The Impact of Systemic Treatment of Atopic Dermatitis on Depressive Symptoms: A Prospective Clinical Cohort Study


  • Lina U. Ivert Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
  • Axel Svedbom 1Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet
  • Maria Lundqvist Department of Dermatology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
  • Carl-Fredrik Wahlgren Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet
  • Maria Bradley Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet. Department of Dermatology, Karolinska University Hospital
  • Emma K. Johansson



Atopic dermatitis, atopic eczema, depression, suicidal ideation, drug therapy, epidemiology


Information on depressive symptoms among patients with atopic dermatitis (AD) undergoing systemic treatment in a real-world setting is scarce. This prospective real-world clinical cohort study analysed data from SwedAD, a Swedish national register comprising patients with AD undergoing systemic treatment. Data were collected at baseline (n = 120) and at follow-up at 6 months (range 3–9 months, n = 59), and 12 months (10 months or later, n = 36). Depression was assessed with the Montgomery-Åsberg Depression Rating Scale-Self-report (MADRS-S) and AD with the Eczema Area Severity Index, the Patient-Oriented Eczema Measure, the Dermatology Life Quality Index and evaluation of pruritus. More than half of patients with moderate-to-severe AD had depressive symptoms at baseline, 24% presented with moderate-to-severe depression and 3% had pronounced suicidal ideation. Systemic treatment of AD significantly reduced both depression and AD symptoms at 6 months, and this positive effect remained at 12 months. In conclusion, depressive symptoms are common among adults with moderate-to-severe AD. Systemic treatment of AD significantly reduced depressive symptoms in parallel with AD symptoms.


Download data is not yet available.


Bylund S, von Kobyletzki LB, Svalstedt M, Svensson Å. Prevalence and incidence of atopic dermatitis: a systematic review. Acta Derm Venereol 2020; 100: adv00160. DOI:

Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers 2018; 4: 1. DOI:

Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345-460. DOI:

Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The burden of atopic dermatitis: summary of a report for the National Eczema Association. J Invest Dermatol 2017; 137: 26-30. DOI:

Sandhu JK, Wu KK, Bui TL, Armstrong AW. Association between atopic dermatitis and suicidality: a systematic review and meta-analysis. JAMA Dermatol 2019; 155: 178-187. DOI:

Rønnstad ATM, Halling-Overgaard AS, Hamann CR, Skov L, Egeberg A, Thyssen JP. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: a systematic review and meta-analysis. J Am Acad Dermatol 2018; 79: 448-456.e30. DOI:

Patel KR, Immaneni S, Singam V, Rastogi S, Silverberg JI. Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol 2019; 80: 402-410. DOI:

Nicholas MN, Drucker AM. Depression and anxiety in atopic dermatitis: increasing recognition and opportunities to intervene. Br J Dermatol 2019; 181: 442-443. DOI:

Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol 2018; 32: 850-878. DOI:

Halling AS, Loft N, Silverberg JI, Guttman-Yassky E, Thyssen JP. Real-world evidence of dupilumab efficacy and risk of adverse events: a systematic review and meta-analysis. J Am Acad Dermatol 2021; 84: 139-147. DOI:

Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med 2016; 375: 2335-2348. DOI:

Swedish quality register of Atopic Dermatitis (SwedAD). Svenskt kvalitetsregister för atopisk dermatit (Swedish) [updated 2021 Mar 15]. [Accessed 2021 Mar 23] Available from

Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382-389. DOI:

Svanborg P, Asberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand 1994; 89: 21-28. DOI:

Wikberg C, Pettersson A, Westman J, Björkelund C, Petersson EL. Patients' perspectives on the use of the Montgomery-Asberg depression rating scale self-assessment version in primary care. Scand J Prim Health Care 2016; 34: 434-442. DOI:

Svanborg P, Ekselius L. Self-assessment of DSM-IV criteria for major depression in psychiatric out- and inpatients. Nord J Psychiatry 2003; 57: 291-296. DOI:

Mattsson S, Olsson EMG, Carlsson M, Johansson BBK. Identification of anxiety and depression symptoms in patients with cancer: comparison between short and long web-based questionnaires. J Med Internet Res 2019; 21: e11387. DOI:

Snaith RP, Harrop FM, Newby DA, Teale C. Grade scores of the Montgomery-Asberg Depression and the Clinical Anxiety Scales. Br J Psychiatry 1986; 148: 599-601. DOI:

