It doesn’t matter whether the psoriasis is mild or severe; it’s still associated with depression, says Roger Ho, MD, MPH, an associate professor of dermatology at NYU Grossman School of Medicine in New York City. People with psoriasis may find themselves caught in a vicious cycle. The chronic stress of a health condition like theirs can lead to depression; in turn, stress and depression might trigger or exacerbate psoriasis flares, leading to more stress and worsening depression. RELATED: How to Beat the Psoriasis-Stress Cycle “The stress of anticipating a negative reaction or feeling embarrassed or stigmatized based on their appearance can contribute to a great psychiatric burden, driving a psoriasis patient’s depression,” Ho notes.

Other factors associated with psoriasis might spark depressive symptoms as well, Ho says. For example, he explains, psoriasis lesions can be itchy and tender and interfere with your daily activities and functioning, especially when the lesions are on your hands. Dealing with the pain and discomfort can be overwhelming at times and cause you to want to isolate yourself by staying at home. But that can be counterproductive, because isolation and physical inactivity can increase your risk of depression, notes Sanam Hafeez, PsyD, clinical director of Comprehensive Consultation Psychological Services in Forest Hills, New York. In addition to dealing with day-to-day psoriasis symptoms, people with psoriasis have a greater risk of a host of other health conditions, including psoriatic arthritis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and cancer, according to the National Psoriasis Foundation (NPF). The increased risk of these other health issues can give people with psoriasis even more to worry about, Ho says.

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 system’s 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 Novelties in Dermatology 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.

How to Recognize the Signs of Depression

The fact that depression is a known risk for people with psoriasis makes knowing the warning signs even more important — for patients, their friends and family, and their dermatologists. As far as symptoms go, depression linked to psoriasis is no different than any other type of depression: “It’s depression,” says Leon Kircik, MD, a clinical professor of dermatology at Indiana University Health Medical Center in Indianapolis and at Icahn School of Medicine at Mount Sinai in New York City. The signs of depression are the same for people with psoriasis as they are for anyone else, Dr. Hafeez concurs. These include:

Difficulty sleepingHaving trouble getting up and out of bedLoss of energyLack of interest in leisure activitiesInability to focus

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:

Stress Reduction Find what techniques work best for you — meditation or mindfulness, for instance — and practice them regularly, advises the NPF. Regular exercise is also a good stress reducer.Healthy Eating There’s no evidence that a particular diet will improve psoriasis, but an overall healthy diet — one that emphasizes lean protein, fruits, vegetables, and whole grains, and is low in unhealthy fats, salt, processed foods, and sugar — will help you feel better, Ho says. Proper nutrition can help you lose extra pounds or maintain a healthy weight, and that can reduce your risk of conditions such as heart disease and diabetes. When you lower your risk, you reduce your worries, too.Good Sleep Solid slumber not only helps your psoriasis but can also reduce stress. Be sure to practice good sleep hygiene: Adhere to a consistent wake-sleep schedule, keep your bedroom cool and dark, and avoid stimulation before lights-out. A review published in July 2021 in Frontiers in Psychiatry found that, similar to depression and psoriasis, sleep deprivation and psoriasis can be a vicious cycle — with one issue triggering the other.Support Groups Attending meetings in person or online can help you feel like you’re not alone, Hafeez says.

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.