“When both conditions coexist, treatment needs special attention. There is evidence that treating one condition can often improve the other, but careful coordination is needed to avoid medications that can make symptoms worse,” says Jafferany.
Team-based care is a game changer, he says. “Unlike single-condition management, communication between dermatology and psychiatry is more important, and collaboration among specialties is essential,” says Jafferany.
Effective psoriasis therapy, especially with biologics, often reduces depression and anxiety, likely because of both improved appearance and lower inflammation, he says.
“Bipolar treatment can also help the skin. Stabilizing mood can reduce stress-driven psoriasis flares. But some bipolar medications — notably lithium — may worsen psoriasis, so drug choice matters,” says Jafferany.
Lithium Risks in People With Psoriasis
Lithium, a common mood stabilizer for bipolar disorder, can cause or worsen psoriasis, even at regular doses.
“Lithium is a well-established trigger for psoriasis in susceptible individuals. It can induce or exacerbate psoriasis; there are many studies that have confirmed this,” says Jafferany.
Often, lithium-induced psoriasis improves after dose reduction or discontinuation.
Potential Drug Interactions
There are risks for drug interactions if you have both conditions, says Jafferany, including the following:
- Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo) used with mood stabilizers, such as valproate (Depakene, Depakote) and carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril) poses a risk of liver toxicity. Those taking both should have their liver function monitored.
- Cyclosporine (Gengraf, Neoral, Sandimmune) used with mood stabilizers or antipsychotics raises the risk of kidney problems, hypertension, and drug interactions.
- Biologics, such as TNF, IL-17, and IL-23 inhibitors, are generally safe when used with psychiatric medications, but there are reports of mood changes, and so mental health monitoring is recommended.
- Systemic corticosteroids can induce mood swings or mania, especially in people with bipolar disorder.
Monitoring and Lifestyle Changes
More frequent monitoring is required when a person has both psoriasis and bipolar since flares in one can trigger problems in the other, says Jafferany.
“Sleep and stress management are important,” he says.
Achieving and maintaining a healthy weight can help cut down on chronic inflammation, says Garnis-Jones.
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