Mental disorders in psoriasis have become the subject of active study in recent years. The prevalence of comorbid depression among patients with psoriasis is quite high, and even higher in cases of more severe psoriasis. It was previously thought that stigmatizing experiences were primarily responsible for this association. However, evidence is now accumulating that overlapping biological mechanisms contribute to the close association between psoriasis and depression. Increased levels of proinflammatory cytokines are present in psoriasis and depression, suggesting that inflammation may represent a pathophysiological link between both diseases. It is important to note that in patients with psoriasis, depressive manifestations are not always obvious, while they determine a lot in the prognosis, course of the disease and in the choice of therapy. Treatment with systemic biologics is aimed at eliminating clinical manifestations, but they may also play an important role in reducing concomitant depressive symptoms in patients with psoriasis. We present a patient with severe psoriasis and comorbid depression, against which the patient refused therapy. During observation of the patient, questionnaire scales were used to diagnose depression. In the article we discuss the effect of depression on the course of psoriasis and the choice of effective therapy. A description of the observation of a patient with severe psoriasis, comorbid depression and the effectiveness of guselkumab (IL-23 inhibitor) in this matter is presented.

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