One of the side-effect warnings one sees in TV ads for prescription psoriasis medication is “May cause suicidal thoughts.” This boggles my mind. The larger question is really: how can any external agent generate thoughts of any kind?
A whole lot of medications (including ones that are not specifically created to treat mental or emotional issues) can affect brain chemistry.
As I roughly understand it, these modern medications that are affecting immune-system disorders, of which disorders psoriasis is one, include substances that cross the blood-brain barrier and that therefore can have unintended effects on brain chemistry. Some of these medicines may indirectly affect serotonin, dopamine, or glutamate systems, which affect mood. If a person is already suffering from depression, these changes can make that depression worse.
The volume of risk is relatively low across all those using these medications, but the consequences can be serious enough to warrant the warnings.
Is it a stab at humor? Not that suicide is humorous. I got this from the old ad, The phrase “the heartbreak of psoriasis” comes from a famous 1960s advertising campaign for Tegrin, a medicated coal tar soap . Heartbreak /= suicide?
From the AI search:
- Commercials and print ads warned people that dry, flaky skin might actually be “the heartbreak of psoriasis”.
- The Meaning: The campaign used “heartbreak” to describe the deep emotional toll and visible stigma of the chronic skin condition.
- Cultural Impact: The slogan became so common that it turned into a pop-culture catchphrase and a frequent joke. [1, 2, 3, 4]
What Psoriasis Actually Is
- The Cause: Psoriasis is a chronic, overactive immune system condition, not just poor hygiene or simple dry skin.
- Physical Signs: It causes raised, red patches covered in thick, silvery scales, along with itchy or cracked skin.
- Deeper Effects: Beyond the skin, it can lead to joint pain (psoriatic arthritis) and higher stress or depression. [1, 2, 3, 4, 5, 6]
If you or someone you know is managing this condition, would you like information on modern medical treatments or coping strategies for flare-ups?
Is what a stab at humor? The medication side effect warnings? That’s not a venue where jokes are made.
If you’re talking about Ocrevus, which gets TV advertising (URRRGH) or Tysabri, which to my knowledge does not, both drugs can cause assorted encephalopathies and for this reason, they are not first-line agents. These meds are mainly for certain subtypes of multiple sclerosis, which may also be autoimmune in some cases. Why they do this is poorly understood.
Let me reply with the insight from a family member who works in pharmaceutical testing. When a drug is being tested, every single potential contraindication, anomaly, physiological change or symptom that the test subject experiences during the trial must be reported. Even if it isn’t related to the drug…because…‘how do we know its not related to the drug?’
So if enough people stub their toe and get a bruised toe while on the drug this needs to be reported and may end up as a ‘potential’ side effect…it ‘may’ cause bruised toes. We don’t know, but enough people reported it while in the trial that we are required to include it.
In this case, there may not be a connection. Or it might be an indirect connection, or purely psychosomatic, or real…But its there because enough people reported it and the FDA requires the pharma company to include it in their literature.
And (implied in your post, I suspect), it’s if enough people in the test cell (i.e., those who received the drug) reported that happening, compared to the proportion of people in the control cell (i.e., those who received a placebo) reporting it.
Though of course, coincidences happen. It might be that the test group, just by random chance, happened to have more stubbed toes than they should. Even if they say that the correlation is at a 95% confidence level, sometimes you just roll a natural 20.
My freshman college dorm roommate developed psoriasis during the year, and he was miserable with it. He always smelled of some topical medicine, because that’s all there was (it might have been that soap, or something else). Whatever it was, it didn’t seem to help much, and I felt heartily sorry for him – I had suffered badly with childhood eczema, which fortunately for me went away when I hit puberty, but I understood the stigma of having a very visible skin condition like that. I don’t know what happened to him, we weren’t close and didn’t keep in touch during the summer.
LSD, which is well known to “generate thoughts” can be absorbed through the skin. Apparently so can fentanyl and several other mind-altering substances, according to this link, as well as “rockstar legends”.
Supposedly Jimi Hendrix was a fan of the transdermal method.
I can tell you from experience: it’s absolutely brutal, and when they said “the heartbreak of psoriasis”, they may have been selling something but they’re not wrong.
Imagine you’ve lived a normal, healthy life into your mid-20s. Then one day you wake up and you itch your scalp and flakes come off. At first you think it’s dandruff so you buy dandruff shampoo and don’t worry about it.
Then you get a spot on your arm that just won’t heal, your skin calcifies but it won’t scab over and go away. Then you get one on your other arm, because for some reason it’s bilateral and nobody knows why. Then it spreads.
Within 5 years you have a wine spot covering most of your head and part of your face, your arms and legs have scales that constantly itch and bleed, and every time you move your skin cracks in the most painful way because it no longer stretches. Everyone has to say something or ask what’s wrong with you, and your choices are to ignore them and then they think you’re the jerk, tell them and let them look at you and treat you like a tragic figure, or if they’re especially rude say something appropriately rude back. Suddenly you’re a cynical jerk who can’t and doesn’t want to deal with people, you just want to hide.
