We know all too well that there are times when living with PsA can absolutely suck. A chronic condition which brings pain, fatigue, stiffness and skin complaints? It would take a super hero not to have some truly bleak days. It may come as little surprise (particularly if you experience it yourself) that over one in five people with PsA have also been diagnosed with depression.1
A survey conducted recently found that unemployment, pain, and fatigue were identified by people with PsA as the key triggers of depression,1 but the link may actually go even further the impact that PsA can have on quality of life; scientists are starting to see biological links between the two. In fact, psoriasis patients who developed depression were at a 37% greater risk of subsequently developing psoriatic arthritis compared with psoriasis patients who did not develop depression.1
The research on the link is still a little unclear (and more studies are currently underway), but the important place to start is this: depression isn't simply emotional or psychological - it also has physical effects, with changes in inflammatory and immune markers having been reported in people with depression.
There's a growing pool of evidence that indicates that the same processes that trigger inflammation in psoriatic disease may also create changes in the brain that affect emotional states. Scientists are now learning more about the correlation among stress, depression and psoriatic disease and are testing new therapies that could potentially help to treat all of those things.1
A lot of PsA symptoms are caused by cytokines (proteins that can affect other cells and cause them to go into overdrive at the slightest physical injury).2 Raised levels of these cytokines may be associated with the increased signalling in areas of the brain that are typically associated with depression-like symptoms, indicating that the same link could be made in people living with PsA.3
Armed with the knowledge that cytokines may be doing double duty in some psoriatic disease patients, leading to both physical and emotional disorders, doctors could develop new treatments that can stop the cycle of inflammation, and the associated stress and depression.
Advances in treatment have the potential to help people who suffer with the co-morbidity of PsA and depression, but there are also other tools that may help. Cognitive behavioural therapy is an area which could also have real value; in a study trial of psoriasis patients, scientists split the cohort into two groups. All stayed on their regular treatment, but one group also underwent six weeks of group therapy, where they learned coping skills and strategies for overcoming negative beliefs. After only six months, 64 percent of patients participating in group therapy had achieved more than 75 percent improvement in their psoriasis, compared to only 23 percent of patients not in the therapy group – which is pretty amazing!4
If you're experiencing depression or anxiety (another condition linked with PsA, which you can read more about here), then it's really important to speak with loved ones, doctors and friends to ensure that you get the support you need. Don't forget, our community is also here for you through the good days and bad.
1McDonough, E et al. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014 May;41(5):887-96 https://www.ncbi.nlm.nih.gov/pubmed/24692521
2Zhang, JM et al. Cytokines, Inflammation and Pain. Int Anesthesiol Clin. 2007 Spring; 45(2): 27–37 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785020/
3Nadeem, A et al. IL-17A causes depression-like symptoms via NFκB and p38MAPK signaling pathways in mice: Implications for psoriasis associated depression. Cytokine. 2017 Sep;97:14-24 https://www.ncbi.nlm.nih.gov/pubmed/28570931
4Psoriasis: Assessment and Management of Psoriasis. NICE Clinical Guidelines 153. https://www.ncbi.nlm.nih.gov/books/NBK327714/
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