REVIEW PAPER
Occurrence of depression in patients with psoriasis – the role of inflammation, stress and mechanism of the vicious circle
 
More details
Hide details
1
Department of Epidemiology and Clinical Research Methodology, Medical University, Lublin, Poland
 
 
Corresponding author
Aleksandra Amalia Kuchnicka   

Department of Epidemiology and Clinical Research Methodology, Medical University, Lublin, Poland
 
 
J Pre Clin Clin Res. 2020;14(2):58-61
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Psoriasis is a chronic skin disease which can have a detrimental impact on the patient’s life. The correlation between depression, psoriasis and inflammation is a subject of many publications. The depressive and psoriatic symptoms, unhealthy coping strategies and stigmatization might be presented in the mechanism of the vicious circle. The appropriate understanding of this phenomenon might be extremely useful for specialists to improve their bedside manner.

Objective:
The aim of this review is to analyze the current data about the worldwide presence of the major depressive disorder – psoriasis, and the occurrence of depression in patients suffering from psoriasis. Research and analysis were based on searching sources such as PubMed, UpToDate and World Health Organization pages for the integrative publications collected mainly from last 10 years. The data about the origin of the psoriasis disease was taken from as 1979 publication.

State of knowledge:
The study demonstrated that the link between psoriasis and depression is bi-directional. The pro-inflammatory cytokine, such as IL-6, TNF-α, CRP and IL-17, are elevated in both cases, which provokes the exacerbation of sickness symptoms. The inflammation dangerously disturbs the functioning of neuronal system and human homeostasis.

Summary:
According to the cited research, the prevalence of depressive disorders in psoriatic patients is higher in comparison to people without psoriasis. Inflammation plays an essential role by being a peculiar connector between psoriasis and depression. Stress and inflammation are crucial factors in pathogenesis of those two disorders and triggers the pathological mechanisms.

ABBREVIATIONS
3-HK – 3-hydroxykynurenine, BBB – Blood-Brain Barrier; CPRD – Clinical Practice Research Datalink; CRH – Corticotrophin-releasing Hormone; CRP – C-Reactive Protein; CSF – Cerebral Spinal Fluid; DLQI – Dermatology Life Quality Index; GAD-7 – Generalized Anxiety Disorder Scale; GR – The Glucocorticoid Receptor; HPA – Hypothalamic-Pituitary-Adrenal; ICD – International Classification of Diseases; IFN-γ – Interferon-γ; IL1β – Interleukin 1β; IL6 – Interleukin 6; IL17 – Interleukin 17; IL22 – Interleukin 22; MDD – Major Depressive Disorder; TNFα – Tumor Necrosis Factor-α; PASI – Total Psoriasis Area Severity Index; PHQ-9 – Patient Health Questionnaire Depression Scale; PSS – Perceived Stress Scale; RR – Relative Risk; QA– Guinolinic Acid; WHO – Word Health Organization; YLDs – Years Lived with Disability; 5-HTT – The Serotonin Transporter
 
REFERENCES (40)
1.
Mueller W, Herrmann B. Cyclosporin A for psoriasis. N Engl J Med. 1979 Sep; 301(10): 555. DOI: 10.1056/NEJM197909063011016.
 
2.
Alariny Ali Fouad, Farid Carmen Ibrahim, Elweshahi Heba Mahmoud, Abbood Sahar Salim, Psychological and Sexual Consequences of Psoriasis Vulgaris on Patients and Their Partners, The Journal of Sexual Medicine. DOI: https://doi.org/10.1016/j.jsxm....
 
3.
Greb JE, Goldminz AM, Elder JT, Lebwohl MG, Gladman DD, Wu JJ, et al. Psoriasis Nat Rev Dis Primers, 2016; 2: 16082. DOI: 10.1038/nrdp.2016.82.
 
4.
Tara D Rachakonda, Clayton W Schupp, April W Armstrong, et al, Psoriasis prevalence among adults in the United States, Journal of the American Academy of Dermatology. 2014 March; 70(3): 512–516. DOI: https://doi.org/10.1016/j.jaad....
 
5.
Bai F, Zheng W, Dong Y, Wang J, Garstka MA, Li R, An J, Ma H. Serum levels of adipokines and cytokines in psoriasis patients: a systematic review and meta-analysis. Oncotarget. 2017; 9: 1266–1278. https://doi.org/10.18632/oncot....
 
