COPD Depression and Anxiety. Please call if you have depression or anxiety with COPD.
COPD is the fourth leading cause of death in the United States,1 affecting an estimated 10.1 million Americans.2 It is associated with multiple comorbidities, including depression and anxiety.3 The prevalence of depression in COPD ranges from 37% to 71%, and anxiety from 50% to 75%.4
Soo Borson, MD, Professor Emerita, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, told Psychiatry Advisor that depression and anxiety are “two of the most common but least treated comorbidities in COPD.” Less than one-third of COPD patients receive appropriate treatment for anxiety or depression.5,6 Untreated or inappropriately treated depression and anxiety compromise adherence with medical therapy, increase frequency and length of hospital stays during acute exacerbations, and are responsible for poor quality of life and premature death.3
Why are Depression and Anxiety so Prevalent in COPD?
The experience of dyspnea can bring on anxiety and panic. In turn, anxiety and panic can increase dyspnea, creating a vicious cycle. In the words of one patient, “It’s scary when you can’t breathe.”9 It is important to distinguish between these episodes and panic disorders.3 “Pulmonary rehabilitation helps patients realize that when they feel dyspnea, they are not dying. They learn to regulate their breathing and tolerate increased activity levels,” said Borson.
Psychological Contributors to Anxiety and Depression
Multiple psychological factors contribute to anxiety and depression in COPD. Reduced exercise capacity leads to increased physical disability, reduced social interaction, dependence on caregivers, loss of social role, and loss of self-esteem.10 In addition, “patients with COPD experience high rates of pessimism about life,” Borson observed. Suicidal thoughts are common and are associated with severe depression and anxiety, more frequent COPD hospitalizations, more severe dyspnea, and disability.11
Psychological therapies have been found to be as effective as antidepressants in patients with COPD and preferred by many patients.16 Cognitive-behavioral therapy can help “decrease the sensation of dyspnea, and can also address symptoms of anxiety and depression,” Borson said. Collaborative care has been studied and found effective in reducing symptoms of depression and anxiety and increasing adherence to COPD therapy.13 The role of the psychiatrist in collaborative care is to provide caseload supervision, clinical advice, and decision support to mental health and allied health professionals and primary care physicians.3
From Psychiatry Advisor Batya Swift Yasgur, MA, LMSW May 22, 2015