- Design
- Systematic review and frequentist network meta-analysis
- Population
- 8 studies, 4,319 adults with moderate to severe plaque psoriasis
- Primary outcome
- Depression and anxiety symptom scores
- Effect
- Depression SMD 0.677 (95% CI 0.473 to 0.881) for IL-12/23; anxiety SMD 0.457 for IL-23 and IL-12/23
This network meta-analysis included eight studies with 4,319 patients with moderate to severe plaque psoriasis. It compared biologics with placebo, and with each other, on depression and anxiety scores.
At class level, every biologic class improved depression and anxiety symptoms against placebo. For depression, IL-12/23 inhibitors had the largest estimate (standardised mean difference 0.677, 95% CI 0.473 to 0.881). For anxiety, IL-23 and IL-12/23 inhibitors were similar (SMD 0.457 for both). At drug level the rankings were uncertain because the networks were sparse and certainty ranged from high to low.
Mood improvement generally followed skin improvement but not in proportion. Treat this as a reason to screen for mood, not as a reason to choose a biologic for depression.
- Ask about low mood and anxiety at every psoriasis review; use PHQ-9 or GAD-7 where you can.
- Expect mood to improve alongside skin on biologics, but do not rely on it.
- Refer or treat depression directly rather than waiting for skin clearance.
- Do not choose a biologic for its mood effect; drug-level rankings were uncertain.
Why it matters
It frames mood as part of what a biologic may treat, which affects how benefit is measured at follow-up.
Don't overread it
The mood gains were short-term, partly from small networks, and may reflect improvement in skin rather than a direct drug effect.
The statistics, in plain English
A standardised mean difference of about 0.5 to 0.7 is a moderate effect in the units of the scales used. The estimates are short-term and the drug-level networks were sparse, so the exact order of drugs is not dependable.
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