6.
Blauvelt A, Ehst BD. Pathophysiology of plaque psoriasis, Uptodate, Available from: https://www.uptodate.com/conte... (access: 2019.12.29).
 
7.
Soutor C, Hordinsky MK. Clinical Dermatology 2013, Chapter 1, Pages 1–5. Available from: http://accessmedicine.mhmedica.... (access: 2019.12.20).
 
8.
World Health Organization, Global Report on Psoriasis 2016.
 
9.
Feldman Steven R, MD, PhD, Epidemiology, clinical manifestations, and diagnosis of psoriasis, UptoDate. Available from: https://www.uptodate.com/conte... (access: 2019.12.30).
 
10.
Springate D, Parisi R, Kontopantelis E, Reeves D, Griffiths C, Ashcroft D. Incidence, prevalence and mortality of patients with psoriasis: a U.K. population-based cohort study. Br J Dermatol. 2017; 176: 650–658. doi:10.1111/bjd.15021.
 
11.
Fernández-Armenteros JM, Gómez-Arbonés X, Buti-Solé M, Betriu-Bars A, Sanmartin-Novell V, Ortega-Bravo M, Martínez-Alonso M, Casanova-Seuma JM. Epidemiology of Psoriasis. A Population-Based Study. Actas Dermo-Sifiliográficas (English Edition). 2019; 110(5): 385–392. ISSN 1578–2190, https://doi.org/10.1016/j.aden....
 
12.
Borzęcki A, Koncewicz A, Raszewska-Famielec M, Dudra-Jastrzębska M. Epidemiology of psoriasis in the years 2008–2015 in Poland. Przegląd Dermatologiczny. 2018 Jan; 105(6): 693–700. DOI: https://doi.org/10.5114/dr.201....
 
13.
Patel N, Nadkarni A, Cardwell LA. et al. Am J Clin Dermatol (2017) 18: 613. https://doi.org/10.1007/s40257....
 
14.
Rigas HM, Bucur S, Ciurduc DM, Nita IE, Constantin MM. Psychological Stress and Depression in Psoriasis Patients – a Dermatologist’s Perspective. Maedica (Buchar). 2019 Sep; 14(3): 287–291. doi: 10.26574/maedica.2019.14.3.287.
 
15.
González-Parra S, Daudén E. Psoriasis and Depression: The Role of Inflammation. Actas Dermo-Sifiliográficas (English Edition). 2019; 110(1): 12–19. https://doi.org/10.1016/j.ad.2....
 
16.
Martínez-Ortega JM, Nogueras P, Muñoz-Negro JE, Gutiérrez-Rojas L, González-Domenech P, Gurpegui M. Quality of life, anxiety and depressive symptoms in patients with psoriasis: A case-control study. Journal of Psychosomatic Research. 2019 Sep; 124: 109780 https://doi.org/10.1016/j.jpsy....
 
17.
Tohid H, Aleem D, Jackson C. Major Depression and Psoriasis: A Psychodermatological Phenomenon. Skin Pharmacol Physiol. 2016; 29: 220–230. https://doi.org/10.1159/000448....
 
18.
World Health Organization (2019), The WHO Special Initiative for Mental Health (2019–2023): Universal Health Coverage for Mental Health, https://apps.who.int/iris/bits... (access: 2020.02.12).
 
19.
Krishnan R, Roy-Byrne PP, Solomon D. Unipolar depression in adults: Epidemiology, pathogenesis, and neurobiology https://www.uptodate.com/conte... (access: 2020.01.31).
 
20.
GBD 2017 Disease and Injury Incidence and Prevalence Collaborator, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018; 392(10159): 1789–1858. ISSN 0140–6736, https://doi.org/10.1016/S0140–...).
 
21.
Malhi GS, Mann JJ. Depression. Lancet. 2018; 392(10161): 2299–2312. doi:10.1016/S0140-6736(18)31948-2.
 
22.
National Institution of Mental Health (NIH) https://www.nimh.nih.gov/healt... (access: 2020.01.31).
 
23.
Moskalewicz J, Boguszewska L. Poprawa stanu zdrowia psychicznego Polaków. Diagnoza i rekomendacje. In: Szymborski J. Zdrowie publiczne i polityka ludnościowa. Warszawa. Rządowa Rada Ludności. 2012.
 
24.
Hoseinzadeh, F, Abadi PH, Agheltar M, Aghayinejad A, Torabian F, Rezayat AA, Akbarzadeh F, Rahimi HR. The Role of Immune System in Depression Disorder. Health. 2016; 8: 1726–1743. http://dx.doi.org/10.4236/heal....
 
