Part 3: Psoriasis and Mental Health: How to Navigate SI/B Warnings With Patients

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.  

A practical framework for patient conversations

In Part 3, Drs Lebwohl and Fried turn to the clinician–patient dialogue around therapies that carry suicidal ideation/behavior warnings (SI/B). Dr Lebwohl describes his efficient and effective approach, designed to give patients clarity without overwhelming them.

He notes that many patients research their medications and inevitably encounter suicidality language. His strategy involves succinctly explaining that the FDA must list every reported event, even when trial data explicitly state there is no causal association. He then grounds the conversation in data; for example, highlighting that bimekizumab-treated patients demonstrated significantly better mental health outcomes than those on placebo.

Reframing the risk: the cost of undertreatment

Both clinicians emphasize that severe psoriasis itself is associated with increased depression, anxiety, suicidal ideation, and suicide. Effective treatment is a powerful tool for reversing these risks.

Dr Lebwohl stresses that when patients are depressed, withholding high-efficacy therapies because of labeling language may cause greater harm. The act of rapidly improving their disease is often the first step toward improving their mental well-being.

Communication style: clear, confident, and compassionate

Dr Fried reinforces the importance of clarity and empathy in these conversations. While shared decision-making is essential, many patients still look to their clinician for a straightforward recommendation.

Both experts recommend a structured approach:

1. Acknowledge the SI/B language
2. Explain the FDA’s reporting requirements
3. Clarify that available data show no causal relationship
4. Highlight that treating the inflammatory disease can improve mental health
5. Recommend the therapy you believe is best for the patient

This entire process, Dr Lebwohl notes, takes about one minute in practice.

Key takeaways

• Dermatologists should address SI/B language proactively and confidently with patients
• FDA-required labeling reflects reported events, not causation
• Effective psoriasis treatment reduces psychiatric symptoms and risk
• Clear, compassionate communication strengthens trust and decision-making
• Patients often benefit from direct guidance on the clinician’s recommendation

Click here to view the other videos in the series.