Specific Inflammatory Markers Linked to Depression in Patients with Psoriasis

Inflammatory markers of C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) are associated with depression in patients with psoriasis, a recent study found.¹

Psoriasis is associated with many comorbidities, such as depression, psoriatic arthritis, and metabolic syndrome. Patients with psoriasis and depression may experience a depressed mood, anhedonia, social withdrawals, sleep, and appetite disturbances.

Studies showed increased pro-inflammatory cytokines such as CRP, TNF-A, IL-17, and IL-6 in psoriasis and depression, indicating they have similar pathogenetic mechanisms.² Stress can also increase the severity of psoriasis by dysregulating the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, peripheral nervous system, and immune system, as well as increasing cortisol levels.¹ However, depression appears on the Brain skin axis with the release of the ACTH hormone and the release of inflammatory factors of IFN-a, IF-2, IL-6, and TNF-a.

In this research, investigators, led by Eleni Mitsiou, from the dermatology department at Aristotle University School of Medicine, Papageorgiou Hospital in Greece, sought to examine the association between inflammatory markers, particularly CRP and ESR, and depression in patients with psoriasis.

“We chose to study these specific indicators of inflammation, because they are easy and economical to measure, while no special preparation for the patient is needed and they are done with a simple blood draw,” wrote investigators.

CRP for certain characteristics, such as body weight and female gender, are associated with an increased prevalence of depressive symptoms.

The study included 80 patients (mean age: 46.11 years; 26% males, 71.4% females) with 28 diagnosed with psoriasis, 24 diagnosed with psoriasis and depression, and 28 as controls, recruited from the Psoriasis Outpatient Clinic of the 2nd Department of Dermatology and Venerelogy, Aristole University of Thessaloniki. Participants were included if they suffered from moderate to severe psoriasis and depression and did not have systematic treatment for psoriasis or depression at the time of joining the study. Participants also had to be aged ≥ 18 years and ≤ 65 years.

Psoriasis was diagnosed with a Beck Depression Inventory-II score of 0 – 13, and psoriasis with comorbid depression was diagnosed with a score of 14 – 63. A psychiatrist made the final depression diagnosis.

The team evaluated psoriasis severity using the Psoriasis Area and Severity Index, Physician Global Assessment, Body Surface Area, and Dermatology Life Quality Index. Other factors assessed included obesity with the Body Mass Index, stress levels with the Beck Anxiety Inventory, and insomnia with the Athens Insomnia Scale. All participants had blood draws and inflammatory markers measured.

Investigators observed the CRP and ESR levels were greater for patients with psoriasis than controls (P = .002 and P = .03, respectively). Additionally, patients with psoriasis and depression demonstrated increased CRP (P = .001) and ESR (P = .022) compared to patients with psoriasis but no depression (P = .210 and P = 1.000, respectively).

Compared to patients with psoriasis and depression, the CRP (P = 1.000) and ESR (P = 0129) levels of just the psoriasis group did not differ from the controls.

“The results of our study confirm the publications so far as we found significantly higher ESR in women with psoriasis and depression and higher CRP was observed in patients with higher BMI at baseline,” investigators wrote.

Investigators also examined the influence of a 3-month systematic treatment for psoriasis on inflammatory markers. However, they found no significant changes in CRP and ESR values between baseline and 3 months after systematic therapy for both patients with psoriasis and patients with both psoriasis and depression.

“We consider that the 3-month period between the 2 measurements was too short to allow safe conclusions on the possible reduction of CRP and ESR after systemic treatment for psoriasis that patients received,” investigators wrote.

They continued by writing how it would be better to measure the markers at baseline since increased values can still “alert” clinicians of a patient’s co-morbidities, such as psoriatic arthritis, cardiovascular disease, or depression.

“More studies are needed to help address this important correlation of specific inflammatory markers with the occurrence of depression in patients with psoriasis,” investigators concluded. “The measurement of the values of CRP and ESR and their use to detect the possibility of the presence of depression can be an important tool for the holistic treatment of our patients with psoriasis.”

References

1. ^{Mitsiou E, Kyriakou A, Parlapani E, et al. Correlation of Specific Inflammatory Markers With the Occurrence of Depression in Patients With Psoriasis and Their Use as Biomarkers for the Diagnosis of Depression. Dermatol Pract Concept. 2024;14(2):10.5826/dpc.1402a104. Published 2024 Apr 1. doi:10.5826/dpc.1402a104}
2. ^{Postal M, Appenzeller S. The importance of cytokines and autoantibodies in depression. Autoimmun Rev. 2015;14(1):30-35. DOI: 10.1016/j.autrev.2014.09.001. PMID: 25242344.}