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Medicine (Baltimore). 2016 May;95(22):e3816. doi: 10.1097/MD.0000000000003816.

Depression and Insomnia in Patients With Psoriasis and Psoriatic Arthritis Taking Tumor Necrosis Factor Antagonists.

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From the Faculty of Medicine and Graduate Institute of Clinical Medicine (C-YW, Y-TC, Y-PL, Y-JC), National Yang-Ming University, Taipei; Division of Gastroenterology (C-YW), Taichung Veterans General Hospital; Department of Public Health and Graduate Institute of Clinical Medical Sciences (C-YW), China Medical University; Department of Life Sciences and RongHsing Research Center for Translational Medicine (C-YW), National Chung-Hsing University, Taichung; Department of Dermatology (Y-TC, H-NL), Taipei Veterans General Hospital, Taipei; Department of Dermatology (C-KJ, J-LS, Y-JC), Taichung Veterans General Hospital; Institute of Biomedical Sciences (J-JS), National Chung Hsing University; and Department of Education and Research (J-JS), Taichung Veterans General Hospital, Taichung, Taiwan.


Psoriasis patients with moderate to severe disease often present with depression and insomnia. Treatment targeting both psoriasis and psychological comorbidities is needed to improve the quality of life of these patients.In this nationwide cohort study, a total of 980 patients with psoriatic arthritis or psoriasis who had received nonbiological disease-modifying antirheumatic drugs and biologics therapy between 2009 and 2012 were identified. The prevalence rates of patients taking medications for depression and insomnia were compared before and after biologics therapy. Logistic regression method was used to investigate the risk factors for depression and insomnia. Further stratified analyses were performed to examine the prevalence of use of medications for depression and insomnia among different patient subgroups.The prevalence of patients taking regular antidepressants before starting biologics therapy was about 20%. There was a more than 40% reduction in this prevalence after biologics therapy for 2 years. Age higher than 45 years, female sex, presence of comorbidities, and psoriatic arthritis were independently associated with depression and insomnia. Further stratified analyses revealed a more rapid and significant reduction in depression/insomnia in those undergoing continuous biologics therapy, younger than 45 years, without psoriatic arthritis and not taking concomitant methotrexate, when compared with their counterparts.The results suggest that biologics therapy may be associated with reduced rates of depression and insomnia, and a reduced rate of regular antidepressants use in psoriasis patients.

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