Course of Depression in COPD

Three Year Follow-up of Depression in COPD Patients

Background: Depression occurs in 17% of adults living in the United States at some time during their life.  It is more common is those with COPD.  In two recent studies, the prevalence of clinically significant depressive symptoms was 42 – 57%. What does depression feel like? Here are some symptoms:
  • A depressed mood during most of the day, particularly in the morning
  • Loss of energy
  • Feelings of worthlessness or guilt
  • Impaired concentration, indecisiveness
  • Trouble sleeping or excessive sleeping almost every day
  • Markedly diminished interest or pleasure in almost all activities nearly every day
  • Recurring thoughts of death or suicide
  • A sense of restlessness or being slowed down
  • Significant weight loss or gain
Man sitting alone on bench

One image of depression: man sitting alone on bench

  Study: Yohannes and colleagues reported on the course of depression over 3 years in the ECLIPSE study of those with COPD.  The article was published on-line in the journal CHEST. Chest. 2016 Jan 5. pii: S0012-3692(15)00440-7. doi: 10.1016/j.chest.2015.10.081. [Epub ahead of print] At the start of the study, patients were split into groups based on depression score (less than 16 and 16 or greater) and whether they were taking antidepressants (yes or no).   Results: 1,580 individuals completed the 3-year follow-up. Of these:
  1. 55% were classified as never depressed
  2. 24% were classified as persistently depressed
  3. 14% developed new onset of depression during the study
  4. 7% had their depression clear up (resolve)
Being a female and having a history of a stroke were associated with a substantial increase in the odds of persistent depression. The odds of new onset increased with worse health status and moderate to severe breathing difficulty. During follow-up, those with persistent or new-onset depression had more worsening of breathing (an exacerbation) and a greater loss in performance based on distance walked in 6 minutes. de-pression-48811290591547Hxs My Comments:  Breathing difficulty can be quite frustrating especially when it limits your ability to do daily activities. This can affect mood and cause feelings of low energy and wanting to “give up.” In my practice, I have observed improvements in mood and interest in life in individuals with COPD who are started on new or better medications that make it easier to breathe.  This can have a huge impact on the person’s outlook and desire to be active. I encourage those individuals with COPD to discuss any depressed feelings  with their health care provider. A trial of a new bronchodilator medication may help with breathing and thereby improve mood. Physical exercise as part of a pulmonary rehabilitation program may also improve your outlook and how your feel. Medication that treats depression is another consideration. Referral to a psychologist or psychiatrist may also be beneficial.  

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.