Psoriasis and Bipolar Disorder: What’s the Connection?

Psoriasis is a chronic, inflammatory skin condition, but its effects go well beyond the skin. While it’s often recognized for its itchy, scaly patches, experts believe that the root causes of psoriasis — inflammation, overactive immune system, and genetic factors — also impact other areas of health, including mental health.

Research suggests that people with psoriasis are more likely to have mood disorders, including bipolar disorder, a condition marked by swings between depressive episodes and periods of mania or hypomania (a less-severe form of mania).

The two conditions also share symptoms: Both can affect energy, mood, and the ability to function in daily life.

For people living with psoriasis and bipolar disorder, understanding the connection can help with controlling risk factors, managing treatment plans, getting support, and working toward the best possible outcomes.

“The evidence so far suggests that there is a link between psoriasis and bipolar disorder, though the exact mechanisms behind the connection are still being researched,” says Mohammad Jafferany, MD, a professor of psychodermatology, psychiatry, and behavioral sciences at Central Michigan University College of Medicine in Saginaw.

Visible, chronic skin conditions like psoriasis can lead to psychological distress and worsen mood disorders, while stress and immune changes from bipolar disorder can worsen skin disease, says Dr. Jafferany.

“Large registry studies show people with psoriasis have higher rates of bipolar disorder than those without,” says Jafferany.

A registry study collects health-related data from a large group of people over time to identify patterns, outcomes, or trends in diseases and treatments. It uses real-world information, like medical records or health surveys, rather than controlled experiments.

Research suggests there’s a genetic component, and on a biological level, psoriasis and bipolar disorder share immune–inflammatory pathways, particularly involving cytokines that drive systemic inflammation, says Jafferany.

“What remains uncertain is the true size of this risk and who is most vulnerable. We don’t yet know whether psoriasis severity, the presence of psoriatic arthritis, or factors like age and sex influence risk,” he says.

The relationship between bipolar disorder and psoriasis appears to be bidirectional, meaning that people with psoriasis are more likely to have bipolar, and people with bipolar disorder appear to have a modestly higher risk of developing psoriasis, says Sylvia Garnis-Jones, MD, a dermatologist at Dermatologie Clinic in Kelowna, British Columbia.

The evidence includes a Mendelian-randomization study that suggests a causal connection from bipolar disorder to psoriasis, says Jafferany.

The connection between the two conditions is related to the autoimmune pathways, says Dr. Garnis-Jones.

“I explain to my patients that a lot of our autoimmune pathways are interconnected, not only to develop mental issues, but also to other conditions, such as diabetes, bowel issues, and eye problems,” she says. The common link? High levels of chronic inflammation in the body, she says.

Immune-system messengers (called cytokines, including IL-6 and TNF-alpha) may affect both the brain and skin, leading to mood symptoms and psoriasis, says Garnis-Jones.

Other factors include:

• Genetic Links Some studies suggest shared genetic factors between psoriasis and bipolar disorder.
• Stress and Brain–Skin Connection The brain and skin are linked through the stress response system. Psoriasis can cause emotional distress and social challenges, which may contribute to or worsen mental health issues like bipolar disorder.
• Hormonal and Nervous System Activity Overactivity in systems like the sympathetic nervous system and stress hormones (cortisol) might contribute to both conditions.

Experts think there are also social and environmental factors behind the connection.

• Lifestyle Factors Obesity and smoking are more common in both conditions and may contribute to inflammation and overall disease risk.
• Frequent Healthcare Visits People with psoriasis often interact with the healthcare system more than average, which could increase this population's likelihood of mental health diagnoses, but also better monitoring and treatment.
• Environmental Issues Visible skin problems from psoriasis can lead to shame, isolation, and increased emotional stress — all potential triggers for mood episodes in bipolar disorder.

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“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.

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.

Support from friends can help you better manage both conditions, says Jafferany. “Connecting with others who understand your challenges can ease feelings of isolation and provide encouragement,” he says.

While there isn’t a single organization dedicated to both psoriasis and bipolar disorder, “there are excellent resources for each condition,” he says:

• The National Psoriasis Foundation provides information, advocacy, and patient support for those living with psoriasis.
• For bipolar disorder, the Depression and Bipolar Support Alliance (DBSA) and the National Alliance on Mental Illness (NAMI) offer community groups, educational resources, and helplines.

• Psoriasis and bipolar disorder are connected through shared biology, stress-related pathways, and medication effects.
• The relationship appears to go both ways: Psoriasis may raise the risk of bipolar disorder, and vice versa, though more research is needed to clarify the strength of this connection.
• Management is more complex when both conditions are present, with medication choices, lifestyle support, and integrated care playing especially important roles.
• With the right care team and support, people living with both psoriasis and bipolar disorder can improve their health and quality of life.