TDNet Discover

Background: Plaque psoriasis is a chronic inflammatory disease manifesting as pruritic lesions on the skin that affects a large patient base. Multiple treatment options are available including topical ointments and creams, systemic injections and tablets, and phototherapy. Dissatisfaction of treatment application and varying rates of efficacy leads to non-adherence. Furthermore, comorbid depression is highly prevalent due to the burden of plaque psoriasis and affects the overall treatment process. Objective: To conduct a systematic review of existing literature to determine the effect of concurrent antidepressant therapy on adherence to plaque psoriasis treatment. Methods: A systematic review was conducted concerning plaque psoriasis, depression, chronic diseases, and treatment adherence by searching four databases: Google Scholar, Medline, PubMed, and Discover Search South College. Final selection of the articles was determined by agreed upon limits, inclusion criteria, and researcher consensus. The approved upon articles were sent to an expert panel of 1, who approved nine articles and suggested an additional article for a total of 10. Each article was evaluated independently and in duplicate. Data was extracted by using an excel spreadsheet tool. Article quality was assessed based on the National Heart, Lung, and Blood Institute quality assessment tools for systematic review and meta-analyses and observational cohort and cross-sectional studies. Qualitative analyses were performed at the manifest and latent levels. Further evaluation of the manuscript by the expert panel resulted in exclusion of two of the 10 articles due to inadequate relation to the research question. The two articles were still used as supporting evidence. Results: The study was inconclusive due to lack of evidence addressing the research question. The remaining results were unintended secondary findings. The depression rate in plaque psoriasis patients ranged from 4.32% to 62.9%, with 16% increased odds of depression that was v statistically significant once adjusted for covariates. Dissatisfaction with plaque psoriasis treatment and illness-related stress showed increased depression which had a negative impact on medication adherence. Plaque psoriasis patients with unhealthy lifestyles in which depression and other mental illnesses played a role also showed decreased adherence. A combination of antidepressant and plaque psoriasis therapy resulted in reduced anxiety/depression and improved pruritus, which resulted in improved quality of life scores. Patients with plaque psoriasis had a 300% higher likelihood of antidepressant usage, however only 9-16.5% of patients in this review were actively taking concurrent antidepressant medications. Conclusion: While there were no primary outcomes of this research, unintended secondary findings emerged. This includes a positive correlation between plaque psoriasis and depression, and a negative correlation with depression and medication adherence. Increased awareness regarding the relationship between plaque psoriasis and depression can lead to better management of plaque psoriasis patients. An integral approach between dermatology and psychiatry should be considered for future management of plaque psoriasis patients to increase overall quality of life. The gap in literature whether the addition of antidepressants to plaque psoriasis treatment regimens affects plaque psoriasis treatment adherence remains and requires future studies, most likely including original research.