An update on the impact of depression on the treatment of psoriasis

ABSTRACT

Introduction: Estimates of the prevalence of comorbid depression vary, ranging from 9 and 62%. Deterioration of mental health may emerge as a result of psoriasis; however, it is theorized that depression alone may independently predispose patients to new-onset psoriasis.

Areas covered: The aim of this brief review is to explore the impact of depression on psoriasis treatment.

Expert opinion: The two studies that directly assess the role of depression in psoriasis treatment outcomes are important, as unaddressed depression can undermine the success of a given treatment. This may reflect the notion that depressed individuals are less likely to be adherent. Thus, it may be valuable for clinicians to not only screen for depression, but to ensure that it is adequately treated. Our knowledge of treatment preferences in psoriasis patients with comorbid depression is limited. Expanding our understanding of preferences may allow providers to better align their recommendations to ultimately increase adherence. Additionally, given that many psoriasis treatments have an impact on depression, it may be beneficial for clinicians to evaluate patients for psychiatric risk factors to optimize the treatment regimen.

KEYWORDS:

• Depression
• psoriasis
• psoriasis treatment
• adherence
• treatment preferences

Article highlights

• Depression is a common comorbid condition in psoriasis patients and may influence clinical response to psoriasis treatment.

• In patients with comorbid depression, treatment duration and individual cost may be particularly important for patients; however, our understanding of treatment preferences in these individuals is limited.

• Expanding our understanding of treatment preferences may allow providers to better align their recommendations with preferences to increase physician-patient trust and ultimately increase patient medication adherence.

• Evaluation for psychiatric risk factors prior to initiation of particular medications may be warranted in some psoriasis patients, as some agents may worsen depression, while others may improve it.

• It is unclear if biologics directly improve depression or whether improvements are indirect and due to improvements in psoriasis severity.

This box summarizes the key points contained in the article.

Declaration of interest

S Feldman has received research, speaking, and/or consulting support from: Galderma, GlaxoSmithKline/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, AbbVie, Samsung, Janssen Pharmaceuticals, Eli Lilly and Company, Menlo, Merck & Co, Bristol-Myers Squibb, Arena Forte, Helsinn, Novartis, Regeneron, Sanofi, Novan, Qurient, the National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He is also the founder and majority owner of www.DrScore.com and founder and part owner of Causa Research. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.