When COPD Causes Anxiety or Depression

The Best Treatments to Try

If you have chronic obstructive pulmonary disease (COPD) or know someone who does, you probably won't be surprised to learn that depression and anxiety are common side effects of this debilitating lung disease. A 2010 study published in the journal Thorax found, for example, that people with COPD are 85 percent more likely to develop anxiety disorders than are other folks.

Similarly, in a 2011 study of more than 2,000 people, 26 percent of those with COPD suffered from depression, compared to 12 percent of subjects who smoked but did not have COPD and 7 percent of nonsmokers without COPD. 

What's more, depression and anxiety in conjunction with COPD can create a vicious cycle: If you have COPD and are struggling to breathe, you can start to panic—but feeling panicky can interfere with breathing. In fact, COPD patients are 10 times more likely than people without the condition to experience panic attacks and panic disorder.

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Prozac
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Anti-anxiety medications such as Xanax (alprazolam) and Valium (diazepam) aren't ideal for people with COPD because these drugs tend to slow breathing. However, certain anti-depressants and non-drug approaches may help with both anxiety and depression and are worth talking to your doctor about. 

 

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There are several classes of antidepressant available for treating depression. Both the oldest class, the tricyclics, and the second oldest class, the monoamine oxidase inhibitors (MAOIs) have been studied in people with COPD but have not been shown to be helpful.

The same is true of the newest antidepressants—selective serotonin reuptake inhibitors, or SSRIs. Even so, SSRIs are considered a better choice than the older drugs for treating depression or anxiety related to COPD. They work by preventing the reuptake (reabsorption) of the neurotransmitter serotonin by the nerve cell that secreted it. This way, more serotonin can be made available in the brain. Low levels of serotonin have been linked to anxiety and depression. SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine).

Anti-depressants that don't fall into any of the above categories, such as Wellbutrin (bupropion), Serzone (nefazodone), and Remeron (mirtazapine ), haven't been well studied in people with COPD.

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Cognitive Behavioral Therapy

If you're like many people with COPD, you may feel more comfortable treating depression or anxiety with cognitive behavioral therapy (CBT) rather than taking a drug. CBT is a structured form of psychological therapy that teaches you to change how you think or feel about situations you can't do anything about.

CBT can be a highly effective way of dealing with all sorts of issues related to depression or anxiety caused by COPD, generally works pretty quickly, and doesn't put you at risk of the physical side effects of medication. Your doctor can likely refer you to a psychologist or other mental health professional who can provide you with CBT. 

Sources:

Eisner, Mark D., et. al. "The Influence of Anxiety on Health Outcomes in COPD." Thorax. Mar 2010; 65(3): 229-234.

Fritzsche, A., et al. "Effects of Medical and Psychological Treatment of Depression in Patients with COPD—A Review." Respiratory Medicine. Oct 201;105(10):1422-1433.

Panagioti, M., et al. "Overview of the Prevalence, Impact, and Management of Depression and anxiety in Chronic Obstructive Pulmonary Disease." International Journal of Chronic Obstructive Pulmonary Disease. Nov 2014 13;9:1289-306.

Usmani, ZA, et al. "Pharmacological Interventions For the Treatment of Anxiety Disorders in Chronic Obstructive Pulmonary Disease." Cochrane Database of Systematic Reviews. Nov 9, 2011;(11):CD008483.

Yohannes, AM, et al. "Pharmacological Treatment of Depression in Older Patients with Chronic Obstructive Pulmonary Disease: Impact on the Course of the disease and Health Outcomes." Drugs and Aging. July 2014;31(7):483-492.

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