25.
Krishnadas R, Nicol A, Sassarini J, et al. Circulating tumour necrosis factor is highly correlated with brainstem serotonin transporter availability in humans. Brain Behav Immun. 2016; 51: 29–38. doi:10.1016/j.bbi.2015.08.005.
 
26.
Haapakoski R, Mathieu J, Ebmeier KP, Alenius H, Kivimäki M. Cumulative meta-analysis of interleukins 6 and 1β, tumour necrosis factor α and C-reactive protein in patients with major depressive disorder. Brain, Behavior, and Immunity. 2015; 49: 206–215. ISSN 0889-1591, https://doi.org/10.1016/j.bbi.....
 
27.
Varatharaj A, Galea I. The blood-brain barrier in systemic inflammation. Brain, Behavior, and Immunity. 2017; 60: 1–12. ISSN 0889-1591, https://doi.org/10.1016/j.bbi.....
 
28.
Strawbridge R, Arnone D, Danese A, Papadopoulos A, Herane Vives A, Cleare AJ. Inflammation and clinical response to treatment in depression: A meta-analysis. European Neuropsychopharmacology. 2015; 25(10): 1532–1543. ISSN 0924-977X, https://doi.org/10.1016/j.euro....
 
29.
OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris. https://doi.org/10.1787/health....
 
30.
Stuart MJ, Singhal G, Baune BT. Systematic review of the neurobiological relevance of chemokines to psychiatric disorders. Front Cell Neurosci 2015; 9: 357. https://doi.org/10.3389/fncel.....
 
31.
Krishnadas R, Nicol A, Sassarini J, Puri N, Burden AD, Leman J, Combet E, Pimlott S, Hadley D, McInnes IB, Cavanagh J. Circulating tumour necrosis factor is highly correlated with brainstem serotonin transporter availability in humans. Brain, Behavior, and Immunity. 2016; 51: 29–38. ISSN 0889-1591, https://doi.org/10.1016/j.bbi.....
 
32.
Alexis R Howerton, Alison V Roland, Tracy L Dorsal. Raphe Neuro-inflammation Promotes Dramatic Behavioral Stress Dysregulation Bale Journal of Neuroscience. 2014 May; 34(21): 7113–7123. DOI: 10.1523/JNEUROSCI.0118-14.2014.
 
33.
Yong-Ku Kim, Kyoung-Sae Na, Aye-Mu Myint, Brian E Leonard. The role of pro-inflammatory cytokines in neuroinflammation, neurogenesis and the neuroendocrine system in major depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2016; 64: 277–284. ISSN 0278-5846, https://doi.org/10.1016/j.pnpb....
 
34.
Carmine M. Pariante, Why are depressed patients inflamed? A reflection on 20 years of research on depression, glucocorticoid resistance and inflammation. European Neuropsychopharmacology. 2017; 27(6): 554–559, ISSN 0924-977X, https://doi.org/10.1016/j.euro....
 
35.
Moon HS, Mizara A, McBride SR. Dermatol Ther (Heidelb). 2013; 3: 117. https://doi.org/10.1007/s13555....
 
36.
Lamb RC, Matcham F, Turner MA, et al. Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting. Br J Dermatol. 2017; 176(4): 1028–1034. doi:10.1111/bjd.14833.
 
37.
Hu SC, Chen GS, Tu HP. Epidemiology of Depression in Patients with Psoriasis: A Nationwide Population-based Cross-sectional Study. Acta Derm Venereol. 2019; 99(6): 530–538. doi:10.2340/00015555-3145.
 
38.
Lakshmy S, Balasundaram S, Sarkar S, Audhya M, Subramaniam E. A Cross-sectional Study of Prevalence and Implications of Depression and Anxiety in Psoriasis. Indian J Psychol Med. 2015; 37(4): 434–440. doi:10.4103/0253-7176.168587.
 
39.
Dommasch E, Li T, Okereke O, Li Y, Qureshi A, Cho E. Risk of depression in women with psoriasis: a cohort study. Br J Dermatol. 2015; 173: 975–980. doi:10.1111/bjd.14032.
 
40.
Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Invest Dermatol. 2014; 134: 1542–51. https://doi.org/10.1038/jid.20....
 
eISSN:1898-7516
ISSN:1898-2395
Journals System - logo
Scroll to top