Having Psoriatic arthritis (PsA) can negatively impact your mental wellbeing. Some people may develop depression or anxiety, which can make your PsA worse.

Symptoms of anxiety include:

• feelings of tension
• worry and irritability 
• physical changes like increased blood pressure

Symptoms of  depression may include:

• sadness
• a lack of interest in daily activities
• weight loss or weight gain
•  insomnia or excessive sleeping
• lack of energy
• inability to concentrate
•  feelings of worthlessness or excessive guilt
• thoughts of death or suicide.

Rates of depression and anxiety in people with arthritis are greater than the rates of the general population.

Studies show that anxiety and depression can lower your pain threshold. Chronic pain can then worsen your anxiety and depression. As a result, you may find yourself in a never-ending loop of pain, poor health and negative mood. This vicious cycle can significantly change the course and management of your arthritis.

Pain and Depression

Many studies have shown that people with arthritis who experience a lot of pain are more likely to be anxious or depressed. Exactly why increased pain is associated with depression is not clear. It seems to be a two-way street.

Pain incites depression. Living with daily pain is physically and emotionally stressful. Chronic stress is known to change your levels of brain and nervous system chemicals. Disrupting your body’s balance of these chemicals can bring on depression in some people.

Depression makes pain worse. Depression weakens a person’s ability to deal and cope with pain. For people with chronic pain, depression is associated with more severe pain and a longer duration of pain compared to people who are not depressed. This is because the way pain is relayed to the brain is complex and can be modified by depression as well as stress, poor sleep and anxiety.

Inflammation and Depression

We know that pain and disability are linked to depression in arthritis, but inflammation is also thought to play a role.

A study that reviewed levels of C-reactive protein (CRP) – a marker of inflammation – in 10,036 people, found people with depression had CRP levels that were 31% higher than those with no depressive symptoms.

Psoriasis and Depression

Psoriasis is common among people with PsA. People with psoriasis are more likely to suffer from depression than those who do not have it. The physical appearance of psoriasis can make people who have it feel embarrassed, ashamed and anxious, which can lead to low self-esteem. This can affect their social, personal, and sexual lives.  Daily activities may also be affected, depending on the severity and location of the psoriasis.  All these factors can reduce a person’s quality of life, further contributing to feelings of depression and anxiety. 

In some people, depression, stress or anxiety can trigger a psoriasis flare.  This can lead to a cycle of depression, psoriasis flares and arthritis-related pain.

Improvements in the physical symptoms of psoriasis can improve mental wellbeing. Treating the psychological and physical aspects of PsA may require collaboration from a GP, a dermatologist and a psychologist.   

Lifestyle and Depression

Having PsA is painful and exhausting. Inflammation and the fatigue that goes with it can further drag you down. Dealing with all of this can make keeping active hard to do. 

All of these health challenges may cause you to engage less in physical activity, become less social, and have worse sleep. These negative changes can increase your pain and dampen your overall mood – bringing on the blues and depression.

No matter exactly what causes depression in people with PsA, the link is real and potentially life-changing. Treating not only your PsA but also treating your anxiety or depression are important to living a full life

For more information on depression and treatments visit beyondblue, Lifeline or SANE

For more information see Arthritis and depression - What you can do about it and Treating depression and anxiety in arthritis