Part 1: Psoriasis and Mental Health: Understanding Depression and Suicidality Risk

This 4-part video series brings together leading dermatologists to explore the intersection of mental health and chronic skin disease, a connection that continues to gain recognition in both research and clinical practice. Across the series, experts examine how psychiatric comorbidities influence dermatologic outcomes, review data on the mental health impact of chronic inflammatory conditions, and discuss how dermatologists can thoughtfully address these concerns in patient care.  

Psoriasis and the psychiatric comorbidity

In Part 1, Mark Lebwohl, MD, is joined by Rick Fried, MD, PhD, both a dermatologist and a clinical psychologist, to examine the deep and often underappreciated mental health impact of psoriasis. They open with a reminder that multiple dermatologic diseases influence mental health, with psoriasis being among the most studied but far from the only condition with significant psychiatric burden.

Dr Lebwohl also outlines 4 dermatologic therapies that carry warnings related to suicidality: brodalumab, isotretinoin, apremilast, and bimekizumab. He notes that concerns about these warnings can meaningfully impact prescribing behavior.

The baseline mental health status of patients with psoriasis

Dr Fried highlights extensive evidence showing that patients with psoriasis have substantially elevated rates of depression, anxiety, suicidal ideation, and completed suicides. Importantly, he notes psoriasis itself is an independent risk factor for these outcomes.

He explains that multiple studies show that when psoriasis improves, associated depression and suicidality often also improve, sometimes dramatically, suggesting that treatment of the skin disease can be a direct, positive intervention for a patient’s mental health.

Dr Lebwohl reinforces this point with data from a large survey demonstrating that major depression occurs more frequently among people with psoriasis than in the general US population, illustrating the need for dermatologists to recognize and address this burden.

When mental health improves with skin disease control

Drawing from his psychology practice, Dr Fried shares that patients with severe psoriasis who have a history of depression or suicidality often benefit the most from highly effective dermatologic treatment, despite clinicians’ hesitations to prescribe when these treatments carry suicidality warnings. These patients frequently experience relief not only from their skin symptoms but also from the social, emotional, family, and intimate impacts of the disease.

By the time patients reach dermatology care, many have endured years of topical prescription and over-the-counter treatment failures. He finds that simply engaging with a clinician who demonstrates empathy and confidence in a treatment plan can be impactful for these patients.

The dermatologist’s role: life-saving potential through effective treatment

Dr Lebwohl stresses that dermatologists may be uniquely positioned to save lives by rapidly improving severe psoriasis with highly efficacious therapy, even if the medication carries a suicidality warning. He notes that FDA labeling reflects a requirement to list all potential events, not proven causation, and that withholding effective therapy due to fear of labeling language may harm patients who need rapid control the most.

Dr Fried agrees, emphasizing transparency and informed consent alongside a broader perspective: while labels enumerate theoretical risks, they do not list the severe consequences of undertreatment, including worsening psychiatric burden.

Both clinicians highlight that untreated psoriasis is associated with worsening systemic and psychiatric outcomes and that dermatologists should be motivated to act quickly and aggressively when indicated.

Closing thoughts

They conclude by reviewing data demonstrating that biologics across classes are associated with lower rates of suicidal ideation and completed suicides compared to untreated psoriasis and compared to the general population. Studies from the past 20 years consistently show that untreated psoriasis is associated with more than a doubling in suicidal ideation and an approximate 20% increase in completed suicides.

Key takeaways

• Psoriasis independently increases the risk of depression, anxiety, suicidal ideation, and suicide
• Effective treatment, especially biologic therapy, can meaningfully reduce psychiatric symptoms
• Dermatologists play a critical role in addressing both physical disease and its mental health consequences
• Suicidality warnings on dermatologic drugs reflect reporting requirements, not proven causality
• Early, effective, empathetic intervention can improve quality of life across emotional, social, and physical domains

Click here to view the other videos in the series.