Not just joints and tendons: PsA can affect your brain as well

Many of us cope with anxiety and depression as well as sore joints, aching tendons and blotchy skin. Enough to make anybody depressed, right? Well, as with most things, there is more to it than that. Here’s some research that comes out of the clinic where I’m a patient. I remember doing the depression questionnaire on one of my visits, and I’m pleased to think that I’m doing my little bit for PsA research, and other PsA patients.

So are we dealing with chickens or eggs, you ask? Does my Psoriasis and Psoriatic Arthritis make me depressed, or does my depression make my disease worse? Apparently some researchers would answer “yes”. It would appear that depression and PsA are very much connected, and that one can make the other worse.

Besides questioning the relationship between psoriatic disease and depression, some other researchers are looking into the notion that the same biological mechanism that triggers inflammation in psoriatic disease may also create changes in the brain that affect emotional states. This is an interesting article about the research into the relationship between depression and psoriatic disease.

Does depression happen to us as a result of the pain and the stress of having psoriatic disease, or do psoriatic disease and depression have a common cause? The answer isn’t clear, but what is clear for me is that I should probably have a rheumatologist for my PsA as well as a psychiatrist if I’m suffering depression and anxiety. And exactly how is that going to happen? Dr. John Koo, who is both a dermatologist and a psychiatrist, has this to say here :

Because their doctors may not be trained in psychiatry, or have the opportunity to address emotional issues during office visits, patients should take the lead to address emotional difficulties they may be experiencing.

I guess we need to make it clear to our rheumatologists when our brain hurts as much as our joints do, even if the brain isn’t their department.

If you’re suffering depression and anxiety along with your PsA, it’s not a coincidence, and you must not suffer in silence. One makes the other worse. So tell your doctors: one of them needs to address this issue, either directly or by referring you to someone can help, because the help is there. And with everything you put up with, you deserve it.


:heart:️:heart:️:heart:️:heart:️:heart:️ (one wasn’t enough :wink: )

This makes so much sense to me… I heard it before but the more I think about it the more it makes sense… I was depressed as long as I could remember until about my 18th birthday… I was diagnosed around that time too… and my depression was the first thing to come back before the flare that has me beat now… when I stopped all drugs it got much worse… and now that I started again I feel much better… like I can breath and see colours again… the drugs aren’t working for my pain yet so it’s not that…


thanks for those links Seenie,perhaps another piece to the puzzle.Im keenly interested in all things scientific and it helps to realise that there may be links there with inflamation and depression,The body is complex and it wouldn’t surprise me at all that the two could be linked. with the reputation that the drugs we take can have for causing depression,i imagine there would be a need for a group with PsA,who were unmedicated to be observed?as a comparison?..although that would seem to be a bit cruel and unethical.So which came first the chicken or the egg?,and were they medicated ?I know from my experinces with depression earlier in my life that with me i didn’t just suddenly come right,rather i see/sawed my way out of those times,a two steps forward one step back scenario untill i eventually felt better,or was a suffering from Psoriatic disease back then as well ?,and perhaps i struggled so hard because of that.I suspect i’ll never know for sure but it does make me wonder as some of my aches and pains stretch a long way back to a time were i just moved through life and ignored them…food for thought,i’m thinking about getting some head shrinking done,i don’t want to lose anymore of my life to depression,the black dog has already stolen a large slice of it


Medical science currently seems very interested in the role inflammation plays in a whole range of physical and mental ills. I’m sure we’ll be hearing a lot more about its impact on mood and mental health.

I reckon the first logical step is to get effective treatment for the inflammatory disease which undoubtedly affects the whole person. I’m not so sure that the main drugs we take are known to cause depression, not the traditional DMARDs and the biologics anyway.

So much of life is depressing. I don’t have to tell you that in the UK we have an election or referendum at least twice a week, we’ll need anti-depressants in the water supply at this rate. Okay, I exaggerate a little but I never know whether grief, sorrow, loneliness, fear etc. should be called depression when they are natural if harrowing responses to real things that happen in our lives.

I kind of assume there’s ‘true’ depression that stands alone as a mental health issue. But it’s just so complicated. All I know is that human beings need other human beings whether they’re family or other members of a forum or a good therapist so I’d grab that last option for sure if I felt I needed it. But also I’d say fear the disease and all the ways it manifests, not the drugs.


I am very interested in discussing this but i am away at the moment so not able to write a long post… but wanted to say i think this is an important issue. Btw Seenie the link takes me to google with a list of different papers. Is that what is meant to happen?


Interesting. Mine improved in that order as well: first the depression, then the pain, so it was not the pain that caused the depression. Maybe it’s a Dutchie thing? Hahahahaha


Thanks for pointing that out, MacMac. I think it’s fixed now. Let me know if it’s not.

1 Like

Oh yes, I’ve wondered the same thing. My history of depression goes way back as well.

I’m glad to hear a rustle of thoughts of head shrinking. Don’t let that black dog snatch any more from you, he’s had enough. It’s your turn now.

