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‘We’ll Get Better Together’

You are most certainly not alone when you are dealing with anxiety or depression.

It may seem like everyone else has their lives together. Between beautiful photos on social media and inspiring stories in the pages of National Psoriasis Foundation (NPF) magazines, it might feel as if you are the only one who experiences emotions like depression and anxiety.

But dig a little further, and you will hear stories of people who wanted to give up and who still struggle every day to put one foot in front of the other.

Mental health can be difficult to talk about, even with loved ones or health care providers. It is an act of vulnerability that many people do not have experience with. But as with psoriatic disease, ignoring the problem does not make it go away.

As you may know, anxiety and depression are common comorbidities of psoriatic disease. People with psoriasis have an increased risk of being diagnosed with depression and anxiety, and the risk may be even higher for those with psoriatic arthritis (PsA). [1] Rheumatologist Vinod Chandran, M.D., Ph.D., says that in one of the studies he and his team worked on, people with PsA were more likely to deal with anxiety.

“About 1 in 5 patients in the psoriasis cohort had anxiety, according to this questionnaire, and more than a third in the PsA group did,” he says. “The stigma of the skin as well as joint disease, the chronic pain that is associated with the arthritis, and the inflammatory state associated with the disease in general all likely play a big role in the higher prevalence of mental health problems in patients with psoriatic disease, and psoriatic arthritis in particular.”

Dr. Chandran also says more and more research is showing the potential relationships among psoriatic disease, inflammation, and depression. There are possible treatments and disease management plans that can address both depression and anxiety while treating psoriasis or PsA. But much more research is needed to better understand this connection. “[There’s still] lots of work to do quantifying the relationship between inflammation and depression,” he adds.

People dealing with chronic conditions or diseases – especially the chronic pain that can come with PsA – might dismiss symptoms of depression and anxiety, says Dr. Chandran. He emphasizes, however, that not everyone who has PsA experiences these symptoms.

“It’s not a given that every patient with arthritis has [mental health] issues, especially if you recognize it and treat [PsA] overall. The arthritis also will feel much better, and the quality of life will improve,” says Dr. Chandran. He adds that many people with psoriatic disease are treated with a biologic and an antidepressant or anti-anxiety medication concurrently.

Dr. Chandran notes that those with psoriatic disease also may face a lesser-known challenge when it comes to mental impacts and disease severity. “If you have anxiety or depression, then you are less likely to respond to [psoriatic disease] treatment and reach a state of minimal disease activity,” he says. This makes it especially important to note any changes in your mood, especially if they impact your day-to-day life. Talk to your primary care provider, dermatologist, or rheumatologist if you suspect anxiety or depression or if you experience mood changes.

“If we diagnose early and start treatment early before the disease gets really well-established, you likely prevent many of these comorbidities,” says Dr. Chandran.

And that includes mental health problems. “It’s not the difficulty in treating the psoriatic part with the current medication that we have, but managing the pain and anxiety, depression, metabolic syndrome, obesity – those things are integral to the disease but still not directly under the control of the dermatologist or the rheumatologist,” he adds. “That is where we have the biggest challenge. And so, ideally, we need to really work closely with primary care and necessary specialists.”

You can do things that can help keep mental health challenges and the other comorbidities of psoriatic disease in check. Dr. Chandran says a regular exercise regimen, good sleep, and mindfulness practice can help. At times, though, that is easier said than done, particularly when dealing with mental health problems. “Yes, you might feel a little worse initially, but eventually, with continued small baby steps, you will ultimately do better,” he says.

Mobility and low-impact exercise routines often are suggested for those with PsA. [2] Even for people without PsA, exercise can improve energy and sleep, and reduce anxiety and depression. [3]

Just as with psoriatic disease, depression and anxiety affect everyone differently. While some may experience intense sadness and hopelessness, to others it may seem as though their ability to have any emotions – good or bad – has abandoned them. If the way your depression or anxiety manifests is different than what you see on TV or what you have heard about from others, this does not mean it cannot or should not be treated.

Ultimately, though the cause of depression may be unknown, you have options that can get you back to your old self. For some, that means treatment with antidepressants or anti-anxiety medication, talk therapy, or exercise. It is important to remember that you deserve to feel your best. While sometimes that may feel like an impossibility, you do not have to make all the changes and decisions at once or in a hurry. And you do not have to do it alone.

Dr. Chandran advises those with psoriatic disease to keep watch for symptoms of depression or anxiety. If a family member is impacted by psoriatic disease, keep watch for him or her. “Look out for each other, and we’ll get better together. We are all there to help each other out,” he says.

You Are Not Alone

Learn more about screening for anxiety and depression at adaa.org/find–help/treatment–help/self–screening.

References

1. McDonough E, Ayearst R, Eder L, et al. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014; 41(5): 887–896. doi:10.3899/jrheum.130797.

2. Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Care Res. 2019; 71(1): 2–29. doi:10.1002/acr.23789.

3. U.S. Department of Health and Human Services. Physical activity guidelines for Americans, 2nd edition. https://health.gov/sites/default/files/2019-9/Physical_Activity_Guidelines_2nd_edition.pdf.

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