Psoriasis and the brain

[Fred]

Can I have a copy please  

PM sent Jim.

[jiml]

Can I have a copy please  

PM sent Jim.  

Many thanks 24 pages... I will look at it when I'm sitting quietly

[Turnedlight]

Just read an interesting article which says that scientists are fast coming to conclusion that they should be treating depression with anti-inflammatories, that depression is in fact a physical illness.

The only issue I have with this is from a personal point of view, I know my immune system has been in overdrive for many years, but I don't have any depression issues, though I do get anxious sometimes. But it's still interesting progress and could explain why there's a rise in numbers of people with depression, now they need to find out now what's causing the problem in the first place.

[D Foster]

I have never come across any relationship between psoriasis and the brain however can I just say GB , need I say more !!!  

By the way if it was Brian then yes I do know of the relationship between my mate Brian and psoriasis.

[jiml]

Just read an interesting article which says that scientists are fast coming to conclusion that they should be treating depression with anti-inflammatories, that depression is in fact a physical illness.

The only issue I have with this is from a personal point of view, I know my immune system has been in overdrive for many years, but I don't have any depression issues, though I do get anxious sometimes. But it's still interesting progress and could explain why there's a rise in numbers of people with depression, now they need to find out now what's causing the problem in the first place.

Yes TL it sounds interesting and I would like to know more but depression is not something I suffer with.
As to the cause of depression, I think modern lifestyles are conducive to depression as we are bombarded with bad news and stories of  unrest from home and abroad on all social media and tv...mix that with personal problems and in my mind you have a perfect recipe for depression.....if it can be treated with anti-inflammatory drugs and they help it can only be a good thing

[D Foster]

I did come across this article. See conclusions

Abstract
Objectives

The aim of this study was to assess associations between objective disease severity, psoriasis symptoms, illness-related stress (IRS), health-related quality of life (HRQL) and depressive symptoms in patients with psoriasis.

Method

Cross-sectional study conducted between  Recruitment of 265 adult patients with psoriasis through Internet advertisements. Analysis of the validity of different measurement models and the fit of hypothesized structural models using a structural equations modeling approach.

Results

Thirty-two percent of the participants screened positive for depression. Because of poor discriminant validity (correlation: 0.919), IRS and HRQL were considered as one factor. The final measurement model had adequate validity and fit. A significant proportion of the variance of depressive symptoms was explained by HRQL (standardized direct effect: 0.916; P<.001). After adjustment for HRQL, objective severity of psoriasis was inversely related to depressive symptoms (standardized direct effect: −0.250; P=.094).

Conclusion

In psoriasis — a condition without direct brain involvement — specific disease-related problems in everyday life seem to cause depression in a significant proportion of patients. It is therefore critically important to regularly assess and work to maximize HRQL in psoriasis patients. Patients with high HRQL impairment despite objectively mild psoriasis should be screened for depression.


Second survey.

Summary
Background

Psoriasis has substantial psychological and emotional effects. We assessed the effect of etanercept, an effective treatment for the clinical symptoms of psoriasis, on fatigue and symptoms of depression associated with the condition.

Methods

618 patients with moderate to severe psoriasis received double-blind treatment with placebo or 50 mg twice-weekly etanercept. The primary efficacy endpoint was a 75% or greater improvement from baseline in psoriasis area and severity index score (PASI 75) at week 12. Secondary and other endpoints included the functional assessment of chronic illness therapy fatigue (FACIT-F) scale, the Hamilton rating scale for depression (Ham-D), the Beck depression inventory (BDI), and adverse events. Efficacy analyses were based on the allocated treatment. Analyses and summaries of safety data were based on the actual treatment received..
Findings

47% (147 of 311) of patients achieved PASI 75 at week 12, compared with 5% (15 of 306) of those receiving placebo (p<0·0001; difference 42%, 95% CI 36–48). Greater proportions of patients receiving etanercept had at least a 50% improvement in Ham-D or BDI at week 12 compared with the placebo group; patients treated with etanercept also had significant and clinically meaningful improvements in fatigue (mean FACIT-F improvement 5·0 vs 1·9; p<0·0001, difference 3·0, 95% CI 1·6–4·5). Improvements in fatigue were correlated with decreasing joint pain, whereas improvements in symptoms of depression were less correlated with objective measures of skin clearance or joint pain.
Interpretation

Etanercept treatment might relieve fatigue and symptoms of depression associated with this chronic disease.

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Edit By Fred: Link removed.

[Turnedlight]

The key words that stand out there is they say 'psoriasis does not have direct brain involvement', and appear to say any depression in a person who has p is caused by stress of having p, difficulty everyday life with p, worrying about your appearance etc.



I'm not really researching this side of things though - I'm interested in the growing belief that depression (not neccessarily in someone with P but in any person) is actually directly caused by the physical effects of inflammation and an overactive immune system, and that giving anti-inflammatory drugs can actually directly help many people with depression regardless of whether they had any outward signs of inflammatory disease at all.

[D Foster]

Etanercept (trade name: Enbrel) is a type of drug known as anti-TNF. In rheumatoid arthritis and some other inflammatory conditions, too much of a protein called TNF (tumour necrosis factor) is produced in the body, causing inflammation, pain and damage to the bones and joints. Anti-TNF drugs such as etanercept block the action of TNF and so reduce this inflammation.
Etanercept (Amgen Pfizer) is the world's third-best-selling pharmaceutical product ($8,697 millions/year)
As this is an anti-inflammatory drug and is such a wide selling one I would have thought that if it could help depression it would have been picked up and at the very least other effects such as help with depression would have been noted when in general use.

[Turnedlight]

That's very true, but maybe people would attribute their mood improvement to improvements in their skin and or joints, and also they weren't actually trialling it for people without psoriasis and only depression?

The reason I raised this subject that they now believe many cases of depression can be helped by giving anti-inflammatories rather than drugs with a serotonin action, was from reading an article in a well known national newspaper.

But you're right, you would think they had noted it as a positive effect of drugs already on the market, and in fact some of the drugs note depression as a side effect..

[Caroline]

Why would they have noted this effect TL?
As long as they do not research it, they often do not see it. They, the doctors, mostly don’t have the time to look good at the patients in the small period of time they have talking to them. So detecting a mood change in more patients, thinking about this and then drawing conclusions will hardly happen.