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Psoriasis is an autoimmune disorder that causes inflamed, scaly patches on the skin. Though psoriasis may appear to be a skin disease, it's systemic and affects the whole body. Psoriasis is associated with other health conditions, including psoriatic arthritis (PsA).
Psoriatic arthritis is an inflammatory disease that affects joints and the areas of the body where tendons and ligaments connect to bone. Up to 41% of people with psoriasis develop psoriatic arthritis.
Both psoriatic arthritis and psoriasis are associated with chronic pain. Living with chronic pain has a tremendous impact on your quality of life and may lead to anxiety and depression.
How PsA Inflammation Contributes to Depression
While psoriatic arthritis is a physical condition that causes fatigue, pain, and stiffness, the disease can have an impact on your mental health, too. The prevalence of depression in people with psoriatic arthritis is significantly higher than in the general population. Approximately 20% of PsA patients also struggle with depression.
Researchers have discovered that depression and inflammation are closely related. Inflammation in the body can lead to depression, and depression can lead to inflammation. Essentially, depression can be both a result of PsA symptoms a contributor to disease progression.
People with PsA often have high levels of cytokines (immune system proteins) that trigger inflammation and may contribute to depression. The stigma and how much the disease impacts daily functioning can also play a role in depression.
Pain, Sleep, and Anxiety
Pain and anxiety—both commonly experienced in people with PsA—often lead to sleep disturbances. If you have trouble sleeping, you know the debilitating fatigue lack of sleep can cause. You may have trouble concentrating, struggle to remember things, and experience mood changes. Disrupted sleep can also worsen joint pain.
Many people with PsA have trouble falling and staying asleep. A 2017 study found that sleep disturbance is associated with pain, anxiety, and increased inflammation. A 2020 study found that approximately 30% of people with PsA experience anxiety.
The unpredictable nature of PsA may be partly to blame. Living with PsA can cause stress and anxiety, including worrying about future flares (when symptoms worsen), which then leads to disrupted sleep that may trigger a flare-up.
How Do I Improve My Sleep?
To stop the vicious cycle of anxiety and pain disrupting sleep, it’s important to get help. Talk with your healthcare provider, who may adjust your medications to better manage your symptoms. Lifestyle changes such as moderate exercise and dietary changes may also help relieve symptoms, reduce flare-ups, and improve your sleep.
Mental Health Effects of PsA
Along with its physical symptoms like painful, swollen joints, back and neck pain, and skin rashes, psoriatic arthritis can also affect your mental health.
You may feel frustrated with how the pain makes it harder to manage your day-to-day life and perform tasks. You may worry about the costs of treatment, or how you’ll manage in the future as the disease progresses. If you also experience psoriasis, the plaques on your skin may be a source of embarrassment and cause low self-esteem.
You may also experience brain fog that makes it difficult to concentrate and causes memory loss. In other words, living with PsA is often a tremendous mental burden.
It’s important to treat your mental health as you would your physical health. Talk to your healthcare provider to discuss treatment options, and take time for self-care.
Caring for Mental Health During PsA Treatment
If you have PsA, managing your mental health is important. Mental health conditions such as depression and anxiety can increase pain and worsen symptoms of the disease. Finding ways to manage your mental health can help you feel your best.
Self-care is different for everyone. Whether it’s a hot bath, breathing exercises, reading a good book, cuddling with your pet or getting cozy on the couch to watch your favorite movie, be sure to carve out time in your day to allow yourself a moment to relax. Engaging in an activity you enjoy can help turn your mind away from the emotional and physical pain.
Meditation is a self-care technique that benefits for mental health. One study found that individuals with arthritis who practiced mindful meditation for a period of eight weeks experienced significant improvements in their mental health.