1 Like

I’ve often wondered about a connection between the two. I was diagnosed with “Generalized Anxiety Disorder” (GAD – great another one of these 3 letter labels!!!) back in 2006 after a sudden bout with panic attacks (I had never experienced them before). The first one was so intense that I ended up in the hospital for a couple of days thinking I was having a heart attack. The drs ran every test they could on my heart and the only negative result they found was that my heart enzymes were “off”. They concluded that I had a heat stroke from working in the yard all day and that was the trigger that started my panic attacks. These continued at various intensities over the next two years, with one other one so bad I collapsed and my wife called 911, again thinking it was a heart attack.

It was during this time that I developed a rash within my ears that my primary care doctor misdiagnosed as eczema and gave me a topical cream that never made it go away. It wasn’t until last year when I started this process that my rheumatologist sent me to a dermatologist who quickly (and angrily towards my non dermatologist dr) pointed out I had psoriasis not eczema.

I was on meds for the anxiety for a couple of years and was able to go off of them once I was able to remove some work stress and learn to just let some things go. I still struggle with this and let things bother me way more than I should and I am a constant worrier. Even though I haven’t had a panic attack in several years, I still deal with anxiety on a daily basis but at least I have managed to learn to cope with it better than I used to. I was very afraid when I first got the PsA diagnosis that it would bring back the attacks, but so far it hasn’t. I can definitely say that for me, there is a direct correlation between my stress and anxiety levels and their effects on my PsA symptoms. I’ve even gone so far to wonder if this is the root cause of my PsA?


I had truly horrible plaque skin psoriasis as a teenager, brought on by a strep throat aged 13. It covered me and of course at that age was just awful as I looked like some skin flaking horror movie actress. Not really a good look whilst dealing with puberty and all that growing up girl teenage stuff.

Then, there was loads of talk of the correlation between ‘stress’ and ‘skin psoraisis’ just lots of it. I learned slowly that if I got overly stressed my psoriasis would get worse. I learnt also how to differentiate between the stress I could deal with as in just deal or let go off and the stress I couldn’t. It made managing it easier.

I’m aghast presently with PsA that there’s so little ‘talk’ of ‘stress’ and how to manage it. I find the lack of correlation just bizzare. I talked of things like ‘reverse Keobner’s syndrome’ to my new rheumatologist and was met with interest, But when I asked so how have you guys figured all that into PsA - she told they hadn’t. And I said why on earth not? She couldn’t answer. I didn’t then bother to start chatting about ‘stress and/or depression’.

I do think our treatment is caught in a bubble of small propertions of getting so excited about the next drug, the next reshaping of our immune systems or genes that somewhere along the way, we’ve forgotten what was learnt so long ago.

I remain of the view that all stress or depression more likely affects loads of things. I think loads of what our immune systems do or don’t do causes significant stress and/or depression. too. I don’t think it’s useful or wise treating them separately and neither do I think just ‘prozac-ing’ the depression is a whole answer either. I think we all do and would do alot better if treated as a whole being, instead of bits of us being treated by different and relatively non communicating specialities.

I will always be of the view that if you want to call something ‘psoriatic’ then you really do need to examine what effect stress and/or depression makes on that and also how it causes either or both.

Just my thoughts and this far along my PsA journey they don’t seem to be wrong. Yet.


Just remembered that way, way back my mother was told that depression was caused by the actual disease process of multiple sclerosis as well as by its effects on peoples’ lives. That would be the '70s or '80s. She was offered psychiatric help as well as anti-depressant medication. Come to think of it there was a fairly joined-up approach to her disease back then and of course MS is another autoimmune disease.

1 Like

Gosh, that was very progressive treatment that your Mom got back then. Anti-depressant therapy was still in its infancy.

1 Like

As I recall my entire family were on valium. Maybe that’s not considered an anti-depressant & I should have said tranquilisers?:dizzy_face: Anyway, it did seem quite a progressive era, she had hyperbaric therapy too. Anything new that came along, off she went! Someone somewhere was splashing the cash in a way that doesn’t seem quite so obvious these days!


It’s an interesting thing, and there’s been a lot written about it over the last year or so. I’ve had bipolar/depression for the last twenty-two years (probably longer). is there a link? I don’t know - but it’s interesting that the current course of steroids I’m on, which reduce inflammation, has made my bipolar better than it has been for a long, long time. Coincidence?


Could be. On the other hand … you’ve had bipolar for a long long time and it just happens to get better while you’re taking prednisone. Sounds like there might just be a connection there, donchathink?

It does seem strange. If nothing else, I certainly feel more alive on the steroids - and now have them for another four weeks at least - so I might actually get to finish the work I’m doing!!

That must be quite a wonderful ‘side effect’ darinfan.

It is - but the only problem with being away for about four more hours a day is that I’m not used to knowing what to do with the extra time!

1 Like

It’s a good side effect Darinfan. I get ‘lots’ done on about 15mg a day. Lower than that I’m not as energetic and higher than that I’m a bit too ‘high’. But it is one of plus sides of them.


Used to think that I didn’t have depression, but how can we help not having some? I am now taking Tramadol for a ruptured disc in my lumbar, it also has a bonus of being a mild antideppresant, and this has helped a lot. I am just taking 3x 50mg, I know that it cannot be stopped without titrating slowly off of it.
Another problem that rampant inflammation causes is a disease called Waldenstrom’s macrogobulimia, it is a Non Hogkins Lympoma, luckily it is slow growing. I was dx’d with this after detecting a IgM spike in my blood work.

1 Like