The Tricky Role Psoriasis Can Play In Mental Illness
People living with psoriasis show increased levels of anxiety, depression, suicidality, vocational impairment, social impairment, and impairments in relationships and intimate functions, says Dr. Richard Fried, a board-certified dermatologist and clinical psychologist at Yardley Dermatology Associates who sits on the medical board for the National Psoriasis Foundation. Because of these burdens, people with psoriasis are often unaware of the degree to which their psoriasis has impaired their quality of life.
Dr. Fried also points out that those most severely affected by their psoriasis are often selected for studies, leaving a potentially larger group of significantly affected individuals unspoken for. This may be one reason that psoriasiss effect on mental health is frequently underestimated. Fatigue, mild to moderate apathy, indifference, lack of pleasure in food, travel, and intimacy are often inappropriately attributed to age and other life factors, says Dr. Fried. Its only after the refinement of the clinical symptoms of psoriasis and the detrimental effects of internal inflammation are understood that the can realize how much their disease had diminished their engagement and quality of life.
Is There A Test For Psoriasis
To see if you have psoriasis, your doctor usually examines your skin, scalp, and nails for signs of the condition. They may also ask questions about your health and history.
This information can help the doctor figure out if you have psoriasis, and, if so, identify which type. To rule out other skin conditions that look like psoriasis, your doctor may take a small skin sample to look at under a microscope.
How Mental Health Affects Psoriatic Arthritis Management
When youre emotionally wiped out, you have less energy for following lifestyle habits that contribute to your overall health, like getting regular physical activity and preparing healthy meals. This, in turn, can increase your fatigue and decrease your ability to manage your psoriatic arthritis, explains rheumatologist Eric Ruderman, MD, a Professor of Medicine at Northwestern University.
In addition, theres a strong link between depression and medication non-adherence, or not following the treatment plan your doctor has prescribed.
Depression is one of the best markers of non-adherence to treatment, says Dr. Bartlett. People who are depressed are far less likely to be taking their treatment as prescribed. Part of that is due to the sense of hopelessness and helplessness thats very much a part of depression.
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More Than Skin Deep: The Emotional Impact Of Psoriasis
The symptoms of psoriasis arent always just on your skin. The impact on many peoples mental health is less visible, but can be just as serious.Research carried out by the National Psoriasis Foundation shows that people who have psoriasis are more likely to have depression than the rest of the population. The report also showed that women are more likely to struggle with the social and emotional side effects of psoriasis than men are1. Lets take a closer look at the link between psoriasis and depression, and what you can do to take care of your mental health and emotional wellbeing if you have psoriasis.
Does Psoriasis Get Worse With Age
No, Psoriasis doesnt get worse with age. Psoriasis may get better or worse depending upon environmental factors.
It is necessary to determine Psoriasis in its early stage to avoid worsening of the condition. Symptoms vary from person to person according to the type of hit. Common Symptoms include:
- Red, raised, inflamed patches of skin
- Silvery Scales and reddishness of skin
- Dry skin prone to bleeding
- Soreness around patches
- Skin-care products by Dermatology Pharmaceutical Companies
However, the clinical and surgical treatments for Psoriasis bring a number of side effects with them. Side effects include blood cancer, skin cancer, lung disorders, and cardiovascular diseases, etc.
So, most people avoid going for any clinical or surgical methods and prefer to go for skincare solutions or derma pharma products as they dont come with any side effects.
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Psoriasis And Bipolar Disorder
Psoriasis has proved to be related to some immunity abnormality in the body which causes the growth of cells 5x times its original rate. On the other hand, bipolar disorder is caused to a person who has come across some psychological or psychiatric problems which lead to devasted mental health.
At some point, both of these disorders affect two of the most important body functions, nervous and immunity. However, research has shown that psoriasis and bipolar disorder are related through psoriasis itself.
A person might start to feel irritated or frustrated after a while of fighting with this skin disorder. Thus, this can lead to some of the changes in the psychological aspects of the person, which are discussed above.
Living With Psoriasis And Self
Its taken me so long to come around to the idea of taking a biologic because I blamed myself for not being more consistent with topical treatments. I thought that if I could just be more diligent, my psoriasis wouldnt be so bad.
It was like boiling a frog maybe I could have kept it at bay in the beginning, but it just got worse and worse. Eventually, I was so accustomed to it and so convinced that its severity was my fault that I chose to stay in the scalding water rather than get a lift out on a ladle. I also do this with my mental health I must not be trying hard enough. If I just keep at it, I wont need to accept more help. If that sounds completely unreasonable, it is but its hard to change thought patterns like that.
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Is Cannabis A Solution
Psoriasis isnt curable and can be difficult to control. Although there are a variety of medications and light therapies for treating the disease, some have serious side effects and others lose their effectiveness when your body builds up a resistance to them.