Practice Good Sleep Hygiene
Getting consistently good sleep can do wonders for your physical and emotional health. It can be difficult to get a full night’s sleep with PsA, but there are steps you can take to help ensure you get the sleep you need. Maintain a regular sleep schedule, make your bedroom a tranquil sleep environment (dark and quiet), and avoid screens an hour before bed. Deep breathing exercises can promote relaxation and help you fall asleep.
Working with a therapist can allow you to process your feelings and understand your behaviors and thought patterns. Talking to a mental health professional such as a psychologist or psychiatrist can provide you with a safe outlet for your feelings. If you’re struggling with depression, you may be prescribed antidepressants to help provide symptom relief.
If you can’t find a local therapist, there are many websites and apps available that offer telehealth counseling sessions.
Getting regular exercise can help reduce stress, depression, and anxiety. It may be difficult to exercise when you’re in pain, but you don’t need to run a marathon or lift heavy weights to improve your mental and physical health. No- and low-impact workouts, such as swimming, walking, yoga, and stretching, are good options to ensure you get the physical activity your body needs.
Aim to get at least 30 minutes a day of exercise. If that’s too much, you can space this out into three 10-minute workouts throughout the day.
While it can be tempting to withdraw from others when you’re dealing with depression and in pain, spending time with others can take your mind off the pain and may help reduce depression and anxiety. Some people find it helpful to talk to others who also have psoriatic arthritis since they can empathize and understand the struggles that come with PsA. Online and in-person support groups can help you find the empathy and assistance you need.
Staying Ahead of PsA Inflammation and Depression
While depression and PsA often go hand in hand, it’s important to treat them both as their own condition. Your PsA can impact your mental health, and your mental health can impact your PsA. While it may be tempting to wait for the depression to go away on its own, seeking treatment can help ensure you feel better sooner. Antidepressant medication and therapy can reduce depressive symptoms.
It’s important to remember that stress is a common trigger for PsA flare-ups, so incorporate stress-reducing habits into your routine to help keep your stress levels low. Getting plenty of sleep, eating a nutritious and balanced diet, exercising regularly, and getting social support can go a long way in helping you feel your best.
Psoriatic arthritis increases your risk of developing depression. This may be caused by chronic pain, inflammation, social isolation, and stress. To cope with depression linked to psoriatic arthritis, practice self-care, manage your stress levels, find support, and get plenty of sleep. Talk with your healthcare provider about seeking therapy or taking antidepressants to help relieve depression symptoms and improve your mental health.
A Word From Verywell
It can be difficult to cope when living with a chronic illness. It’s important to remember you don’t have to go through it alone. Talk to your healthcare provider to learn more about resources that are available to you. Reach out to friends and family for assistance, too. While PsA can be a debilitating disease, many people with the condition live happy and fulfilling lives.
Frequently Asked Questions
- Is it safe to take antidepressants with PsA treatment?
In most cases, yes. Ask your healthcare provider if you need antidepressant medication to reduce depressive symptoms. These medications work by increasing levels of serotonin (the “happy” hormone) in the brain. Your doctor will work with you to find the right antidepressant that is safe to take with any other medications you are taking to manage PsA.
- What helps with PsA anxiety?
Self-care and relaxation techniques such as exercise, meditation, yoga, breathing exercises, and gentle stretching can help reduce PsA anxiety. Social support in the form of PsA support groups can provide an outlet to process your anxiety with people who understand. Therapy and medication are options if your anxiety is debilitating.
- How does PsA affect concentration?
Many people with psoriatic arthritis report having trouble concentrating, having memory loss, and sometimes having difficulty thinking clearly. This is sometimes referred to as brain fog, and inflammation in the body (linked to both depression and PsA) may be at least partially to blame. Chronic pain and fatigue can also make it difficult to concentrate and think clearly. A recent study found that nearly half of people with PsA experience mild cognitive impairment.
- How many PsA patients have depression?
Approximately 20% of PsA patients also struggle with depression. Inflammation in the body can lead to depression, and depression can lead to inflammation. Depression can be both a result of PsA symptoms and may contribute to disease progression.