Phillips JL, Norris S, Talbot J, Hatchard T, Ortiz A, Birmingham M, et al. Single and repeated ketamine infusions for reduction of suicidal ideation in treatment-resistant depression. Neuropsychopharmacology 2020; 45: 606-612. DOI:

Grinich EE, Schmitt J, Kuster D, Spuls PI, Williams HC, Chalmers JR, et al. Standardized reporting of the Eczema Area and Severity Index (EASI) and the Patient-Oriented Eczema Measure (POEM): a recommendation by the Harmonising Outcome Measures for Eczema (HOME) Initiative. Br J Dermatol 2018; 179: 540-541. DOI:

Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-216. DOI:

Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, et al. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol 2012; 92: 502-507. DOI:

Yosipovitch G, Reaney M, Mastey V, Eckert L, Abbé A, Nelson L, et al. Peak pruritus numerical rating scale: psychometric validation and responder definition for assessing itch in moderate-to-severe atopic dermatitis. Br J Dermatol 2019; 181: 761-769. DOI:

Thomas KS, Apfelbacher CA, Chalmers JR, Simpson E, Spuls PI, Gerbens LAA, et al. Recommended core outcome instruments for health-related quality of life, long-term control and itch intensity in atopic eczema trials: results of the HOME VII consensus meeting. Br J Dermatol 2021; 185: 139-146. DOI:

Ferrucci S, Casazza G, Angileri L, Tavecchio S, Germiniasi F, Berti E, et al. Clinical response and quality of life in patients with severe atopic dermatitis treated with dupilumab: a single-center real-life experience. J Clin Med 2020; 9: 791. DOI:

Bender BG, Ballard R, Canono B, Murphy JR, Leung DY. Disease severity, scratching, and sleep quality in patients with atopic dermatitis. J Am Acad Dermatol 2008; 58: 415-420. DOI:

Jeon C, Yan D, Nakamura M, Sekhon S, Bhutani T, Berger T, et al. Frequency and management of sleep disturbance in adults with atopic dermatitis: a systematic review. Dermatol Ther (Heidelb) 2017; 7: 349-364. DOI:

Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med 2019; 23: 2324-2332. DOI:

Ring J, Zink A, Arents BWM, Seitz IA, Mensing U, Schielein MC, et al. Atopic eczema: burden of disease and individual suffering - results from a large EU study in adults. J Eur Acad Dermatol Venereol 2019; 33: 1331-1340. DOI:

Buske-Kirschbaum A, Geiben A, Hellhammer D. Psychobiological aspects of atopic dermatitis: an overview. Psychother Psychosom 2001; 70: 6-16. DOI:

Nicholas MN, Gooderham MJ. Atopic dermatitis, depression, and suicidality. J Cutan Med Surg 2017; 21: 237-242. DOI:

Johansson R, Carlbring P, Heedman Å, Paxling B, Andersson G. Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life. PeerJ 2013; 1: e98. DOI:

Thyssen JP, Hamann CR, Linneberg A, Dantoft TM, Skov L, Gislason GH, et al. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide. Allergy 2018; 73: 214-220. DOI:

Whiteley J, Emir B, Seitzman R, Makinson G. The burden of atopic dermatitis in US adults: results from the 2013 National Health and Wellness Survey. Curr Med Res Opin 2016; 32: 1645-1651. DOI:

Dieris-Hirche J, Gieler U, Petrak F, Milch W, Te Wildt B, Dieris B, et al. Suicidal ideation in adult patients with atopic dermatitis: a german cross-sectional study. Acta Derm Venereol 2017; 97: 1189-1195. DOI:

Malhi GS, Mann JJ. Depression. Lancet 2018; 392: 2299-2312. DOI:

Mina S, Jabeen M, Singh S, Verma R. Gender differences in depression and anxiety among atopic dermatitis patients. Indian J Dermatol 2015; 60: 211.

Wikberg C, Nejati S, Larsson ME, Petersson EL, Westman J, Ariai N, et al. Comparison between the Montgomery-Asberg Depression Rating Scale-Self and the Beck Depression Inventory II in primary care. Prim Care Companion CNS Disord 2015; 17: 10.4088/PCC. DOI:



How to Cite

Ivert, L. U., Svedbom, A., Lundqvist, M., Wahlgren, C.-F., Bradley, M., & Johansson, E. K. (2022). The Impact of Systemic Treatment of Atopic Dermatitis on Depressive Symptoms: A Prospective Clinical Cohort Study. Acta Dermato-Venereologica, 102, adv00801.





Most read articles by the same author(s)

1 2 3 > >>