The Impact of Psoriasis Treatment on Depression and Suicide Risk: A Systematic Review
Clinical Snapshot
PICO Framework
| P — Population | Adult patients with psoriasis (chronic inflammatory skin condition) who have comorbid depression and/or suicidal ideation |
| I — Intervention | Psoriasis treatments including topical therapies, phototherapy, oral systemic medications, and biologic agents (e.g., guselkumab, brodalumab, bimekizumab) |
| C — Comparator | Placebo, comparator treatments, or baseline pre-treatment psychological status (comparators not uniformly defined across included studies) |
| O — Outcomes | Depression symptom severity, suicidal ideation, quality of life, and psoriasis severity (e.g., PASI scores) |
Bottom Line
This systematic review examines the effect of psoriasis treatments — particularly biologics — on depression and suicidal ideation. While the clinical question is important and timely, the review has significant methodological limitations that constrain its evidence grade. Only 10 studies were included, no meta-analysis was performed, no GRADE assessment was applied, and grey literature was not searched. The finding that biologics such as guselkumab and bimekizumab may reduce depression symptoms is plausible and consistent with the known relationship between inflammatory burden and mood disorders, but cannot be quantified from this review alone. The suicidal ideation signal with brodalumab is clinically important and consistent with existing regulatory warnings from the TGA and FDA, but the review does not provide incidence data or risk quantification. For Australian clinicians, the key practical takeaways are: (1) routine psychiatric screening should accompany biologic initiation; (2) brodalumab requires specific mental health monitoring per TGA risk management requirements; and (3) multidisciplinary care involving dermatology and psychiatry or psychology is best practice for patients with moderate-to-severe psoriasis and comorbid depression. This review is best regarded as a narrative overview rather than a definitive evidence synthesis.
Key Findings
P Value: Not reported at the review level
Effect Size: Not reported — no pooled effect sizes or standardised mean differences provided; findings described qualitatively as 'notable reductions'
Primary Outcome: Biologic therapies (guselkumab, brodalumab, bimekizumab) demonstrated reductions in depression symptom scores in patients with psoriasis, likely mediated through improvement in psoriasis severity and quality of life
Nnt Or Sensitivity: Not calculable from available data; no NNT, NNH, or absolute risk data for suicidal ideation with brodalumab are reported at the review level
Confidence Interval: Not reported
Clinical Application
Biologic therapies are feasible in specialist dermatology settings but require shared care arrangements with mental health services for monitoring of psychiatric adverse events. Routine depression screening using validated tools (e.g., PHQ-9) prior to and during biologic initiation is clinically warranted but not universally implemented. In Australia, biologic therapies for psoriasis including guselkumab (Tremfya), bimekizumab (Bimzelx), and brodalumab (Siliq/Kyntheum) are TGA-approved. Brodalumab carries a TGA-mandated Risk Management Plan due to the suicidal ideation signal, consistent with the FDA REMS program. PBS listing for biologics in psoriasis requires failure of conventional systemic therapy and a PASI score ≥15 or DLQI ≥15. RACGP guidelines support integrated care for psoriasis patients with mental health comorbidities. Australian dermatologists should be aware of the psychiatric monitoring requirements embedded in brodalumab's prescribing conditions. The Psoriasis Association of Australia and the Royal Australasian College of Dermatologists (RACD) both advocate for routine psychological assessment in moderate-to-severe psoriasis management. Adults with moderate-to-severe plaque psoriasis who have comorbid depression or are at risk of suicidal ideation; particularly relevant for patients being considered for biologic therapy escalation
Abstract
BACKGROUND: Psoriasis is a long-lasting inflammatory condition of the skin associated with various comorbidities, including depression and suicidal ideation. Management strategies for psoriasis include symptom alleviation, quality-of-life enhancement, and prevention of disease progression. Psoriasis treatments include topical therapies, phototherapy, oral systemic medications, and biologics. OBJECTIVES: In this review, we evaluate the impact of psoriasis treatments on depression and suicidal ideation in affected patients. METHODS: We systematically searched multiple databases, including PubMed, Scopus, and Web of Science, until September 30, 2024, to identify relevant articles. Studies that examined the effects of psoriasis therapies on depression and suicidal thoughts were included. Data on treatment modalities, psychological health outcomes, and psoriasis severity was obtained. Quality evaluation instruments, such as JBI, consolidated standards of reporting trials (CONSORTs), Center for Evidence-Based Management (CEMBa), and appraisal tool for cross-sectional studies (AXIS), were used to appraise study quality. RESULTS: Ten studies met inclusion criteria, predominantly focusing on biologic therapies. Biologics like guselkumab, brodalumab, and bimekizumab have shown notable reductions in depression symptoms, probably through the alleviation of psoriasis severity and the enhancement of quality-of-life. Suicidal ideation occurred in some cases, especially with brodalumab; however, a definitive causal relationship was not established. CONCLUSIONS: Treatments for psoriasis, especially biologics, have shown some advantages in reducing depression symptoms as well as relieving skin symptoms. However, cautious monitoring is required due to the possible hazards of suicidal thoughts with certain therapeutic options such as biologics. Addressing the complex issues of psoriasis requires comprehensive therapy that includes dermatologists and mental health specialists.
References
- 1.Shahsavaripoor, B., Karami, S., Sahebi, A., & Jafferany, M. (2026). The impact of psoriasis treatment on depression and suicide risk: A systematic review. Depression and Anxiety. https://doi.org/10.1159/000448122
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