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When you suffer from Hidradenitis Suppurativa, there is more to worry about than just the blisters and pain associated with your skin condition. There is a strong correlation between HS and major depression disorders so make sure you seek help if needed.

When it comes to hidradenitis suppurativa treatment, there are many options available to patients to try to rid themselves of these painful lumps. Some of the mainstay therapy options for patients to consider would be hidradenitis suppurativa treatment with lasers and surgery for more definite treatments. A common feature that all these therapies also share, unfortunately, is there inability to provide a cure for HS. Even after invasive surgery, there is a relapse rate of this painful acne inflammation in 33 percent of cases. Patients may benefit from prophylactic measures such as hidradenitis suppurativa treatment with metformin or to use antidepressants to treat hidradenitis suppurativa. [1] Here, we will analyze why hidradenitis suppurativa can be managed with antidepressants and how effective this therapy can actually be. 

The Link Between Depression and Hidradenitis Suppurativa 

Studies demonstrate that there is a very critical link between chronic skin disorders and depression in patients. This is a logical connection because as patients deal with chronic pain and frustration due to marginally effective therapies, they will gradually become more and more frustrated with their current status and this can easily lead to depression. [2

In one cohort study conducted on the Danish population, it was determined that patients with HS were almost 2.5 times more likely to successfully commit suicide compared to the standard population after controlling for confounding variables. This clearly depicts that patients suffering from hidradenitis suppurativa are more likely to suffer from severe depression.

This same study showed that patients with hidradenitis suppurativa were only taking antidepressant medication at a rate of about 30 percent higher than the general population. This shows that even if the patients with this skin disorder are suffering from depression, they are not likely to take antidepressant medications. [3]

One explanation of this link is due to the symptoms that are often associated with HS. The pain that occurs secondary to blisters and lesions seen in HS patients dramatically reduces the quality of life in these patients. This pain can lead to problems with sleep and concentration, changes in appetite and even suicidal idealizations. This cascade of conditions is a part of what symptoms to expect when patients suffer from a major depressive disorder. [4]

How Effective is this Therapy? 

When you consider the severity of hidradenitis suppurativa as well as the limited options of hidradenitis suppurativa treatment, it is no surprise that depression will be sure to follow. Antidepressants are becoming a more and more popular adjuvant therapy in patients who have been diagnosed with HS to help treat the mood disorders associated with this condition. [5]

Multiple studies show that various treatment options for HS can improve quality of life parameters in statistically significant proportions. Biological treatments and surgical interventions seem to be the most beneficial regarding making patients feel better mentally [6]. This modest improvement will help patients suffering from minor episodes of depression, but when symptoms become more severe, this will not be enough to help patients with HS. Stronger antidepressant medication will have to be used to alter neurotransmitters levels in the brain to adequate levels. 

We group antidepressant medications into three different main subcategories based on what neurotransmitter they target

Older medications still on the market go by the name of tricyclic antidepressants (TCAs), and they may still be used in patients who do not respond to the newer antidepressants. Unfortunately, they have some side effects, so it is better to avoid them if possible [7]. 

A medication that will be used as a first-line treatment to familiarize yourself with belong in the selective serotonin reuptake inhibitor (SSRI) family, which is a class of medication that is the most effective at treating major depressive disorders. The most common drug used in this class goes by the name of Sarafem, but studies show that all SSRIs have the same efficacy when it comes to treating depression, so cheaper versions are just as helpful. Studies show that about 60 percent of patients will notice improvements in their symptoms after taking this medication for six weeks. One caveat of SSRI medications, however, is that patients will not notice any improvement in their symptoms for the first six weeks as the body needs time to create new receptors and become accustomed to higher levels of serotonin in your body once again. [8]

The last commonly used class blocks both serotonin and norepinephrine to try to restore good moods in patients. They go by the name of SNRIs, and they are used as a second-line treatment in the event the SSRI medications do not help patients. 

All in all, patients with HS need to be mindful that not only will their skin need to be treated, but also their psychological status. Most patients will naturally suffer from some depression, whether mild or severe, and patients and physicians should both be aware of considering this aspect when prescribing a treatment option for HS. Antidepressants to treat hidradenitis suppurativa must be a staple in HS therapy due to the high prevalence of major depressive disorders and higher levels of suicide in this population. If you have any thoughts of committing suicide, access to firearms in your house or have plans for how you would carry out your plan, seek medical attention immediately because there are simple solutions that physicians can utilize to make you feel better. 

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