Until biologicals like Humira and Stelara came about, that was the reality. They are absolutely life altering for people like me with severe plaque psoriasis. But in exchange for that I have to accept the small to moderate potential for liver damage and I can’t take things like live vaccines. I also have to get semi-annual bloodwork and give myself shots, which for a needle-phobe like me is torture. It’s a fair trade. I no longer have to scrub my arms and legs with Scotch-Brite and my body doesn’t hurt to move (or at least not from that).
Anyway, all of those “potential” side effects are things that the test subjects reported. Psoriasis causes a lot of psychological issues, and it wouldn’t surprise me in the least that some of the test subjects were reporting suicidal ideations in an effort to be completely up front about it. There is no documented evidence that monoclonal antibodies actually cause people to kill themselves, but like Prop 65 in California, if you say it might happen you’re protecting yourself so you warn against everything.
I bet “suicidal ideation” is the first question on the survey too, as a defense against lawsuits.
I was surprised to learn of the relationship between psychiatric depression and, to me, seemingly unrelated cardiac events like routine surgery or MCI/attack. It is particular to the heart and is different from and in addition to the emotional difficulties of other yucky hospital visits like, say, a stroke or concussion or gunshot wound.
In very large numbers, too. It affects outcomes in a lot of negative ways.
Mental health disorders can follow all sorts of cardiac problems. Studies have shown that depression or anxiety affect more than 30% of people who have their aortic heart valve replaced and 30% to 40% of people who have heart bypass surgery.
From my childhood experiences with eczema, and from watching my college roommate, I can sort of imagine something of what your life and your feelings have been like. I am so glad for you and everyone who has been helped by these new medicines, that make such a difference. Thank you for sharing.
It can’t directly.
It can change the conditions in which thoughts are generated, though. For example, anti-depressant meds quiet these neurons, increase those, make these increase more of that, and those decrease this other thing. You’re neural circuitry gets influenced/changed by the meds. And quickly. Thoughts are born out of your neurons/neural pathways doing things the usual way and now the meds are messing with it. Sometimes for good, sometimes neutral, sometimes negative. Something like that. How an external agent can do that, I don’t know. It’s chemistry and biology…I think.
That’s explaining the actual mechanism of how a med can cause a side effect. It’s not necessary for anyone to know that though to say X causes Y. Studies show it can and so they warn you about it.
I think for a lot of medicine the actual mechanism is not really clear, just that studies show that it can do it at a greater rate than if you did not take the med.
Thanks; this comes closest to answering my question (although the digressions about the nature of psoriasis were also interesting).
I kinda felt that my thoughts were the product of my sensory input plus my life experiences, run through my own cognitive processes. To think that the process could be tweaked by taking a pill was weird.
I hear ya, it is weird.
But also, sugar can do it. That doesn’t seem as weird to me (for some reason), but it’s the same kind of principle. Lots of ingested things other than pills can caused changing thoughts and behavior. I don’t know how well it’s understood or not.
Many drugs are absorbed via the skin. I personally use scopolamine patches for sea-sickness. As a prescribing doctor I once made a nice old lady hallucinate by prescribing a seasick patch. I have induced pain relief (and euphoria) with Fentanyl patches as well. But I digress.
The classic medical cases for drug warnings about suicide are for ANY antidepressant, and for Accutane. Accutane treats severe acne. It happens that people who are depressed and teenagers with severe acne attempt more suicides than the average person. It goes without saying that people who are prescribed drugs for depression or acne have a higher risk of suicide. That is not the same as saying antidepressants or acne drugs cause suicide, but you can bet the drug company lawyers will post “black-box” warnings about the suicidal risks of prescribing their drugs to people.
LSD doesn’t readily absorb through the skin unless you get it in a mucus membrane. What is a source of transdermal LSD is combining it with DMSO (dimethyl sulfoxide), which the Dead Kennedys helpfully taught us.
I do my part behind the lines
Swabbing door handles of cop cars
With DMSO
Mixed with LSD
For the OP: I don’t know what ad you’ve seen, but looks like there are a half dozen psoriasis meds new enough (patented enough) to be advertised. Narrowing it down I suspect the medication is Bimzelx (Bimekizumab). The pharmacology is complicated so I’ll defer to an expert on any cause. Their full report is here, relevant part:
Plaque Psoriasis
During the two 16-week, placebo-controlled periods of Trials Ps-1 and Ps-2, higher rates of suicidal ideation as assessed by C-SSRS were reported in BIMZELX-treated subjects than in subjects receiving placebo. Pooled analysis of C-SSRS data indicated that 12/670 (1.8%) BIMZELX-treated subjects and 1/169 (0.6%) subjects receiving placebo reported passive suicidal ideation with an estimated relative risk of 3.0 (95% confidence interval: 0.39, 22.74). Subjects without a prior history of SI/B treated with BIMZELX also reported a higher rate of new onset suicidal ideation on the C-SSRS than subjects receiving placebo (1.3% vs 0.6%). During the open-label extension trial, one completed suicide was reported in a BIMZELX-treated subject [see Adverse Reactions (6.1)].
That last reference notes they excluded people with a history of ideation in subsequent trials, but still saw an increase in reported incidence. So a rare side effect, but a potentially real one.