9 Things to Know about PsA and Your Mental Health
It's not all in your head: The physical symptoms of psoriatic arthritis (joint swelling, back and neck pain, and skin rashes) are not the only challenges this chronic disease brings. PsA can also affect your mental health and cognitive functioning. Stress, depression, anxiety, even brain fog and dementia—all have a powerful connection to this autoimmune disorder. We’ll explain how they all interconnect—with inflammation potentially playing a key role—and then offer expert advice on how to better manage the symptoms that can affect your mind and well-being.
Stressed Out With PsA? It's a Common Experience
Stress and PsA flares have what you might describe as a vicious circle sort of relationship. “Stress can trigger exacerbations of psoriasis and psoriatic arthritis, and those exacerbations can in turn trigger more stress,” says Vinod Chandran, M.D., associate professor of rheumatology at the University of Toronto. Specific PsA stressors—like the financial burden of some disease-modifying drugs and other expensive therapies, plus worries over the social stigma (and frequent, unsolicited commentary) that can come with symptoms like difficult-to-conceal skin rashes—can add to your emotional woes.
The PsA-Depression Link Is Real
Stress also contributes to depression, which is more common among people with PsA. “People with PsA often report a depression symptom called ‘anhedonia,’ which means the inability to experience pleasure and a loss of interest in things they used to enjoy,” Dr. Chandran says. According to a 2020 study he co-authored, depression and anxiety in people with PsA may be linked to systemic inflammation, thought to be at the root of many PsA symptoms. Other research shows how patients with PsA who were treated with disease-modifying, anti-inflammatory drugs showed significant improvement in depressive symptoms.
People With PsA Have an Elevated Risk for Anxiety, Too
So, PsA is a triple-threat: Anxiety, which is characterized by feelings of tension, worried thoughts, and even spikes in blood pressure, is also common among people with this condition. A University of Pennsylvania study showed that people with psoriatic disease had a 31% increased risk of anxiety compared with participants who did not. And a 2019 British review of studies involving more than 30,000 people found that one in three people with PsA reported experiencing mild anxiety, while one in five people with PsA said they battled moderate levels—making PsA a significant anxiety risk factor.
Brain Fog, Dementia, and Inflammation Are Also Linked to PsA
Many people with PsA report experiencing “brain fog”—trouble concentrating and memory loss (which can also be tied to depression, according to the Mayo Clinic). But it’s not just momentary mental lapses that can occur. A large 2020 study from South Korean researchers found that the risk of developing Alzheimer’s disease (AD) was slightly and significantly higher in people with psoriasis and other untreated immune disorders, likely tied to chronic inflammation. While not everyone with psoriasis develops PsA, roughly a third do. The good news? Those who took disease-modifying treatments had lower rates of AD than those who did not.
Inflammation May Be at the Root of PsA Mental Health Issues
Increased stress, more depression and anxiety, plus brain fog and perhaps dementia, too—is a rogue inflammatory response to blame? “Inflammation such as we see in psoriatic arthritis is not good for the central nervous system. The brain does not like inflammation,” says Jasvinder Singh, M.D., professor of medicine and epidemiology at the University of Alabama at Birmingham and co-author of the 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. “It’s possible the inflammatory process of PsA is contributing to these mental health issues—and that’s something researchers are still studying.”
Controlling Inflammation Is Key
The first step, then, in managing the mental health and cognitive symptoms of PsA is to work on disease control. Disease-modifying drugs that tame inflammatory symptoms can also improve depression, anxiety, and other mental health effects, says Dr. Chandran, whether these issues are caused by the inflammation itself, the daily pressures of living with PsA, or both. “Early treatment is very important because long-term chronic pain can become ingrained in the neural circuits and then are more difficult to manage,” he adds. Beyond medications, there are other things you can do to beat PsA’s psychological challenges, too. Keep reading.
Move More For a Better Mood
Working up a sweat is well known to have positive effects on stress, depression, and anxiety, says Dr. Singh, but it can be difficult to exercise when you’re experiencing chronic pain. Still, you don’t need to join a kickboxing class or run a marathon to improve your mental health and well-being along with your overall physical condition. The National Psoriasis Foundation recommends at least 30 minutes a day of low- and no-impact workouts like swimming, walking, and bicycling, as well as gentle stretching and flexibility exercises, like yoga. (You can spread these out into three 10-minute workouts if that’s easier for you.)
Focus on Sleep Hygiene
Exercise also helps improve your sleep—a big plus, since the National Alliance on Mental Illness notes how poor sleep is a known contributor to many mental health issues, like not dealing well with stress, plus upticks in anxiety and depression, too. So get proactive about your sleep hygiene. You probably already know the right steps—maintain a regular sleep schedule; promote a tranquil sleep environment; avoid exercise, alcohol, and caffeine right before bed; and try practicing deep breathing and relaxation techniques—but they only work if you commit to them. So make a point of starting tonight.
Talk Openly with Your Doctor
“Be sure to discuss any depression, anxiety, and stress you are experiencing with your doctor,” says Dr. Chandran. If you’re truly struggling, a therapist might help. “Sometimes, we’re so focused on the physical symptom of this disease, such as pain and joint inflammation, that mental and emotional health does not receive enough attention.” Shame and stigma can still be associated with mental health issues, he notes. “But these diseases are just like any other, and the more you communicate with your doctor about them, the better they can be managed.”
- PsA and Depression (1): Rheumatology and Therapy. (2020). “Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation.” ncbi.nlm.nih.gov/pmc/articles/PMC7211219/
- PsA and Depression (2): International Journal of Rheumatic Disease. (2019). “Systematic review of depression and anxiety in psoriatic arthritis.” onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.13553
- PsA and PsA and Depression (3): JAMA Dermatology. (2010). "The risk of depression, anxiety, and suicidality in patients with psoriasis: A population-based cohort study." jamanetwork.com/journals/jamadermatology/fullarticle/210088
- PsA and PsA and Depression (4): Journal of the European Academy of Dermatology and Venereology. (2013). “Depression and the risk of psoriasis in US women.” onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-3083.2012.04703.x
- PsA and Mental Health: The Journal of Rheumatology. (2014). “Depression and anxiety in psoriatic disease: prevalence and associated factors.” jrheum.org/content/early/2014/03/26/jrheum.130797.abstract
- PsA and Anxiety (1): International Journal of Rheumatic Disease. (2019.) “Systematic review of depression and anxiety in psoriatic arthritis.” onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.13553
- PsA and Anxiety (2): The Journal of Rheumatology. (2014). “Depression and anxiety in psoriatic disease: prevalence and associated factors.” jrheum.org/content/early/2014/03/26/jrheum.130797.abstract
- PsA and Anxiety (3): JAMA Dermatology. (2010). "The risk of depression, anxiety, and suicidality in patients with psoriasis: A population-based cohort study." jamanetwork.com/journals/jamadermatology/fullarticle/210088
- PsA and Cognition: Scientific Reports. (2020). “Increased risk of Alzheimer’s disease in patients with psoriasis: a nationwide population-based cohort study.” nature.com/articles/s41598-020-63550-2
- PsA and Sleep Hygiene: National Sleep Foundation. (n.d.). “Tips and Tricks for Sleeping Better.” sleepfoundation.org/articles/healthy-sleep-tips