When it comes to psoriasis and depression, there’s no shortage of first-person stories of having both. Sam R., from Spokane, Washington, was first diagnosed with depression two years after his first psoriasis flare. But for Noemi L., from Evansville, Indiana, depression came first. It’s clear that many people experience both depression—and other mood disorders, like anxiety—and psoriasis. But what’s not so clear is whether one causes the other.

Is It the Stigma?

A population-based cohort study published in Archives of Dermatology found that people with psoriasis have a 39 percent increased risk of being diagnosed with depression compared to those without the disease. One theory is that the stigma and discrimination that often accompany a visible skin disease may increase the likelihood of depression. Sam can attest to this. “I noticed that my mood was lowest whenever I had a flare-up,” he says. “When the itch is bad, it’s uncomfortable to do the things I enjoy, like running and swimming. And I don’t want to get intimate with my girlfriend during a bad flare-up, which affects my self-esteem and my mental health in general.”

When Depression Comes First

Noemi’s experience of living with both psoriasis and depression is quite different. “I was diagnosed with depression at age 19,” she says. “In my mid 20s, I developed psoriasis.”