COPD and the Risk of Depression
Coughing, chest tightness, and difficulty breathing are common physiological symptoms of chronic pulmonary obstructive disease (COPD). Many patients experience psychological effects as well, particularly as the condition progresses.
“COPD becomes more disabling as the disease gets worse,” said Aleksander Shalshin, MD, pulmonary critical care physician at Plainview Hospital in Long Island, New York. A person’s quality of life suffers as basic tasks like getting dressed, going to work, and meeting friends become exhausting.
“People will modify their behavior to escape their symptoms,” said Dr. Shalshin. “Over time they’ll become more isolated, which is demoralizing and eventually causes depression.”
Roughly 40 percent of people with COPD are affected by severe depression, according to the National Institutes of Health. “As their ability to breathe decreases, then the depression sets in and worsens,” said Samuel A. Allen, DO, FCCP, director of the Pulmonary Hypertension Center at Beaumont Hospital in Troy, Michigan.
A May 2013 study presented at the American Thoracic Society’s annual conference found that patients with severe shortness of breath were at a “significantly greater risk” for depression.
“Patients with depression often suffer from low self-confidence or self-efficacy, and early diagnosis and treatment of depression is very important for improving a patient’s quality of life,” said study author Lopez Jove, MD, chief of the pulmonary laboratory at the Hospital Cetrangolo in Argentina.
Difficulty breathing can trigger feelings of anxiety or panic attacks. “An anxiety disorder develops as breathing gets worse,” said Dr. Allen. “Patients describe it like they’re ‘breathing through a small straw.’ It causes panic if they can’t catch their breath.”
According to the authors of a 2012 study in the journal Heart & Lung: “The relationship between anxiety and breathing was experienced as a vicious cycle by some patients. Living with anxiety was challenging, and patients voiced a fear of breathlessness that could be disabling.”
COPD patients with psychological symptoms can benefit from pulmonary rehabilitation, which combines physical conditioning with group support. “Pulmonary rehab puts people in a supportive environment that promotes physical activity…which allows for more self-confidence and less anxiety and depression,” said Shalshin.
Friends and family can be critical in recognizing signs of depression or anxiety in people with COPD and helping them seek treatment. “It’s just as important to have family support as it is to have the right medications in managing COPD,” said Shalshin. “They can help with getting the person out of the house or even checking on them at home.”
“People who do the best with COPD are people who stay active and go out and do things,” said Ashley Henderson, MD, assistant professor of pulmonary and critical care medicine at University of North Carolina School of Medicine. “They’re the ones who know how to manage the disease and have a better quality of life.”