Given the physical and emotional burden of psoriasis, new treatment options are needed. Cannabis is one of the treatment possibilities being explored. Research into the effectiveness of cannabis addresses different aspects of the disease.
Sexual Health Effects Of Psa
Several studies over the past 40 years have also found that sexual difficulties were reported in PsA patients, sometimes in as many as 70% of them. “When patients are experiencing a PsA flare-up, they may not feel comfortable having sex and sex can be painful,” Manos said.
Covert said that PsA has also had an effect on her sexual health. “Flares are unpredictable. Some last a few hours, some for days, while others may linger for weeks, months, or even years. The last thing I want to do when my body is throbbing in pain is to have sex with my husband.”
Covert suggested some strategies to handle the impact of PsA on sexual health and relationships talk with your partner, try different positions and different forms of intimacy to find what works best and advised against comparing yourself to others. “Do not compare your sex life with other couples or what you see in movies or read in novels.”
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Interference And Feedback Between Psoriasis And Mental Health
Stress is a common trigger of psoriasis, which is hard to fix because having psoriasis is pretty stressful. As my mental health waxes and wanes, my psoriasis follows suit in an awful feedback loop. The stress of depression makes my psoriasis flare, and the hit to my self-esteem certainly doesnt do good things for my depression.
My mental health definitely gets in my way when it comes to skincare. Even if I didnt have depression, I probably wouldnt be able to keep up with the treatment routine, but when depression makes getting out of bed and changing my clothes difficult, you can bet that Im not spending an hour and 20 minutes per day applying goop to the skin I hate looking at.
When Secondary Symptoms And Meds Mess With Your Mental Health
People living with psoriasis are more likely to have other diseases that are linked to inflammation, such as heart disease and diabetes. If you have a disease that creates enough inflammation that its affecting your heart, its also very hard for your brain to function well, said Dr. Suzanne Olbricht, associate professor of dermatology at Harvard Medical School, in an article in Harvard Health Publishing.
A lack of answers can also ramp up patient anxiety. People living with an autoimmune disease are often misdiagnosed or stay undiagnosed for long periods of time because they have a unique presentation of the symptoms and disease, according to Dr. Goldstein. It may take years to make a proper diagnosis which can prevent from accessing the treatment they need. That can take a toll on a persons mental health and push them into isolation without a drive to seek the help they may need.
Dr. Goldstein recommends that psoriasis sufferers see a rheumatologist/immunologist with a specialty in autoimmune diseases. He also stresses that many medications for immune disorders can cause psychiatric problems. If a patient has a sudden change in mental health, he says, they should voice their concerns to their doctor and see a mental health expert immediately.
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Psoriasis Internalized Stigma Scale
In 2015, the Psoriasis Internalized Stigma Scale was first applied to psoriasis patients . Internalized stigma includes endorsing negative feelings and beliefs and applying them to oneself, decreasing self-esteem and life-satisfaction, increasing depression and suicidality, and causing difficulty in coping with the illness . The Psoriasis Internalized Stigma Scale was proved to be reliable and valid with Cronbachs alpha 0.89. The Psoriasis Internalized Stigma Scale was significantly correlated with the Dermatology Quality of Life Index scores . A multi-centered, cross-sectional study included 1,485 patients, investigated the internalized stigma state of patients with psoriasis, and identified the factors influencing internalized stigma using Psoriasis Internalized Stigma Scale . Authors found that disease severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses were associated with high levels of internalized stigma. Another comparative multi-centered study investigated the internalized stigma in pediatric psoriasis patients . Internalized stigma in pediatric patients was associated with poorer quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma in pediatric patients was mainly determined by psoriasis itself, rather than disease severity or involvement of visible body parts, genital area, or folds.
The Vicious Cycle Between Psoriasis And Mental Health
For years, Melissa P.*, 30, thought the white flakes that kept appearing in her dark hair were really bad dandruff. Thats what doctors told her, she says. It wasnt until well-meaning friends raised concerns that she went to a different doctor, who diagnosed her with psoriasis.
Melissa started getting corticosteroid injections to help manage her psoriasis, but the condition escalated during an especially hard period of her life that included domestic violence. As life became more complicated and more real-world stuff was happening, the psoriasis became worse, she tells SELF, explaining that due to the violence she was experiencing, she didnt feel safe enough to travel to get the injections. Her psoriasis plaquesdry, raised lesions covered with scaleswere bigger and in noticeable areas where she couldnt cover them, like around her eyebrows and on her forehead. My psoriasis had never been worse than it was then, Melissa says.
Melissa was diagnosed with generalized anxiety disorder and depression as a teenager and was later diagnosed with both post-traumatic stress disorder and complex PTSD, which is associated with prolonged, repeated, or multiple incidences of trauma. Getting help for her mental health involved a combination of inpatient trauma treatment, therapy, and mindfulness techniques.
