Pulmonary Disease & Depression

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For patients with chronic obstructive pulmonary disease (COPD), that elephant in the room may not just be sitting on your chest—it may be depression. Approximately 40% of people who suffer from COPD also have a depressive disorder. Many experts predict that the effects of COPD can lead a person to develop depressive symptoms. Regrettably, it is these depressive symptoms that can decrease the effectiveness of COPD treatment and increase the likelihood of disability or death. 

COPD is the inflammation of a person’s airways. Its presence is like having chronic bronchitis and emphysema simultaneously and constantly. The inflammation causes damage to the air sacs and also produces increased coughing and mucus. Fatigue, a constant cough, and shortness of breath can lead to a host of issues, including difficulty sleeping, lack of appetite, low confidence, an inability to partake in activities, and overall hopelessness. Not only can these symptoms of COPD lead to depression, but they are also signs of depression. 

Depression Slows Healing?

In a study published in the American Journal of Respiratory and Critical Care Medicine, Chinese and Canadian researchers examined the effects of depression on COPD patients. About 500 patients with COPD, age 30 or older, created monthly reports about flare-ups or hospitalizations. At the beginning of the study, each participant took a depression and anxiety inventory to assess their levels of either disorder. At the end of 12 months, the participants with elevated depression scores, experienced more flare-ups and hospitalizations than those with no identifiable depression. Participants with higher anxiety scores tended to endure flare-ups that lasted longer.

While the researchers are careful not to prematurely conclude that depression and anxiety with aggravate COPD, the results do indicate that these disorders, particularly depression, decreases the success of the maintenance and treatment of COPD. The research team from McGill University, Montreal, believes that depression may worsen COPD in a number of ways:

• Depression can cause problems with the immune system, increasing inflammation and making people “more vulnerable to environmental triggers”.
• People with depression may be less able to tolerate symptoms of COPD and may be more sensitive to flare-ups.
• Depression can make people apathetic to medical advice and treatment, which is a significant part of improving COPD symptoms. Follow through is necessary to prevent episodes.

Depression Causes Patients to Stop Treatment?

The latter is the focus of another study, conducted by Andrew Busch, Ph.D., and a team of researchers at The Centers for Behavioral and Preventive Medicine at The Miriam Hospital. The researchers found that people with co-existing depression and COPD were less likely to complete pulmonary rehabilitation (PR), mostly due to the presence of depressive symptoms. PR is a non-medicinal treatment of COPD intended to enhance a person’s overall quality of life. Its components include developing patients’ tolerance of physical activity, increasing depth of breath, and improving symptoms of depression and anxiety. Unfortunately, depression is associated with a 30% early drop-out rate.

Of the 111 COPD patients enrolled in The Miriam Hospital PR study, only 68% completed the 20-week program. According to the self-reported assessment, having low depressive scores was an independent factor contributed to completing the program. 

Depressed COPD Patients Lose Benefits

Non-commitment to PR is troubling to researchers and physicians, because it is the only treatment that is a multi-faceted approach with many benefits. It is also the singular program that addresses both COPD and mental disorders. The reason why PR is highly recommended for people with co-existing COPD and depression is because it is relatively safe, does not interfere with other medication, improves various symptoms of COPD, and offers counseling and group therapy services to its patients. Most significant are the benefits of exercise. Not only does physical activity help treat the symptoms of COPD, but evidence supports its positive effects on depressive symptoms. Overall, PR has more advantages than disadvantages as a holistic, multi-disciplinary treatment.

Patients Should Seek Help Immediately

Busch urges further research into treatments that may manage depression more vigorously. “Depression predicts earlier mortality in those with COPD," Busch asserts. "Our results suggest that non completion of pulmonary rehabilitation may be one variable that explains this relationship, and we plan to use these results to help design and implement treatment for depression among those with COPD."

For now, people struggling with the effects of both COPD and depression should seek help. Depression cannot be treated unless recognized. Individual and family therapy, and possibly coupled with antidepressant medication, may be necessary to maintain depressive symptoms. Above all, physicians encourage activity, because inactivity is a common link between COPD and depression. It may be difficult to participate in certain activities due to the physical limitations of COPD, but finding new hobbies and socializing with others may help to elevate mood and alleviate pulmonary symptoms. Making a plan and finding support are key components to both physical and mental healing.

- Melissa Lavery, M.S.

References

Hitti, M. (n.d.). Depression May Worsen COPD. Retrieved January 29, 2015, from http://www.webmd.com/lung/copd/news/20081024/depression-may-worsen-copd

Learn COPD Basics. (n.d.). Retrieved January 29, 2015, from http://www.copd.com/about-copd/?rotation=71700000006631907&banner=58700000274916307&kw=5479263185&cc=us:p1114c00183:e1:w1:p25&pid=9263185&bing=e_

Lifespan. (2014, July 9). Effect of depressed mood on pulmonary rehab completion. ScienceDaily. Retrieved January 29, 2015 from www.sciencedaily.com/releases/2014/07/140709140306.htm

McCoy, K. (2013, March 29). COPD and Depression. Retrieved January 29, 2015, from http://www.everydayhealth.com/copd/copd-and-depression.aspx