psoriasis-associated anxiety and depression in individuals with psoriasis.
- In a multicenter, randomized, open-label study of 352 psoriatic patients, etanercept treatment significantly improved scores for concomitant depression and anxiety.
- This study showed a significant improvement in DLQI at 16 weeks in patients with psoriasis treated with adalimumab compared with those treated with placebo.
- A similar study by Langley et al showed a significant improvement in DLQI at 52 weeks in patients with psoriasis treated with ustekinumab compared with those treated with placebo.
- Patients receiving the modified Goeckerman regimen for psoriasis showed a significant improvement in anxiety and depression scores compared with those who received conventional therapy.
- The improvement in mental health of psoriatic patients treated with biologic therapies and the modified Goeckerman regimen support the use of these therapeutic agents to manage psoriasis and simultaneously improve anxiety, depression, and suicidal ideation, if present.
- These studies strongly suggest that when skin disease improves, patients have a concurrent improvement in their psychiatric symptoms.
View source ↗