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Learning How To Relax
One way of helping to ease anxiety and worry is to practise muscle relaxation. Research has shown that relaxing your muscles can help reduce the worry and panic you may feel in certain situations. These situations may include going out on a date or dealing with people who are staring or making comments about your skin. Also, if you feel less worry or anxiety it may be less likely that your psoriasis will flare.
Muscle relaxation exercise: Effective relaxation involves releasing tension in the body. One way of approaching this is to focus on individual groups of muscles, to be aware of how they feel in their tensed and relaxed states, and to relax them one by one.
Work systematically through the muscle groups and try to relax them. Remember to tense your muscles to only about two thirds of their maximum. You dont want to give yourself cramp! If you have joint problems you may want to discuss these exercises with your GP before you try them.
What Are The Psychological Effects Of Psoriasis
Psoriasis is associated with a variety of psychosocial symptoms, including:
- Feelings of guilt, shame, embarrassment or helplessness
- Poor self-esteem and low self-worth, sometimes leading to social isolation
- Sexual dysfunction, due to self-consciousness or painful lesions
- Suicidal ideation, which occurs in up to 10% of patients with psoriasis
- Interference with activities of daily living, including dressing, bathing and sleeping
- A negative impact on the patients family functioning, including financial hardship, caregiver burnout and degeneration of patientfamily relationships
- Stress which can trigger flares of psoriasis in 4368% of patients
- Depression, due to a decreased quality of life.
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How To Manage Depression
The best way to treat your depression may be to treat your psoriasis. In fact, research indicates that after a person with psoriasis receives effective treatment, their quality of life improves, Dr. Kircik notes.
Other steps you can take to manage the psoriasis-depression cycle include:
You may find that you need depression treatment from a mental health professional, who might suggest:
- Cognitive Behavioral Therapy This form of therapy works by identifying negative thoughts and feelings and helping you change them to something more positive and functional, Hafeez says.
- Medication Antidepressants prescribed by your healthcare provider might be appropriate, Hafeez says.
Psoriasis And Your Relationships
Psoriasis and family life
Usually the person with psoriasis is the one who suffers most. However, sometimes the whole family can feel the psychological distress of psoriasis. Tension can arise for a number of reasons. These include feelings of isolation, rejection, embarrassment and not being understood. To keep family life as happy as possible it is important to:
- Communicate: explain how you are feeling. Dont bottle things up as this will only create tension.
- Be calm: even if you feel upset. Remember that stress will not only make you and your family feel upset, it can also make your psoriasis worse. Fill in a thought table and try to change those negative thoughts before they get out of hand.
Psoriasis and forming new relationships
Some people with psoriasis report that they feel afraid to enter into new romantic relationships. They actively avoid relationships that may lead to sexual contact. They fear that once the psoriasis is discovered they will be rejected. These fears are often unfounded, as they are usually not based on actual past experience.
To overcome this fear it is important that you challenge your negative thoughts about forming new relationships.
It may be useful to fill out a thought table like the one in the previous section. Instead, if there is someone you are attracted to but are too anxious to approach, then maybe it would be useful to try out some of the relaxation techniques. These may help you to ease this anxiety.
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Inflammation Might Contribute To Both Psoriasis And Depression
Biological factors could also be driving the relationship between psoriasis and depression. Psoriasis is the result of an imbalance in the immune systems activators and regulators. Maybe the same mediators of the immune system that are central to the cause of psoriasis also play a role in the development of major depression, Ho speculates.
The study found another possible explanation for the link between depression and psoriasis: inflammation. A growing body of evidence indicates that inflammation may help trigger depression, the authors write. Inflammation also plays a role in psoriasis.
The authors suggest that studying this possible link could lead to new drugs and potential lifestyle changes that could help treat both conditions, especially in the 30 percent of psoriasis patients with depression who do not respond to treatments.
Exploring The Developing Psoriasis Pipeline
There is evidence that psoriasis symptoms are worsened by certain drugs approved to treat depression and bipolar disorder, such as lithium and diazepam, and so physician awareness of the connection between the conditions is crucial. However, research from the US National Psoriasis Foundation and American Academy of Dermatology suggests focusing on effective treatment of psoriasis can help to mitigate the anxiety and depression aspects of the condition.
The NPF has compiled a list of drugs in the pipeline for psoriasis, as well as keeping track of ongoing clinical trials in the indication.
One example is Eli Lillys mirikizumab . The drug is currently being evaluated in a long term Phase III study to better understand the safety and maintenance of treatment effect in patients with moderate-to-severe plaque psoriasis. The drug is an IgG4 monoclonal antibody that binds to the p-19 subunit gene of interleukin-23 .
The first IL-23 inihibitor to be approved in the US was guselkumab in 2017 it is known by the brand name Tremfya and manufactured by Janssen. IL-23 remains a key area of investigation for psoriasis drugs.
Lillys mirikizumab is administered through a subcutaneous injection Lilly has conducted previous trials to work out the correct dosing formulation of the drug.
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