Could Suicide Be Fostered Through the Potential Antidepressant Mechanism of Biological Agents? A Psychodermatological Approach to Existing Bibliography

Abstract

Background: Bipolar disorder (BD) is a biological condition that affects between 2% and 5% of the population. Despite this, it is often underdiagnosed as unipolar depression, which increases the possibility of prescribing errors. This could foster episodes of inverse polarity (“switching”) which, in turn, raises the risk of suicide. Objective: This work reviews the existing literature for evidence that while biological agents could improve the mood of patients with psoriasis treated with these drugs, this same favorable antidepressant effect on humor may trigger a switch into mania, favoring attempted and completed suicide in undiagnosed bipolar patients treated for psoriasis with the abovementioned agents. Method: A systematic review of the literature was performed for evidence. Based on their titles and abstracts, 48 relevant articles from 18 countries in English, Spanish, and French from 2004 to 2019 were selected for this review. Results: Inherently, all antidepressants can be associated with treatment-emergent affective switch (TEAS). Biological agents may modify the neurotransmitter levels either improving or worsening the mood. A plausible hypothesis arises on the double-edged nature of biological agents: they would have an antidepressant effect that would be beneficial to treat the psychiatric comorbidity of the patient with psoriasis. However, this same antidepressant effect, in a patient with genetic vulnerability for depression with a concomitant inflammatory disease, could trigger a mood alteration. Conclusion: Both BD and psoriasis should be considered as a multisystem entity with a common physiopathology. Consequently, it is vital to emphasize the importance of the initial psychiatric evaluation.